CphT Rx Study Non-formulary     Last updated on 2010     1     29, a full moon day;

your direction is:

In common, hospitals deploy formulary only. Non-formulary is for exceptional handling, therefore management committee creates codes for non-formulary. Meta data for non-formulary is:

Code Definition Remark
Integer Adverse drug reaction; Drug diet interaction; Drug drug interaction; Brand name; Generic name;
Alpha FILE; FILE LATER;
Alphanumeric DAW; Special Status;
... ...

FILE is designed, based on ACTION, common conditions to be filed are:

1. new Rx
2. current Rx is changed
3. Pt does not pick up Rx


FILE LATER is designed, based on ACTION, uncommon conditions to be filed are:

1. Pt is a non-registered person, so default formulary
2. Pt is not a member, e.g. without insurance, via emergency, so default formulary
 

DAW, Dispense As Written, so CphT dispenses as written [no substitution];

 

Special Status is designed, based on status of Pt such as blood donator status, lactation status, organ donator status, pregnancy status, royal status [including king, queen, other sovereign], ... ; IFF Special Status is true, formulary becomes non-formulary automatically, aka quantitative becomes qualitative;

 

http://cl.kp.org provides online formulary;

 

CphT calculation no. 51:

Morphine ER has been formulary. But, Pt's meta data prompts Allergy [so allergic to formulary]. Non-formulary code prompts that Pt agrees to pay for non-formulary drug:

(a) Guaifen/Codein 100-20mg/3ml SF     (b) Protonix EC     (c) Effexor XR     (d) Opana ER

So, CphT dispenses.

 

Answer: Opana ER, its generic is Oxymorphone;

 

CphT calculation no. 52:

Concerning product in formulary [in common], due to treatment failure of generic equivalent, Rx is written non-formulary brand name with:

(a) DAW (b) Substitution of formulary (c) Substitution of non-formulary (d) Intolerance to brand name

Sometimes, Pt is intolerant to brand name also, even though brand name has been non-formulary;

 

Answer: DAW, Dispense As Written;

 

CphT calculation no. 53:

Formulary has been statin, HMG-CoA reductase inhibitor, to lower cholesterol; But, Pt's meta data "Definition" prompts Intolerance, so CphT should dispense:

(a) non-statin for LDL reduction

(b) non-formulary statin for LDL reduction

(c) formulary statin for LDL reduction

(d) statin for LDL reduction

 

Answer: non-statin, for LDL reduction;

 

CphT calculation no. 54:

Pt has failed generic equivalent of product, and the generic equivalent of product has been formulary in a hospital, so CphT should dispense:

(a) formulary drug, aka generic drug
(b) non-formulary drug, aka formulary alternative drug, aka brand
(c) the same generic drug
(d) different brand with different generic drug
 

Answer: (b) brand as non-formulary;

 

CphT calculation no. 55:

Venlafaxine has been formulary in a hospital to treat depression and anxiety, its non-formulary would be:

(a) Narcotic dependency of morphine

(b) Felodipine, calcium channel blocker

(c) Amlodipine, calcium channel blocker

(d) Effexor

 

Answer: Effexor, because generic as formulary to brand as non-formulary;

 

CphT calculation no. 56:

New member, aka new Pt means idiosyncrasy risk; Even though formulary provides lesser cost, but for a new Pt, non-formulary drug Felodipine is Rx for treating high BP aka hypertension [so, doctor will evaluate the Pt within a time period]; After the time period, Rx will change non-formulary Felodipine to formulary:

(a) Amlodipine
(b) Norvasc
(c) Plendil
(d) Morphine


Because, high cost to low cost, by risk management;

IFF Felodipine is formulary, and then non-formulary would be Plendil;

Answer: Amlodipine, calcium channel blocker;

 

CphT calculation no. 57:

In common, hospitals deploy formulary only. DAW can change formulary to non-formulary, if Pt agrees to pay. Proof of Adverse Drug Reaction can also change formulary to non-formulary; If code is Special Status, Rx will be written and then dispensed:

(a) formulary
(b) non-formulary
(c) generic equivalent of product
(d) non-brand
 

Answer: non-formulary;

 

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