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Free AHM-530 Exam Braindumps
Network Management Questions 91–95 (page: 20)

Updated On: 9-Feb-2026
Page 20 of 42
PDF with 202 Questions

In most health plan pharmacy networks, the cost component of the reimbursement formula is based on the average wholesale price (AWP). One true statement about the AWP for prescription drugs is that

  1. AWPs tend to vary widely from region to region of the United States
  2. The AWP is often substantially higher than the actual price the pharmacy pays for prescription drugs
  3. A health plan's contracted reimbursement to a pharmacy for prescription drugs is typically the 39 AWP plus a percentage, such as 5%
  4. The AWP usually is lower than the estimated acquisition cost (EAC) for most prescription drugs

Answer(s): B



In the paragraph below, two statements each contain a pair of terms enclosed in parentheses. Determine which term correctly completes each statement. Then select the answer choice that contains the two terms you have chosen.

A formulary lists the drugs and treatment protocols that are considered to be the preferred therapy for a given managed population. The Fairfax Health Plan uses the type of formulary which covers drugs that are on its preferred list as well as drugs that are not on its preferred list. This information indicates that Fairfax uses the (closed / open) formulary method. In using the formulary approach to pharmacy benefits management, Fairfax most likely experiences (higher / lower) costs for its members' prescription drugs than it would if it did not use a formulary.

  1. closed / higher
  2. closed / lower
  3. open / higher
  4. open / lower

Answer(s): D



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

  1. 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.
  2. Under a unified pharmacy benefit, an health plan cannot use mail-order services to provide drugs to its members.
  3. 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.
  4. Compared to programs that do not manage pharmacy benefits in-house, unified pharmacy benefits programs make drug therapy interventions for plan members more difficult.

Answer(s): C



The following statements can correctly be made about the advantages and disadvantages to an health plan of using the various delivery options for pharmacy services.

  1. A disadvantage of using open pharmacy networks is that the health plan's control over costs is limited to setting reimbursement levels.
  2. An advantage of using performance-based systems is that they tend to increase participation in the health plan's pharmacy network.
  3. A disadvantage of using customized pharmacy networks is that these networks typically can be implemented only in companies with fewer than 500 employees.
  4. All of these statements are correct.

Answer(s): A



The Walton Health Plan uses the fee-for-service pharmaceutical reimbursement approach known as the maximum allowable cost (MAC) method. If Walton's MAC list specifies a cost of 8 cents per tablet for a particular drug but the participating pharmacy pays 10 cents per tablet for the drug, then Walton will be obligated to reimburse the pharmacy for

  1. 8 cents per tablet, but the pharmacy can bill the subscriber for the remaining 2 cents per tablet
  2. 8 cents per tablet, and the pharmacy cannot bill the subscriber for the remaining 2 cents per tablet
  3. 10 cents per tablet, but the pharmacy must refund the extra 2 cents per tablet to the subscriber
  4. 10 cents per tablet, and the pharmacy is not required to refund the extra 2 cents per tablet to the subscriber

Answer(s): B



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