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
A drug is placed in the 'non-preferred' tier rather than the 'preferred' tier on a formulary. What does this typically mean for a patient?
Answer: The patient will pay a higher copay or coinsurance
Non-preferred tier placement signals that cost-sharing is higher than for preferred alternatives, incentivizing use of preferred drugs.
When conducting a formulary review for diabetes medications, a P&T committee should consider cardiovascular outcomes trial (CVOT) data primarily because:
Answer: CVOTs provide evidence on cardiovascular safety and benefit beyond glycemic control
CVOTs for diabetes medications reveal cardiovascular safety signals and potential protective benefits, which are critical for patient population risk stratification.
Which of the following best describes a 'closed formulary'?
Answer: A formulary restricted to only listed drugs, with no coverage for non-listed agents
A closed formulary restricts coverage exclusively to drugs on the approved list, maximizing cost control but limiting patient choice.
What is the primary goal of a formulary exception process?
Answer: To allow coverage of non-formulary drugs when medically necessary for individual patients
Formulary exceptions provide a mechanism for patients with unique clinical needs to access non-formulary drugs when formulary alternatives are medically inappropriate.
In the context of formulary management, what does 'generic substitution' mean?
Answer: Dispensing a generic equivalent for a brand-name drug when legally permissible
Generic substitution replaces a brand-name drug with an AB-rated generic equivalent, maintaining therapeutic equivalence while reducing costs.
Which of the following situations would most likely trigger a prior authorization (PA) requirement on a formulary?
Answer: A prescriber orders a high-cost specialty biologic without documented failure of standard therapies
PA requirements are commonly applied to specialty biologics to ensure appropriate use and require documentation of step therapy failure.
A health plan's formulary includes only one ACE inhibitor and one ARB. A patient's prescriber requests a different ARB not on formulary. What formulary management tool most directly applies?
Answer: Therapeutic interchange
Therapeutic interchange allows substitution of a formulary drug in the same class with equivalent efficacy, with prescriber agreement.