Question 1

DUR can be conducted prospectively, concurrently, or retrospectively. One true statement about prospective DUR is that it

Ainvolves periodic audits of the medical records of a certain group of patients

Bis based on historical data

Cfocuses on the drug therapy for a single patient rather than overall usage patterns

Dis conducted by physicians, without input from pharmacists

Answer : C

Question 2

All states have laws describing the conditions under which pharmacists can substitute a generic drug for a brand-name drug. With respect to these laws, it is correct to say that in every state,

Apharmacists must obtain physician approval before substituting generics for brand-name drugs

Bpharmacists must obtain authorization from the health plan before substituting generics for brand-name drugs

Cprescribers must obtain authorization from the health plan before prescribing a brand-name drug

Dprescribers have some mechanism that allows them to prevent pharmacists from substituting generics for brand-name drugs

Answer : D

Question 3

PBMs are accredited by the same organizations that accredit health plans.

ATrue

BFalse

Answer : B

Question 4

One way that health plans can make their benefits more appealing to employers and employees is to offer coverage for specialty services. It is correct to say that specialty services typically

Ainvolve the same types of providers and delivery systems as do standard medical services

Bare a subset of a health plan's standard medical-surgical services

Care not monitored by health plans for quality or utilization

Drequire specialized knowledge for service delivery and management

Answer : D

Question 5

The nature of behavioral healthcare creates unique medical management challenges for health plans. One method health plans have used to support the delivery of appropriate services in a cost-effective manner is to

Aremove behavioral healthcare services from the primary care setting

Bshift behavioral healthcare from acute inpatient settings to alternative settings when feasible

Creserve the use of psychotherapy for treatment of those conditions that persist over long periods of time or for the life of the patient

Doffer the same level of compensation to all of the professional disciplines that provide behavioral healthcare services to plan members