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Formulary Management and Step Therapy Graph Model

Run the Formulary Management and Step Therapy Graph Model MicroSim Fullscreen

About This MicroSim

This graph models how a pharmacy benefit manages drugs. A benefit plan USES_FORMULARY, the formulary INCLUDES drugs at various tiers, and every drug is a MEMBER_OF a therapeutic class. Two special relationships drive utilization management: STEP_THERAPY_BEFORE edges require trying a lower-cost generic before a brand drug is covered, and ALTERNATIVE_TO edges link interchangeable therapeutic options. This structure is what a pharmacy claim is adjudicated against in real time.

How to Use

Start at the plan, follow USES_FORMULARY to the formulary and INCLUDES to the covered drugs, and read each drug's tier. Trace the red STEP_THERAPY_BEFORE edges to see that the generic (Tier 1) atorvastatin must be tried before the brand (Tier 3) Lipitor is covered, and follow MEMBER_OF edges to see the drugs grouped into the statin class. Drag nodes and use the navigation buttons to explore.

Iframe Embed Code

You can add this MicroSim to any web page by adding this to your HTML:

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<iframe src="https://dmccreary.github.io/modeling-healthcare-data/sims/formulary-management-step-therapy-graph-model/main.html"
        height="450px"
        width="100%"
        scrolling="no"></iframe>

Lesson Plan

Grade Level

9-12 (High School Geometry)

Duration

10-15 minutes

Prerequisites

TODO: List prerequisites.

Activities

  1. Exploration (5 min): TODO
  2. Guided Practice (5 min): TODO
  3. Assessment (5 min): TODO

Assessment

TODO: List assessment criteria.

References

  1. TODO: Add references.