Specialty Pharm Final Exam Questions and Answers
A prescriber calls your pharmacy asking for a recommendation on a HCV treatment for
a new patient. Before you make a recommendation, what HCV clinical factors would
you need to know? List them. - Answers-- Genotype of HCV (determines treatment)
-Baseline lab tests performed (RNA level, liver staging)
-Treatment history (naive vs experienced)
-Any co-infections
-Allergies
-DDIs
.What are some important clinical factors to include on an HCV prescription order sent
to a specialty pharmacy? - Answers--Genotype and subtype
-Cirrhosis status
-Treatment history
-Viral load
-Renal and liver functions
-BBW for Hepatitis B
-Med list
-Patient info and insurance
.Dr prescribes a non-formulary HCV product for a patient. Harvoni and Epclusa are
covered. You see in the patient's chart that the patient has HCV genotype 3. What
medication and treatment duration would you recommend to the Dr's office and why? -
Answers--Epclusa 100mg/400mg 1 tab PO QD for 12 weeks
-Epclusa is approved for genotype 3 (Harvoni is for types 1, 4, 5, 6)
-Epclusa is safe for patients with normal renal function (contraindicated in renal failure)
-Patient is treatment naive
-Take w/ or w/out food, antacid interactions
.You receive a new approval for Mavyret for 12 weeks through a patient's commercial
insurance. However, their copay is $250/month, which is unaffordable to the patient.
What financial assistance could you offer the patient, and what would the estimated out-
of-pocket cost be each month? - Answers--Copay cards
-Estimated no more than $5/month OOP
.A Medicare Part D patient calls the pharmacy to ask about patient assistance programs
for his new Vosevi prescription. Would it be appropriate to sign him up for a copay card?
Why or why not? What alternative is available if he can't use a copay card? - Answers--
Cannot use copay card because Med D is federally funded
-PAN can be offered, also grants
, .You are calling a patient to introduce your pharmacy and the patient's new medication:
Mavyret. How would you counsel the patient about this new medication? - Answers--
Must take 3 tablets by mouth AT THE SAME TIME once daily with food
-Take at the same time daily
-Take full course of therapy
-Side effects: headache, fatigue, nausea
-Cannot use medication with severe liver disease (decompensated cirrhosis)
-Do not double up doses
-Missed dose info: if it has been <18hrs, take it; if >18hrs, wait until next scheduled dose
-Store at room temp in safe, dry place
.A patient calls your pharmacy wanting to take an OTC calcium carbonate to treat
heartburn she is experiencing. You notice the patient is half-way through her 12 week
course of Epclusa. How would you counsel the patient to take an antacid in relation to
the Epclusa? - Answers--Epclusa interacts with acid-reducing medications
-Separate Epclusa and antacid by 4 hours
.A patient calls asking how to take omeprazole with his Harvoni. How would you counsel
this patient? - Answers--Safe to take omeprazole 20 mg
-Take Harvoni and omeprazole AT THE SAME TIME on an empty stomach
.Based on a Janet's med history and recent testing for genotype 3 HCV, it is determined
that it is more appropriate for her to take Epclusa for her treatment. When arranging her
first fill of Epclusa, Janet whines "I want the Harvoni. I saw it on TV after that cute add
for the new knitting needles I like, and I hear Harvoni works better for Hepatitis C." How
would you respond to Janet's request? - Answers--Janet, your specific type of Hep C
requires Epclusa instead of Harvoni, the Harvoni won't effectively treat you
-(Support Epclusa efficacy and safety)
.During a refill call, Gertrude admits she missed doses of her Vosevi because she was
too busy watching Ellen. What suggestions or strategies could you offer her to improve
adherence? - Answers--Keep med in a place you see daily (kitchen, on night stand, etc)
-Set reminders on phone
-Take at same time each day or at same point in daily routine
-Weekly organizer pill tray
-"Accountability buddy"
.You call a patient to counsel on a new medication. The patient tells you "I don't usually
set up my medications- my wife does that. Can you just talk to her?" How would you
respond? - Answers--"Yes, as long as I can document your permission in me speaking
to your wife about your medical information, but it is very important that you know how
to take your medication properly, so you should listen in on the phone call also"
-If patient over 18: cannot give out info to others without patient permission
-If patient under 18: can talk to parents without HIPAA violation
A prescriber calls your pharmacy asking for a recommendation on a HCV treatment for
a new patient. Before you make a recommendation, what HCV clinical factors would
you need to know? List them. - Answers-- Genotype of HCV (determines treatment)
-Baseline lab tests performed (RNA level, liver staging)
-Treatment history (naive vs experienced)
-Any co-infections
-Allergies
-DDIs
.What are some important clinical factors to include on an HCV prescription order sent
to a specialty pharmacy? - Answers--Genotype and subtype
-Cirrhosis status
-Treatment history
-Viral load
-Renal and liver functions
-BBW for Hepatitis B
-Med list
-Patient info and insurance
.Dr prescribes a non-formulary HCV product for a patient. Harvoni and Epclusa are
covered. You see in the patient's chart that the patient has HCV genotype 3. What
medication and treatment duration would you recommend to the Dr's office and why? -
Answers--Epclusa 100mg/400mg 1 tab PO QD for 12 weeks
-Epclusa is approved for genotype 3 (Harvoni is for types 1, 4, 5, 6)
-Epclusa is safe for patients with normal renal function (contraindicated in renal failure)
-Patient is treatment naive
-Take w/ or w/out food, antacid interactions
.You receive a new approval for Mavyret for 12 weeks through a patient's commercial
insurance. However, their copay is $250/month, which is unaffordable to the patient.
What financial assistance could you offer the patient, and what would the estimated out-
of-pocket cost be each month? - Answers--Copay cards
-Estimated no more than $5/month OOP
.A Medicare Part D patient calls the pharmacy to ask about patient assistance programs
for his new Vosevi prescription. Would it be appropriate to sign him up for a copay card?
Why or why not? What alternative is available if he can't use a copay card? - Answers--
Cannot use copay card because Med D is federally funded
-PAN can be offered, also grants
, .You are calling a patient to introduce your pharmacy and the patient's new medication:
Mavyret. How would you counsel the patient about this new medication? - Answers--
Must take 3 tablets by mouth AT THE SAME TIME once daily with food
-Take at the same time daily
-Take full course of therapy
-Side effects: headache, fatigue, nausea
-Cannot use medication with severe liver disease (decompensated cirrhosis)
-Do not double up doses
-Missed dose info: if it has been <18hrs, take it; if >18hrs, wait until next scheduled dose
-Store at room temp in safe, dry place
.A patient calls your pharmacy wanting to take an OTC calcium carbonate to treat
heartburn she is experiencing. You notice the patient is half-way through her 12 week
course of Epclusa. How would you counsel the patient to take an antacid in relation to
the Epclusa? - Answers--Epclusa interacts with acid-reducing medications
-Separate Epclusa and antacid by 4 hours
.A patient calls asking how to take omeprazole with his Harvoni. How would you counsel
this patient? - Answers--Safe to take omeprazole 20 mg
-Take Harvoni and omeprazole AT THE SAME TIME on an empty stomach
.Based on a Janet's med history and recent testing for genotype 3 HCV, it is determined
that it is more appropriate for her to take Epclusa for her treatment. When arranging her
first fill of Epclusa, Janet whines "I want the Harvoni. I saw it on TV after that cute add
for the new knitting needles I like, and I hear Harvoni works better for Hepatitis C." How
would you respond to Janet's request? - Answers--Janet, your specific type of Hep C
requires Epclusa instead of Harvoni, the Harvoni won't effectively treat you
-(Support Epclusa efficacy and safety)
.During a refill call, Gertrude admits she missed doses of her Vosevi because she was
too busy watching Ellen. What suggestions or strategies could you offer her to improve
adherence? - Answers--Keep med in a place you see daily (kitchen, on night stand, etc)
-Set reminders on phone
-Take at same time each day or at same point in daily routine
-Weekly organizer pill tray
-"Accountability buddy"
.You call a patient to counsel on a new medication. The patient tells you "I don't usually
set up my medications- my wife does that. Can you just talk to her?" How would you
respond? - Answers--"Yes, as long as I can document your permission in me speaking
to your wife about your medical information, but it is very important that you know how
to take your medication properly, so you should listen in on the phone call also"
-If patient over 18: cannot give out info to others without patient permission
-If patient under 18: can talk to parents without HIPAA violation
