AHIP AHM-540 Exam Practice Test Instant Access

Question 1

Occasionally, employers combine workers' compensation, group healthcare, and disability programs into an integrated product known as 24-hour coverage. One true statement about 24hour coverage is that it typically

Aincreases administrative costs

Brequires plans to maintain separate databases of patient care information

Cexempts plans from complying with state workers' compensation regulations

Dallows plans to apply disability management and return-to-work techniques to nonoccupational conditions

Answer : D

Question 2

One of the steps in drug utilization review (DUR) is defining optimal drug use, which can be accomplished by applying diagnosis criteria and drug-specific criteria. Drug-specific criteria are standards that identify the

Aappropriate dosages, duration of treatment, and other elements related to the use of a particular drug

Bactual prescribing and dispensing patterns for a particular drug

Ctypes of diseases, conditions, or patients for which a drug should be used

Dcost-effectiveness of all possible drug treatments for a particular condition

Answer : A

Question 3

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

Ahas not been tested for safety and efficacy in large clinical trials B. is available without a prescription at a reasonable cost

Chas been classified by the Food and Drug Administration (FDA) as safe, but that has not been proven fully effective

Dcontains active ingredients that are identical to those of the prescribed brand-name drug

Answer : D

Question 4

The paragraph below contains two pairs of terms enclosed in parentheses. Determine which term in each pair correctly completes the paragraph. Then select the answer choice containing the two terms that you have chosen.

Greenhouse's prescription drug reimbursement policy indicates that the plan formulary is classified as (open / closed), and that compliance by patients and providers is (mandatory / voluntary).

Aopen / mandatory

Bopen / voluntary

Cclosed / mandatory

Dclosed / voluntary

Answer : C

Question 5

In most health plans, the formulary system is developed and managed by a P&T committee. The P&T committee is responsible for

Aevaluating and selecting drugs for inclusion in the formulary

Boverseeing the manufacture, distribution, and marketing of prescription drugs

Ccertifying the medical necessity of expensive, potentially toxic, or nonformulary drugs

Dall of the above

Answer : A

Question 6

In recent years, the demand for prescription drugs has increased dramatically. Factors that have contributed to this increase include

Aincreased education regarding the purpose and benefits of drug formularies

Breductions in the cost of prescription drugs

Cincreased use of direct-to-consumer (DTC) advertising

Dall of the above

Answer : C

Question 7

Maxwell Midler's health plan operates a drug formulary that includes a typical three-tier copayment structure with required copayments of $5, $10, and $25. Mr. Midler recently filled a prescription for a $75 drug that was not included in the formulary. According to the plan's formulary copayment structure, the amount that Mr. Midler was required to pay for his prescription was

A$5

B$10

C$25

D$75

Answer : C

AHIP AHM-540 AHM Medical Management Exam Practice Test