Pharmacy Technician Certification Board Practice Exam

In the context of pharmacy billing procedures, determining the order of billing insurance plans is essential for maximizing coverage and minimizing patient out-of-pocket expenses. The correct choice for which insurance plan to bill first is a private insurance plan.

Private insurance plans typically have coordination of benefits clauses that stipulate how multiple insurance policies will interact if a patient has more than one plan. When billing for prescriptions, pharmacies usually follow the guideline of billing the private insurance first, as it often provides more comprehensive coverage for prescription medications compared to government programs like Medicaid and military coverage such as Tricare.

Billing a private insurance plan first allows the pharmacy to submit a claim for the medication under the more favorable terms of the private insurance contract. Once the claim is processed, any remaining balance can then be billed to secondary insurance, such as Medicaid or Tricare, if applicable.

Considering the other options, Medicaid and Tricare are typically considered the payer of last resort, meaning they only come into play after any primary insurance has been billed and processed. A manufacturer coupon card is also not considered a primary insurance plan; it is typically used to reduce the cost of a medication after other insurances have been billed. Therefore, the private insurance plan is the correct choice to bill first, as it aligns