Test 3 Formularies

Question 1

What is a P&T committee?

Answer 1

Policy-recommending body to an organization regarding the therapeutic use of drugs

Question 2

Define formulary

Answer 2

A formal, organizationally sanctioned, dynamic system which uses an expert panel to continuously and objectively evaluate and select appropriate drug products based on effectiveness, safety and cost.

Question 3

Purpose of a Formulary System

Answer 3

• To provide a precise system for monitoring drug use and drug therapy management
• To provide safe, appropriate, effective, and economical use of drugs

Question 4

Formulary vs Non-Formulary

Answer 4

• Open Formulary
• Incentive Formulary
• Closed Formulary

Question 5

Open Formulary

Answer 5

formulary and nonformulary drugs are covered at the same benefit level (copays vary)

Question 6

Incentive Formulary

Answer 6

member pays a higher copay or coinsurance for non-formulary drugs

Question 7

Closed Formulary

Answer 7

member pays applicable copay or coinsurance for formulary drugs; non-formulary drugs are not covered

Question 8

What is the purpose of a tier structure?

Answer 8

• to differentiate between preferred and non-preferred
• Tier one: preferred generic or rebated products
• Tier two: preferred brand
• Tier 3: non-preferred

Question 9

What is step-therapy?

Answer 9

• encouraging you to try a specific product before you can try another product
• prior auths may be required for certain steps
• based on clinical guidelines

Question 10

3 goals of a formulary system

Answer 10

• Foster safe, appropriate, and effective drug therapy
• Contribute to the education of the providers in the network
• Achieve some degree of cost containment

Question 11

How does the formulary system achieve their goals?

Answer 11

• Formulary additions and deletions
• Drug product selection (generic usage)
• Access to non-formulary / higher tier drugs
• Processing non-formulary / higher tier requests
• Therapeutic interchange
• Off-label usage
• Experimental drugs
• High-cost/breakthrough drugs
• Exclusions
• Maximum allowable supply / length of therapy

Question 12

excluded vs nonformulary

Answer 12

• excluded not covered

- non-formulary may be covered

Question 13

What are the steps in developing a preferred product list?

Answer 13

• Review all available efficacy and safety data on the selected drug category
• Review practice guidelines and/or seek opinions of leaders in the field
• Prepare list of acceptable lower tiered products
• Review cost (and rebates if applicable) for entire drug category
• Determine final tier structure based on efficacy, safety, and cost data
• Develop criteria for moving between steps
• Educate providers and members
• Implement new tier structure
• Review outcomes/results