ACE Apexus Certified Expert Practice Test PDF (Free Printable 2026 June)

Free ACE Apexus Certified Expert Practice Test PDF Download

The ACE (Apexus Certified Expert) credential is the leading professional certification for compliance professionals working within the 340B Drug Pricing Program. Administered by Apexus — the prime vendor for the 340B program under contract with HRSA — the ACE exam validates your expertise in covered entity eligibility, patient definitions, manufacturer prohibitions, audit preparedness, and HRSA oversight requirements.

Our free ACE practice test PDF lets you study every major 340B compliance domain offline at your own pace. Print it, annotate it, and use it alongside the Apexus online training modules to build the mastery needed to pass the ACE exam and protect your organization's 340B program integrity.

What the ACE Apexus Certified Expert Exam Covers

340B Program Eligibility and Covered Entities

The 340B Drug Pricing Program was established under Section 340B of the Public Health Service Act and requires drug manufacturers to provide discounted outpatient drugs to eligible covered entities. The ACE exam tests your thorough understanding of which organizations qualify — including Federally Qualified Health Centers (FQHCs), Ryan White HIV/AIDS Program grantees, disproportionate share hospitals (DSH), children's hospitals, critical access hospitals, sole community hospitals, rural referral centers, and several other categories. Each entity type has specific statutory requirements that must be continuously met to remain eligible. For hospital covered entities, the ACE exam places particular emphasis on disproportionate share hospitals, which must maintain a DSH adjustment percentage above 11.75% and must have at least one contract with a state Medicaid program. FQHC eligibility depends on HRSA grant status or FQHC Look-Alike designation, and you must understand how changes in grant funding or organizational structure trigger re-registration obligations with HRSA's Office of Pharmacy Affairs (OPA).

Eligible Patient Definitions and Compliance

One of the most frequently tested and most nuanced areas of 340B compliance is the definition of an "eligible patient." Under HRSA's 1996 guidelines — still the operative standard — a patient is eligible for 340B pricing only when the covered entity has an established relationship with the individual, the individual receives healthcare services from the covered entity (not merely referral services), and the covered entity maintains records documenting the provision of care. The ACE exam requires you to apply the patient definition to real-world scenarios: walk-in patients, emergency department visits, referred patients, inmates, and individuals receiving services through contracted providers. A particularly high-stakes area is contract pharmacy: since 2010, covered entities may dispense 340B drugs through third-party pharmacies under contract, but robust duplicate discount and diversion prevention controls are mandatory. You must know how Medicaid carve-in and carve-out elections interact with contract pharmacy arrangements, as these determine when 340B pricing can and cannot be used for Medicaid patients.

Manufacturer Prohibitions and GPO Restrictions

The 340B statute and implementing guidance place distinct restrictions on both covered entities and drug manufacturers. Covered entities face two core prohibitions: they must not allow diversion of 340B drugs to individuals who are not eligible patients, and they must not allow duplicate discounts where both a 340B discount and a Medicaid rebate are claimed on the same drug unit. The GPO (Group Purchasing Organization) prohibition is equally critical — most hospital covered entities are prohibited from using GPO contracts to purchase outpatient drugs that they also purchase under 340B pricing. This prohibition applies to inpatient drugs differently: hospitals may use GPO contracts for inpatient drugs. The ACE exam tests your ability to distinguish which settings and drug types trigger the GPO prohibition and how mixed-use environments (where the same drug is used for both inpatient and outpatient care) must be managed. Manufacturers, for their part, must offer ceiling prices to covered entities for all covered outpatient drugs, and the exam covers the statutory formula for calculating 340B ceiling prices (AMP minus the Unit Rebate Amount).

Split Billing and Accumulator Systems

Split billing software is the operational foundation of 340B compliance for covered entities that dispense drugs from a single inventory to both eligible and ineligible patients — most commonly hospitals with mixed inpatient/outpatient populations. The ACE exam tests your knowledge of how split billing systems track drug units, assign 340B or WAC (wholesale acquisition cost) pricing, and generate audit trails that satisfy HRSA's expectation of near-real-time inventory tracking. You must understand accumulator methodologies: the virtual inventory (replenishment) model and the actual inventory model each carry distinct compliance implications. Under the replenishment model, a covered entity purchases drugs at commercial pricing and retroactively reconciles for 340B pricing based on eligible dispenses; the accumulator tracks when the threshold for replenishment ordering is crossed. Common split billing failure points tested on the exam include misconfigured patient eligibility feeds, incorrect Medicaid carve-in/carve-out flags, and failure to exclude contract pharmacy dispenses from the split billing pool when those pharmacies operate their own accumulator systems.

Free ACE Practice Tests Online

Want to test your 340B knowledge interactively before printing the PDF? Our ACE Apexus Certified Expert practice tests give you immediate question-by-question feedback so you can identify compliance knowledge gaps across eligibility, manufacturer rules, audit requirements, and HRSA oversight before exam day.