Formulary Management (Exam 2 Cut Off)

Question 1

What is a Formulary?

Answer 1

• List of drugs available to enrollees
• Help manage drug costs
• Cover at least one drug in each class
• Prefer generics over brand

Question 2

Criteria for Product Selection

Answer 2

• Safety
• Efficacy
• Positive therapeutic outcome
• Accepted in medical community
• Cost-effective
• Not experimental or investigational
• Coverage mandated due to federal, state, CMS and/or regulatory agency requirements

Question 3

Why do we need Formularies?

Answer 3

• Crucial to keep prescription medications affordable
• Ensure the medications are safe and effective
• Reduces waste

Question 4

Types of Formularies

Answer 4

• Open
• Closed
• Tiered
• Value

Question 5

Utilization Management Tools

Answer 5

-PA
-Step edits
-Specialty limits
-Tier placement/cost-sharing
-Disease/indication edits
-Drug drug interactions
-Drug Disease interactions
Data and analytics to review cost and prescribing patterns

Question 6

Formulary Development

Answer 6

• P&T Committee
• Clinical literature review
• Pipeline reviews
• Financial implications
• Finding a provider champion

Question 7

Pharmacy and Therapeutic Committee

Answer 7

• Committee that decides on the drugs that are placed on the formulary
• Use scientific evidence and ensure the medication are cost effective
• Establish procedures to ensure appropriate drug review and inclusion