Medical Management: AHM-540

Drugs included in a health plan's formulary can be classified according to how freely they can be prescribed. By definition, a drug that requires some sort of review or approval by a plan physician or group

of physicians before the prescription can be filled is

A. an unrestricted drug

B. a monitored drug

C. a restricted drug

D. a conditional drug

Demetrius Farrell, age 82, is suffering from a terminal illness and has consulted his health plan about the care options available to him. In order to avoid unwanted, futile interventions, Mr. Farrell signed an advance directive that indicates the types of end-of-life medical treatment he wants to receive. His family is to use this document as a guide should Mr. Farrell become incapacitated.

For this question, if answer choices (A) through (C) are all correct, select answer choice (D). Otherwise, select the one correct answer choice.

Decisions regarding Mr. Farrell's end-of-life care are legally the right and responsibility of

A. Mr. Farrell and his family

B. Mr. Farrell's physician

C. Mr. Farrell's health plan

D. All of the above

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

A. involve the same types of providers and delivery systems as do standard medical services

B. are a subset of a health plan's standard medical-surgical services

C. are not monitored by health plans for quality or utilization

D. require specialized knowledge for service delivery and management