HOM 5307 Exam 2025 Latest Questions Answered 100%
Electronic prescribing offers which of the following potential outcomes?
Improvement in physician drug formulary prescribing conformance
Reduction in drug interactions and resulting serious adverse effects
Reduction in prescribing and dispensing errors
In January 2006, what large federal prescription drug program was implemented that
offered pharmacy benefits to more than 40 million people at that time and is expected to
increase by 30% throughout the next decade?
Medicare Part D
Two desirable outcomes of tiered prescription member copayments are:
The use of less expensive generic drugs increases and members save money by paying
lower Tier 1 generic copayments
One potential negative consequence of drug formularies with high copayments is:
High copayments may be a barrier to adherence
What is the common benefit design trend in commercial (employer group
sponsored) prescription drug benefits?
Increasing copayment amounts, especially for Tier 2 preferred brand drugs and Tier 3 non-
preferred brand drugs.
,Increasing use of percent coinsurance, especially for Tier 3 and Tier 4 specialty tiers when
available..
Increasing number of consumer-directed health plan designs with higher front-end deductibles.
What technique is used by many pharmaceutical companies with health plans and PBMs to
increase formulary access and utilization of specific products?
Rebates for preferred formulary position
Health economic data, including a growing number of head-to-head clinical trials
Member copayment coupons to offset copayment
Select the one technique for controlling drug benefits costs that MOST health plans and PBMs
DO NOT routinely use.
Value-based insurance designs that assign "high-value" drugs to Tier 1 for ALL
therapeutic categories.
Approximately What percentage of behavioral care spending is associated with what
percentage of patients?
5%
Which organization(s) accredit managed behavioral health care companies?
National Committee for Quality Assurance
The Joint Commission
Utilization Review Accreditation Commission
Councile of Accreditaion
Academic detailing refers to:
Personal meetings between a respected clinician and a doctor or a small group of doctors
donabedians classical model of quality management..
structure, process, outcome
, Each of the following is a traditional way to group a member, except:
Answers:
A. Gender
B. Claims experience
C. Lifestyle
D. B & C
D
T/F: Process measures of health care performance focus on the context in which care
and services are not provided.
T
Which of the following is the leading reason for member complaints?
Answers:
A. Enrollment issues such as a missing ID card
B. Interactions with their PCP
C. Lack of coverage
D. Claims issues
D
T/F: Although important, the provision of general information to members should not be
considered to be one of the key aspects of member services.
F
Which key legislative mandates have included information technology for MCOs?
A. HIPAA
B. PPACA
Electronic prescribing offers which of the following potential outcomes?
Improvement in physician drug formulary prescribing conformance
Reduction in drug interactions and resulting serious adverse effects
Reduction in prescribing and dispensing errors
In January 2006, what large federal prescription drug program was implemented that
offered pharmacy benefits to more than 40 million people at that time and is expected to
increase by 30% throughout the next decade?
Medicare Part D
Two desirable outcomes of tiered prescription member copayments are:
The use of less expensive generic drugs increases and members save money by paying
lower Tier 1 generic copayments
One potential negative consequence of drug formularies with high copayments is:
High copayments may be a barrier to adherence
What is the common benefit design trend in commercial (employer group
sponsored) prescription drug benefits?
Increasing copayment amounts, especially for Tier 2 preferred brand drugs and Tier 3 non-
preferred brand drugs.
,Increasing use of percent coinsurance, especially for Tier 3 and Tier 4 specialty tiers when
available..
Increasing number of consumer-directed health plan designs with higher front-end deductibles.
What technique is used by many pharmaceutical companies with health plans and PBMs to
increase formulary access and utilization of specific products?
Rebates for preferred formulary position
Health economic data, including a growing number of head-to-head clinical trials
Member copayment coupons to offset copayment
Select the one technique for controlling drug benefits costs that MOST health plans and PBMs
DO NOT routinely use.
Value-based insurance designs that assign "high-value" drugs to Tier 1 for ALL
therapeutic categories.
Approximately What percentage of behavioral care spending is associated with what
percentage of patients?
5%
Which organization(s) accredit managed behavioral health care companies?
National Committee for Quality Assurance
The Joint Commission
Utilization Review Accreditation Commission
Councile of Accreditaion
Academic detailing refers to:
Personal meetings between a respected clinician and a doctor or a small group of doctors
donabedians classical model of quality management..
structure, process, outcome
, Each of the following is a traditional way to group a member, except:
Answers:
A. Gender
B. Claims experience
C. Lifestyle
D. B & C
D
T/F: Process measures of health care performance focus on the context in which care
and services are not provided.
T
Which of the following is the leading reason for member complaints?
Answers:
A. Enrollment issues such as a missing ID card
B. Interactions with their PCP
C. Lack of coverage
D. Claims issues
D
T/F: Although important, the provision of general information to members should not be
considered to be one of the key aspects of member services.
F
Which key legislative mandates have included information technology for MCOs?
A. HIPAA
B. PPACA
