MTM Formulary Management & Drug Selection 5

Question 1

Under Medicare Part D, what is a 'protected class' of drugs and why are these classes significant for formulary management?

Accepted Answer

Six drug classes CMS requires Part D plans to cover all or substantially all drugs within

Answer

CMS designates six protected classes (e.g., antiretrovirals, antidepressants, antipsychotics) in which Part D plans must offer broad formulary coverage to protect vulnerable patient populations.

Question 2

When evaluating biosimilars for formulary placement, a P&T committee should consider which of the following as most clinically relevant?

Accepted Answer

FDA interchangeability designation and evidence of comparable efficacy and safety to the reference biologic

Answer

FDA interchangeability designation means the biosimilar may be substituted for the reference biologic without prescriber intervention, making it highly relevant for formulary substitution policies.

Question 3

A health plan wants to reduce inappropriate antibiotic prescribing through formulary design. Which formulary management strategy would be most effective?

Accepted Answer

Placing narrow-spectrum antibiotics on preferred tiers and requiring step therapy or PA for broad-spectrum agents

Answer

Preferring narrow-spectrum agents and requiring documentation for broad-spectrum use stewards antibiotic use without removing necessary treatment options.

Question 4

In formulary benefit design, what is the difference between 'cost-sharing' and 'cost containment'?

Accepted Answer

Cost-sharing shifts drug expenses to members; cost containment reduces total drug expenditure for the plan

Answer

Cost-sharing strategies (copays, coinsurance) transfer some drug expense to members, while cost containment strategies (rebates, generics, step therapy) reduce the plan's total drug spend.

Question 5

A patient's oncologist prescribes a non-formulary chemotherapy agent. The plan's formulary includes an alternative with different toxicity but comparable response rates. What should the MTM pharmacist prioritize?

Accepted Answer

Review the individual patient's comorbidities and discuss clinical nuances with the oncologist before any formulary switch

Answer

Oncology formulary decisions require individualized clinical review because toxicity profiles may be critical for patients with specific comorbidities or prior treatment histories.

(MTM) Medication Therapy Management Board Certification Practice Test

(MTM) Medication Therapy Management Board Certification Practice Test

MTM Formulary Management & Drug Selection 5