MTM Formulary Management & Drug Selection 4

Question 1

A P&T committee is comparing two statins for formulary placement. Drug A has a lower AWP but no outcomes data; Drug B costs more but has proven cardiovascular mortality reduction. What is the best formulary decision?

Accepted Answer

Place Drug B preferred because of superior outcomes evidence

Answer

P&T committees should weight proven clinical outcomes over acquisition cost alone, favoring Drug B for its demonstrated mortality benefit.

Question 2

Which federal program requires that drug manufacturers pay rebates to state Medicaid programs as a condition of Medicaid coverage?

Accepted Answer

The Medicaid Drug Rebate Program (MDRP)

Answer

The MDRP requires drug manufacturers to enter rebate agreements with CMS in exchange for having their drugs covered by Medicaid.

Question 3

What is the clinical significance of a drug's 'therapeutic index' when making formulary decisions for narrow therapeutic index (NTI) drugs?

Accepted Answer

NTI drugs require careful monitoring because small dose changes can cause toxicity or treatment failure

Answer

NTI drugs like warfarin, levothyroxine, and lithium have narrow ranges where efficacy and toxicity intersect, requiring careful management when switching products.

Question 4

A pharmacy benefit manager (PBM) negotiates manufacturer rebates. How do rebates typically influence formulary tier placement?

Accepted Answer

Drugs offering larger rebates may receive preferred tier status, lowering member cost-sharing

Answer

PBMs often grant preferred tier placement to drugs whose manufacturers offer larger rebates, which can reduce net plan costs despite higher list prices.

Question 5

An MTM pharmacist identifies that a Medicare Part D beneficiary is in the coverage gap ('donut hole'). How does formulary selection affect their out-of-pocket costs during this phase?

Accepted Answer

Generic drugs still have lower cost-sharing than brands in the gap, making formulary generics more advantageous

Answer

In the coverage gap, beneficiaries pay a percentage of the drug cost, so lower-cost generics on the formulary result in lower absolute out-of-pocket payments.

(MTM) Medication Therapy Management Board Certification Practice Test

(MTM) Medication Therapy Management Board Certification Practice Test

MTM Formulary Management & Drug Selection 4