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AHM-540 Exam Dumps : Medical Management

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Medical Management Questions and Answers

Question 1

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

Options:

A.

evaluating and selecting drugs for inclusion in the formulary

B.

overseeing the manufacture, distribution, and marketing of prescription drugs

C.

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

D.

all of the above

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Question 2

For this question, if answer choices (a) through (c) are all correct, select answer choice (d). Otherwise, select the one correct answer choice.

Well-crafted clinical practice guidelines (CPGs) can benefit healthcare delivery processes and outcomes by

Options:

A.

providing a framework for care while also allowing for patient-specific variations, based on physician judgment

B.

serving as a basis for evaluating whether providers are practicing in accordance with accepted standards

C.

focusing on the prevention or early detection of a particular condition

D.

all of the above

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

Options:

A.

has not been tested for safety and efficacy in large clinical trials

B.

is available without a prescription at a reasonable cost

C.

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

D.

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