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AHM-530 – Network Management

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Showing 7–9 of 15 questions

Question 7 (Volume A)

The following statements are about the inclusion of unified pharmacy benefits in health plan healthcare packages. Select the answer choice containing the correct statement.

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    When pharmacy benefits management is incorporated into an health plan’s operations as a unified benefit, the health plan establishes pharmacy networks, but a pharmacy benefits management (PBM) company manages their operations.

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    Under a unified pharmacy benefit, an health plan cannot use mail-order services to provide drugs to its members.

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    Compared to programs that do not manage pharmacy benefits in-house, unified pharmacy benefits programs typically give health plans more control over patient access to prescription drugs.

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    Compared to programs that do not manage pharmacy benefits in-house, unified pharmacy benefits programs make drug therapy interventions for plan members more difficult.
Question 8 (Volume B)

The Argyle Health Plan has contracted to obtain the services of the providers in the Column Medical Group, a faculty practice plan (FPP). The following statement(s) can correctly be made about this contract:

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    Column most likely contracted with the legal group representing the FPP rather than with the individual physicians within the FPP.

    Both A and B
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    Column most likely will provide only highly specialized care to Argyle's plan members.


    A only
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    B only
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    Neither A nor B
Question 9 (Volume A)

One reason that an health plan would want to use the actual acquisition cost (AAC) pricing system to calculate its drug costs is that, of the systems commonly used to calculate drug costs, the AAC system

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    Provides the lowest level of cost for the health plan

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    Most closely represents what pharmacies are actually charged for prescription drugs

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    Offers the best control over multiple-source pharmaceutical products

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    Is the least expensive pricing system for the health plan to implement