Formulary Management & Drug Selection Flashcards
7 cards from real MTM practice questions. Tap to flip, then mark Knew It or Still Learning — missed cards come back until you master them.
Read the first 7 Formulary Management & Drug Selection flashcards as text
Which tier on a typical commercial formulary generally requires the highest patient cost-sharing?
Answer: Specialty drugs
Specialty drugs, often on Tier 4 or 5, carry the highest cost-sharing due to their complex manufacturing and high acquisition costs.
A Pharmacy and Therapeutics (P&T) committee is reviewing two drugs in the same class with equivalent efficacy but different safety profiles. What should be the primary driver of the formulary decision?
Answer: The drug with the superior safety profile
P&T committees must prioritize clinical evidence, including safety, over financial considerations when evaluating formulary placement.
What is the purpose of a 'step therapy' requirement on a formulary?
Answer: To require use of a first-line agent before a more costly alternative is covered
Step therapy protocols require patients to try and fail preferred (usually lower-cost) therapies before coverage is extended to higher-cost alternatives.
Which metric best evaluates the clinical appropriateness of a formulary drug selection for a specific patient population?
Answer: Drug utilization review (DUR) data
DUR data identifies prescribing patterns, inappropriate use, and outcomes, making it the best tool for evaluating clinical appropriateness across a population.
A MTM pharmacist notices a patient is using a non-formulary proton pump inhibitor (PPI) when an equivalent formulary PPI is available. What is the best next action?
Answer: Recommend the formulary-equivalent PPI to the prescriber as a cost-saving opportunity
MTM pharmacists should collaborate with prescribers to suggest clinically equivalent formulary alternatives to optimize cost without compromising care.
Which type of formulary gives plan members the greatest flexibility in accessing non-formulary medications?
Answer: Open formulary
An open formulary covers both formulary and non-formulary drugs, typically with higher cost-sharing for non-formulary selections.
Which of the following is a common criterion used by P&T committees when evaluating a new drug for formulary inclusion?
Answer: Evidence from randomized controlled trials (RCTs) and systematic reviews
P&T committees rely on peer-reviewed clinical evidence, especially RCTs and meta-analyses, to make unbiased formulary decisions.