MTM Formulary Management & Drug Selection 2

Question 1

Which tier on a typical commercial formulary generally requires the highest patient cost-sharing?

Accepted Answer

Specialty drugs

Answer

Specialty drugs, often on Tier 4 or 5, carry the highest cost-sharing due to their complex manufacturing and high acquisition costs.

Question 2

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?

Accepted Answer

The drug with the superior safety profile

Answer

P&T committees must prioritize clinical evidence, including safety, over financial considerations when evaluating formulary placement.

Question 3

What is the purpose of a 'step therapy' requirement on a formulary?

Accepted Answer

To require use of a first-line agent before a more costly alternative is covered

Answer

Step therapy protocols require patients to try and fail preferred (usually lower-cost) therapies before coverage is extended to higher-cost alternatives.

Question 4

Which metric best evaluates the clinical appropriateness of a formulary drug selection for a specific patient population?

Accepted Answer

Drug utilization review (DUR) data

Answer

DUR data identifies prescribing patterns, inappropriate use, and outcomes, making it the best tool for evaluating clinical appropriateness across a population.

Question 5

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?

Accepted Answer

Recommend the formulary-equivalent PPI to the prescriber as a cost-saving opportunity

Answer

MTM pharmacists should collaborate with prescribers to suggest clinically equivalent formulary alternatives to optimize cost without compromising care.

(MTM) Medication Therapy Management Board Certification Practice Test

(MTM) Medication Therapy Management Board Certification Practice Test

MTM Formulary Management & Drug Selection 2