Free PTCB Billing & Reimbursement Practice Test 2026 — CPhT Exam Questions

This free PTCB Billing & Reimbursement practice test covers pharmacy billing and reimbursement — third-party insurance, PBM adjudication, DAW codes, prior authorization, Medicare Part D, NDC numbers, and discount coupons. Each question includes a detailed explanation — perfect for PTCB / CPhT exam prep.

Key Topics in PTCB Billing & Reimbursement

6 Free PTCB Billing & Reimbursement Practice Questions with Answers

Sample Question 1 — Pharmacy Billing and Reimbursement

A patient presents a prescription covered by insurance with a copay of $10. The medication's cash price is $50. How much should the patient pay at the pharmacy?

  1. A. $0
  2. B. $10 (Correct answer)
  3. C. $50
  4. D. $40

Correct answer: B

Explanation: With insurance coverage, the patient only pays the copay amount, which is $10.

Sample Question 2 — Pharmacy Billing and Reimbursement

Which of the following is the primary function of a prior authorization in pharmacy billing?

  1. A. To verify patient identity
  2. B. To confirm drug availability
  3. C. To ensure insurance coverage for certain medications (Correct answer)
  4. D. To check drug interactions

Correct answer: C

Explanation: Prior authorization is used to ensure that specific medications are covered by the patient's insurance, often due to cost or formulary restrictions.

Sample Question 3 — Pharmacy Billing and Reimbursement

How can a pharmacy technician verify insurance coverage for a new patient?

  1. A. By calling the insurance company's customer service
  2. B. By looking up the patient's information online
  3. C. By asking the patient for the insurance card and entering details into the system (Correct answer)
  4. D. By dispensing the medication and charging the full price

Correct answer: C

Explanation: The standard procedure is to obtain the insurance card details from the patient and verify it by entering the information into the pharmacy system.

Sample Question 4 — Pharmacy Billing and Reimbursement

Which document is typically required by insurance companies for reimbursement of compounded medications?

  1. A. A copy of the patient's medical history
  2. B. A detailed bill of materials (Correct answer)
  3. C. A manual calculation of the cost
  4. D. A signed waiver from the patient

Correct answer: B

Explanation: Insurance companies usually require a detailed bill of materials showing the ingredients and quantities used in the compounded medication for reimbursement.

Sample Question 5 — Pharmacy Billing and Reimbursement

A patient is confused about a denied claim due to 'step therapy.' What should the pharmacy technician explain?

  1. A. The medication requires a higher copay
  2. B. The insurance requires trying another medication first (Correct answer)
  3. C. The medication is not on the formulary
  4. D. The prescription was filled incorrectly

Correct answer: B

Explanation: Step therapy requires patients to try one or more proven, cost-effective medications before 'stepping up' to newer or more expensive drugs.

Sample Question 6 — Pharmacy Billing and Reimbursement

When a patient has both Medicare and Medicaid, which insurance is typically billed first?

  1. A. Medicare (Correct answer)
  2. B. Medicaid
  3. C. The patient's choice
  4. D. The pharmacy decides

Correct answer: A

Explanation: Medicare is the primary payer and must be billed first, while Medicaid acts as the secondary payer.

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