Download Organizational Influence Module

Making the CA$E for Drug Company Independence
Marketing of Medicines (MoM)
Organizational Influences on Prescribing
Evaluation Questions
1. Evidence-based formularies are intended to reduce cost, improve quality, and
simplify medication delivery.
A. True
B. False
2. Efficacy data is the only factor pharmacy benefits managers use in determining
preferred formulary status for drugs.
A. True
B. False
3. Differences between hospital-based formularies and outpatient pharmaceutical
benefits are likely to contribute to patient confusion about their medications or
medication errors.
A. True
B. False
4. The Institute of Medicine (IOM) is a branch of the US government.
A. True
B. False
5. In a NEJM study of patients whose statin lost preferred formulary status, nearly
50% of patients switched to the preferred drug showing the impact of formulary
decision-making on prescribing.
A. True
B. False
6. A number of major US pharmacy chains now offer some generic medications at
low prices to the consumer. This may aid patient compliance with medications, and
influence prescribing.
A. True
B. False
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7. The US Government’s rebate program requires that Medicaid pricing equals
that of other formulary programs.
A. True
B. False
8. Many pharmaceutical companies provide patient support programs that include
coupons for trials of drugs, low cost medication programs for low income patients,
and freely accessible information regarding diseases and treatments.
A. True
B. False
9. Prescribing can be influenced by which of the following organizational
mechanisms:
A. Institutional pharmacy and therapeutics committees.
B. Clinical pathways developed by professional societies.
C. Insurance company tiering processes.
D. Pharmaceutical company pricing and marketing practice.
E. All of the above.
10. The PhRMA code on interactions with healthcare professionals states that
pharmaceutical representatives should focus on informing healthcare professionals
about products by providing scientific and educational information.
A. True
B. False
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Organizational Influences on Prescribing
Evaluation Questions
1. Answer A: True. The goals of an evidence-based formulary are to support costeffective, quality care by promoting the use of a limited number of medications that have
proven effective for specific diseases. This practice should also simplify delivery as
prescribers may become more familiar with a smaller number of medications, and
institutional pharmacies may not need to maintain large inventories.
2. Answer B: False. In an ideal world formularies would be based on clear evidence to
support appropriate decision-making for patients. In practice they are influenced by
several factors. For one thing, clear evidence is not always adequate to make these
decisions. Additionally, the business of medicine involves pricing of medications and
contractual agreements between pharmaceutical makers and pharmacy benefit mangers,
and, in some cases providers attempt to maintain autonomy in decision making by
influencing formulary decisions.
3. Answer A: True. For example, your patient may be discharged home on a medication
despite the fact that it might not be covered by your patient’s outpatient pharmacy
benefit, or could require a larger co-payment. This may be frustrating for your patients
and you as you work through the system to determine whether you will change the
medication to one covered by your patient’s insurer for outpatient treatment, or complete
a prior authorization form. In some cases a patient might be discharged on a me-too
medication that may be different from what they already have at home. This could cause
confusion and increased side effects and risks from unintentional double dosing.
4. Answer B: False. The Institute of Medicine is a private, non-governmental
organization. It is largely composed of unpaid volunteer experts who author reports
based on evidence and is free from many of the constraints of governmental
organizations.
5. Answer A: True. Additionally 9% stopped using statins altogether only 42% remained
on the old drug. This study clearly shows that formulary decisions can drive
prescribing.
6. Answer A: True. To our knowledge there have been no detailed studies of this
practice, but anecdotal evidence suggests that providers may direct patients to these
locations to fill prescriptions. This may support use of cost-effective generics and patient
compliance, which may also influence prescribing.
7. Answer A: True. This is designed to maintain pricing equity, but may provide an
incentive for pharmaceutical companies to hide pricing concessions to other groups.
8. Answer A: True. These programs may help patients, and may influence prescribing.
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9. Answer E: All of the above. Clinicians should be aware of these influences when
making decisions to ensure that they are prescribing appropriately.
10. Answer A: True. Some pharmaceutical companies are further adjusting their
support of CME and physician outreach even as this presentation is under preparation.
Clinicians should be aware of potential bias in all sponsored educational programs, and
integrate this into their clinical decision-making. Please see our module on
communication with pharmaceutical representatives for additional information.
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