CPhT - Certified Pharmacy Technician Practice Questions: Pharmacy Billing and Reimbursement Domain

Published: June 12, 2025 | 5 min read

Test your CPhT - Certified Pharmacy Technician knowledge with 5 practice questions from the Pharmacy Billing and Reimbursement domain. Includes detailed explanations and answers.

CPhT - Certified Pharmacy Technician Practice Questions

Master the Pharmacy Billing and Reimbursement Domain

Test your knowledge in the Pharmacy Billing and Reimbursement domain with these 5 practice questions. Each question is designed to help you prepare for the CPhT - Certified Pharmacy Technician certification exam with detailed explanations to reinforce your learning.

Question 1

Which entity is primarily responsible for defining the formulary used by a specific insurance plan?

A) The FDA

B) The insurance provider

C) The pharmacy

D) The prescriber

Show Answer & Explanation

Correct Answer: B

Explanation: The insurance provider is responsible for defining the formulary, which is a list of medications that are covered under their specific insurance plan.

Question 2

When an insurance claim is rejected due to 'non-formulary' status, what is the most appropriate action for the pharmacy technician?

A) Contact the insurance company to argue the claim.

B) Notify the patient and suggest speaking with the prescriber about alternatives.

C) Automatically substitute with a similar medication.

D) Ignore the claim and submit it again.

Show Answer & Explanation

Correct Answer: B

Explanation: When a medication is not covered because it is non-formulary, the correct step is to notify the patient and suggest they discuss alternatives with their prescriber.

Question 3

When processing a claim, you receive a rejection code indicating ‘NDC not covered’. What is the most appropriate next step?

A) Choose an alternative medication with the same therapeutic effect.

B) Dispense the medication and bill the patient directly.

C) Contact the insurance for a potential alternative NDC.

D) Inform the patient of the rejection and cancel the prescription.

Show Answer & Explanation

Correct Answer: C

Explanation: The appropriate action is to contact the insurance company to obtain a covered NDC or an alternative solution.

Question 4

What is the purpose of a copayment in an insurance plan?

A) To cover the entire cost of a prescription

B) To represent the insurance company's portion of the cost

C) To require the patient to share a portion of the costs

D) To prevent pharmacies from charging more than the insurance allows

Show Answer & Explanation

Correct Answer: C

Explanation: A copayment is a fixed amount the patient pays for a covered healthcare service, which is a cost-sharing mechanism between the patient and the insurance company.

Question 5

A pharmacy technician receives a prescription with unclear handwriting. What should be the technician's first course of action?

A) Guess the medication based on context and fill the prescription.

B) Consult with the pharmacist for clarification.

C) Call the prescriber for clarification.

D) Ask the patient what medication they were expecting.

Show Answer & Explanation

Correct Answer: B

Explanation: CORRECT: Consulting with the pharmacist ensures professional oversight before contacting the prescriber. OPTION A: Guessing can lead to medication errors. OPTION B: Correct. OPTION C: While calling the prescriber is necessary, the pharmacist should be consulted first. OPTION D: Relying on the patient's expectation can lead to errors.

Ready to Accelerate Your CPhT - Certified Pharmacy Technician Preparation?

Join thousands of professionals who are advancing their careers through expert certification preparation with FlashGenius.

✅ Unlimited practice questions across all CPhT - Certified Pharmacy Technician domains
✅ Full-length exam simulations with real-time scoring
✅ AI-powered performance tracking and weak area identification
✅ Personalized study plans with adaptive learning
✅ Mobile-friendly platform for studying anywhere, anytime
✅ Expert explanations and study resources

Start Free Practice Now

Already have an account? Sign in here

About CPhT - Certified Pharmacy Technician Certification

The CPhT - Certified Pharmacy Technician certification validates your expertise in pharmacy billing and reimbursement and other critical domains. Our comprehensive practice questions are carefully crafted to mirror the actual exam experience and help you identify knowledge gaps before test day.

Continue Your Preparation: Return to our main CPhT Study Guide for comprehensive exam preparation.