QUESTION: 153

PBM plans operate under several types of contractual arrangements. Under one contractual arrangement, the PBM plan and the employer agree on a target cost per employee per month. If the actual cost per employee per month is greater than the target cost, t

fee-for-service arrangement
risk sharing contract
capitation contract
rebate contract

Answer(s): B

Reveal Solution Next Question

QUESTION: 154

Pharmacy benefit management (PBM) companies typically interact with physicians and pharmacists by performing such clinical services as physician profiling. Physician profiling from a PBM's point of view involves

ascertaining that physicians in the plan have the necessary and appropriate credentials to prescribe medications
compiling data on physician prescribing patterns and comparing physicians' actual prescribing patterns to expected patterns within select drug categories
monitoring patient-specific drug problems through concurrent and retrospective review
establishing protocols that require physicians to obtain certification of medical necessity prior to drug dispensing

Answer(s): B

Reveal Solution Next Question

QUESTION: 155

Phillip Tsai is insured by both a indemnity health insurance plan, which is his primary plan, and a health plan, which is his secondary plan. Both plans have typical coordination of benefits (COB) provisions, but neither has a nonduplication of benefits p

$0
$300
$400
$900

Answer(s): C

Reveal Solution Next Question

QUESTION: 156

Phillip Tsai is insured by both a traditional indemnity health insurance plan, which is his primary plan, and a health plan, which is his secondary plan. Both plans have typical coordination of benefits (COB) provisions, but neither has a nonduplication of

$0
$300
$400
$900

Answer(s): C

Reveal Solution Next Question

Free AHM-250 Exam Braindumps (page: 40)

QUESTION: 153

QUESTION: 154

QUESTION: 155

QUESTION: 156

AHM-250 Exam Discussions & Posts