ExCPT Test Pharmacy Operations 2 — Questions and Answers

Question 1: What does the term 'days supply' mean in pharmacy dispensing?

The number of tablets in the bottle
The number of days a dispensed quantity will last at the prescribed dosing regimen (Correct answer)
The maximum days allowed by insurance
The number of days until expiration

Correct answer: The number of days a dispensed quantity will last at the prescribed dosing regimen

Days supply is calculated by dividing the total quantity dispensed by the daily quantity used as directed by the prescriber.

Days supply calculation is a fundamental pharmacy technician skill. Formula: Days Supply = Total Quantity Dispensed ÷ Daily Dose. For example, if 90 tablets are dispensed with directions 'take 1 tablet three times daily' (3 tablets/day), the days supply = 90 ÷ 3 = 30 days. Accurate days supply calculation is critical for insurance billing — insurance plans use this figure to control refill timing and supply limits. Incorrect calculation can result in claim rejections or audit findings.

Question 2: A pharmacy technician is filling a prescription and notices the patient has a known drug allergy to penicillin. The prescription is for amoxicillin. What should the technician do?

Dispense and add an allergy warning label
Dispense since amoxicillin is usually safe in penicillin allergy
Alert the pharmacist immediately about the allergy before dispensing (Correct answer)
Substitute cephalexin without consulting the pharmacist

Correct answer: Alert the pharmacist immediately about the allergy before dispensing

Amoxicillin is a penicillin-class antibiotic. A documented penicillin allergy is a potential contraindication that the pharmacist must evaluate before dispensing.

Amoxicillin is a semisynthetic penicillin-class antibiotic. Patients with documented penicillin allergy may have cross-reactivity to amoxicillin. While the clinical significance varies (true allergy vs. intolerance, reaction type), the technician's role is to flag the allergy alert to the pharmacist — never to independently assess clinical risk or make substitutions. The pharmacist will evaluate the allergy history, contact the prescriber if necessary, and make the clinical decision about dispensing safety.

Question 3: In pharmacy, what is a 'formulary'?

A list of all FDA-approved drugs
A list of drugs covered and preferred by a specific insurance plan (Correct answer)
A pharmacy's master inventory list
A reference guide for compounding formulas

Correct answer: A list of drugs covered and preferred by a specific insurance plan

A formulary is a list of prescription drugs covered by a health insurance plan, often tiered by co-pay amount to encourage use of preferred (lower-cost) options.

A formulary (also called a drug list or preferred drug list) is maintained by health insurance plans, PBMs (Pharmacy Benefit Managers), and managed care organizations to guide drug prescribing and dispensing. Drugs are typically organized into tiers: Tier 1 (generic/preferred — lowest copay), Tier 2 (preferred brand), Tier 3 (non-preferred brand — highest copay), and sometimes specialty tiers. If a prescribed drug is not on formulary, the prescriber may submit a prior authorization request or prescribe a formulary alternative.

Question 4: What is the purpose of a pharmacy benefit manager (PBM)?

To own and operate retail pharmacy chains
To administer prescription drug benefits on behalf of health insurance plans (Correct answer)
To manufacture generic medications
To regulate pharmacy licensing at the state level

Correct answer: To administer prescription drug benefits on behalf of health insurance plans

PBMs act as intermediaries between insurance plans, pharmacies, and drug manufacturers, managing prescription drug benefits including formularies, claim processing, and rebate negotiations.

Pharmacy Benefit Managers (PBMs) are third-party administrators that manage prescription drug benefits for health insurers, employers, Medicare Part D plans, and other payers. Their functions include: developing and managing drug formularies, processing pharmacy claims, negotiating drug prices and rebates with manufacturers, establishing pharmacy networks, and implementing utilization management programs (prior authorizations, step therapy, quantity limits). Major PBMs include CVS Caremark, Express Scripts, and OptumRx.

Question 5: What is a 'prior authorization' (PA) in pharmacy practice?

Pre-approval required from the patient before a drug can be dispensed
Approval from an insurance plan required before certain drugs will be covered (Correct answer)
Authorization from the DEA to stock controlled substances
The pharmacist's final review before releasing a prescription

Correct answer: Approval from an insurance plan required before certain drugs will be covered

Prior authorization is an insurance/PBM requirement that a prescriber must obtain approval before a specific drug will be covered for a particular patient.

Prior authorization (PA) is a cost and utilization management tool used by insurance plans and PBMs. For certain drugs (often expensive, specialty, or high-risk medications), the prescriber must submit clinical justification to the payer before the drug will be covered. The PA process involves the prescriber submitting documentation of medical necessity, the payer reviewing against clinical criteria, and approval or denial. Approved PAs have a defined authorization period. If denied, prescribers can appeal or prescribe a formulary alternative.

Question 6: When a prescription is labeled 'DAW 1,' what does this mean?

Dispense as written — patient requests brand name
Dispense as written — prescriber mandates brand name, no generic substitution (Correct answer)
Drug approved for waiver — generic allowed
Daily administration warning

Correct answer: Dispense as written — prescriber mandates brand name, no generic substitution

DAW (Dispense As Written) code 1 indicates that the prescriber has specified brand name only — the pharmacist cannot substitute a generic equivalent.

Dispense As Written (DAW) codes are used in pharmacy billing to communicate substitution status. DAW 0 = no product selection indicated (generic substitution permitted). DAW 1 = substitution not allowed by prescriber (brand medically necessary). DAW 2 = substitution allowed — patient requested brand. DAW 3-8 are other specific codes. DAW 1 is the code entered when a physician writes 'brand medically necessary' or equivalent on the prescription and the insurer requires documentation to justify brand-name pricing.

ExCPT Test Pharmacy Operations 2

What does the term 'days supply' mean in pharmacy dispensing?