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The Walton Health Plan Uses the Fee-For-Service Pharmaceutical Reimbursement Approach

Question 42

Multiple Choice

The Walton Health Plan uses the fee-for-service pharmaceutical reimbursement approach known as the maximum allowable cost (MAC) method. If Walton's MAC list specifies a cost of 8 cents per tablet for a particular drug but the participating pharmacy pays 10 cents per tablet for the drug, then Walton will be obligated to reimburse the pharmacy for


A) 8 cents per tablet, but the pharmacy can bill the subscriber for the remaining 2 cents per tablet
B) 8 cents per tablet, and the pharmacy cannot bill the subscriber for the remaining 2 cents per tablet
C) 10 cents per tablet, but the pharmacy must refund the extra 2 cents per tablet to the subscriber
D) 10 cents per tablet, and the pharmacy is not required to refund the extra 2 cents per tablet to the subscriber

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