AHM-540 Free Practice Test

The following statement(s) can correctly be made about the use of screening for secondary prevention:
* 1. Screening activities may involve specialty care providers as well as primary care providers (PCPs) and the health plan
* 2. Secondary prevention often results in more utilization of services immediately following screening
* 3. Screening focuses on members who have not experienced any symptoms of a particular illness

1. A. All of the above
2. B. 1 and 3 only
3. C. 2 and 3 only
4. D. 1 only

Correct Answer: A

Health plans that choose to contract with external organizations for pharmacy services typically contract with pharmacy benefit managers (PBMs). Functions that a PBM typically performs for a health plan include
* 1.Managing the costs of prescription drugs
* 2.Promoting efficient and safe drug use
* 3.Determining the health plan’s internal management responsibilities for pharmacy services

1. A. All of the above
2. B. 1 and 2 only
3. C. 2 and 3 only
4. D. 1 only

Correct Answer: B

Adele Stanley, a member of the Greenhouse Health Plan, recently went to a network pharmacy to have a prescription filled. The pharmacist informed Ms. Stanley that the prescribed drug was not in the plan formulary and that reimbursement for the drug was not available except in extraordinary circumstances. The pharmacist asked Ms. Stanley if she would accept a generic substitute.
If Ms. Stanley agrees to the generic substitution, she will receive a drug that

1. A. has not been tested for safety and efficacy in large clinical trials
2. B. is available without a prescription at a reasonable cost
3. C. has been classified by the Food and Drug Administration (FDA) as safe, but that has not been proven fully effective
4. D. contains active ingredients that are identical to those of the prescribed brand-name drug

Correct Answer: D

The following statement(s) can correctly be made about accrediting agency standards for delegation:
* 1. The National Committee for Quality Assurance (NCQA) allows health plans to delegate
all medical management functions, including the responsibility to perform delegation oversight activities
* 2. In some cases, accreditation standards for delegation oversight are reduced if the delegate has already been certified or accredited by the delegator’s accrediting agency

1. A. Both 1 and 2
2. B. 1 only
3. C. 2 only
4. D. Neither 1 nor 2

Correct Answer: C

The Harbor Health Plan’s formulary policy encourages network pharmacists who are asked to fill a prescription for a costly, brand-name drug to dispense a different chemical entity within the same drug class in order to reduce costs. This type of drug substitution is referred to as

1. A. generic substitution, and prescriber approval is not required
2. B. generic substitution, and prescriber approval is always required
3. C. therapeutic substitution, and prescriber approval is not required
4. D. therapeutic substitution, and prescriber approval is always required

Correct Answer: D