Section 4: The Capstone: Mock Interview & Confidence Framing

Sarah (Interviewer): “Hi Alex, thanks for joining me today. I’m Sarah Jenkins, and I manage the clinical review team here. I’ve had a chance to look over your resume, and it’s quite impressive. To start, could you just walk me through your background and tell me a bit about yourself?”

Alex (Candidate): “Thank you, Sarah. It’s great to connect with you. I’m currently a Pharmacy Manager and a recently Certified Prior Authorization Pharmacist with over eight years of experience in leading high-volume pharmacy operations. In my role, I’ve become deeply involved in our clinical programs, focusing on improving medication adherence and implementing cost-containment strategies at the ground level. I found I was most energized when I was working on complex cases, navigating formulary challenges, and collaborating with providers to find the most effective and affordable therapies for patients. This led me to pursue the CPAP certification to formalize my skills in utilization management. That’s why I’m so excited about this role; it feels like the ideal next step to apply my clinical and analytical skills on a broader, population-health level.”

Interviewer’s Monologue: “Excellent start. Alex used the Present-Past-Future formula perfectly. He was concise, confident, and immediately bridged his retail experience to managed care with the CPAP certification. He didn’t just recite his resume; he told a story about his career progression and why he’s here. He sounds motivated and strategic.”

Analysis: Alex’s answer is a textbook example of a strong opening. It’s under 90 seconds, hits the key value points (cost-containment, UM), and clearly articulates his motivation. He has already framed himself as a strategic thinker, not just a dispenser.

Sarah: “That’s a great background, and it’s clear why you’re interested in the managed care space. So, tell me, what do you know about our company, and what specifically about this role interested you?”

Alex: “From my research, I’ve been very impressed with [PBM Name]’s innovative approach to managing specialty pharmacy, particularly your proprietary ‘Gene Therapy Solutions’ program. It shows a commitment to tackling the most complex and costly areas of healthcare head-on. My CPAP training included a deep dive into the utilization management criteria for these novel therapies, so I understand the unique challenges in ensuring appropriate use. I was interested in this role specifically because the job description emphasized the need for pharmacists who can handle complex oncology and immunology cases. My experience as the go-to person in my district for specialty drug PAs has prepared me well for that challenge, and I’m eager to contribute my skills to a team that’s a clear leader in the field.”

Interviewer’s Monologue: “Okay, he’s done his homework. He didn’t just say our company name; he mentioned a specific, high-profile program. That’s impressive. He then immediately connected his certification and experience directly to that program. He’s not just flattering us; he’s showing me exactly how he fits into our business strategy. He wants to solve the problems we are actively trying to solve.”

Analysis: Alex avoids generic praise. He demonstrates genuine interest and business acumen by referencing a specific company initiative. This shows he is not just looking for “a job” but is specifically interested in “this job” at “this company.”

Sarah: “That’s great to hear. Let’s shift to some behavioral questions. Tell me about a time you identified a significant cost-saving opportunity.”

Alex: (Using a pre-prepared STAR story from his Story Bank)

(S) “In my role as Pharmacy Manager, I was performing a quarterly review of our purchasing data and noticed our pharmacy had a surprisingly low dispensing rate for a newly-launched authorized generic of a very popular combination inhaler.”

(T) “My goal was to understand the reason for the low uptake and develop a strategy to increase the dispensing of this more cost-effective authorized generic, which would save both patients and payers a significant amount of money without any change in clinical effect.”

(A) “First, I investigated the root cause and found that the new authorized generic was not being automatically substituted by our software, meaning technicians and pharmacists had to manually intervene. To address this, I developed a simple workflow aid—a brightly colored sticker placed on the shelf next to the brand product—that prompted the team to check for the AG. I then held a 10-minute huddle with my team to explain the clinical and financial benefits and get their buy-in. Finally, I ran a report of all patients on the brand drug and initiated a proactive outreach to their prescribers, informing them of the AG’s availability and our intent to switch unless they specified ‘brand necessary’.”

(R) “As a result of this multi-pronged initiative, our pharmacy’s dispensing rate for the authorized generic increased from 15% to over 80% in just two months. Based on our volume, this single change resulted in an estimated annualized drug spend savings of over $150,000 for our patient’s health plans.”

Interviewer’s Monologue: “Wow. That was a fantastic STAR story. It was specific, data-driven, and showed incredible initiative. He didn’t just wait for a problem; he proactively sought one out in the data. He addressed the system, the people, and the process. The result was quantified and significant. This demonstrates cost-consciousness, leadership, and process improvement skills. This is exactly what we look for.”

Analysis: This is a powerful story because it’s not just about saving money. It showcases a wide range of transferable skills: data analysis (reviewing purchasing data), problem-solving (identifying the software issue), process improvement (the sticker and workflow aid), leadership (training the team), and provider relations (the outreach). It’s a perfect PBM-focused story derived from a retail experience.

Sarah: “That’s a very impressive result. Now, let’s move to a clinical case study. I’m going to send you a profile in the chat. Please take a moment to review it, and then walk me through your thought process and how you would adjudicate the request.”

Patient: Mary Jones, 45 y/o female.
Diagnosis: Migraine headaches.
Request: Ubrelvy (ubrogepant) 100mg.
Med History: Sumatriptan (failed due to ‘chest tightness’), Rizatriptan (failed due to ‘dizziness’), Topiramate (used for prophylaxis, discontinued due to cognitive side effects).
Notes: “Patient has 6-8 migraine days per month. Has failed two triptans. Please approve Ubrelvy for acute treatment.”

Interviewer’s Monologue: “This is a classic case. It looks straightforward, but there are nuances. I want to see if he can spot the details. Will he just approve it because two triptans were tried? Or will he dig deeper and think like a utilization manager?”

Analysis: The interviewer is testing Alex’s ability to apply criteria methodically, not just react to the surface-level information. The key is to demonstrate a structured thought process.

Alex: (Takes a moment of silence to read and think)

“Okay, thank you for sharing that. I’m ready to walk you through my process.”

(1. Summarize) “So, we have a 45-year-old female with chronic migraines, experiencing 6-8 headache days per month. The request is for the CGRP antagonist Ubrelvy for acute treatment. The key supporting information is the documented failure of two triptans, sumatriptan and rizatriptan, due to side effects.”

(2. Identify Positives) “The positive information here is strong. The patient has a clear diagnosis, and the number of headache days per month establishes medical necessity for an effective acute treatment. Most importantly, the documented failure of two triptans from different formulations is the primary step-therapy requirement for this class of drug, and that appears to be met.”

(3. Identify Gaps) “As I look deeper, I’m considering potential quantity limit issues. The request is for the 100mg strength. PBMs typically limit CGRP antagonists to a specific number of tablets per month—often 8 or 10—to prevent overuse and encourage appropriate prophylactic therapy. The request doesn’t specify a quantity, so that’s a detail I would need to confirm. Also, while the patient failed topiramate for prophylaxis, I’d want to ensure they are on some form of prophylactic therapy if they are having 8 migraines a month, as these drugs are not intended for overuse.”

(4. Formulate Determination) “Based on the information, I would approve this request for Ubrelvy. The patient has met the core clinical criteria by failing two triptans. However, my approval would be specific.”

(5. Outline Next Steps) “I would approve the request but apply the plan’s standard quantity limit, which is likely 8 tablets per 30 days. In the approval notes, I would add a comment for the dispensing pharmacy and prescriber clarifying this limit. Clinically, I would also consider if a pharmacist outreach to the provider would be valuable to discuss optimizing the patient’s prophylactic regimen, as reducing the overall number of migraine days is the ultimate goal. This represents an opportunity for holistic management beyond just approving the acute treatment.”

Interviewer’s Monologue: “Perfect. He nailed it. He used the 5-step framework without me even having to prompt him. He correctly identified the core criteria were met but didn’t stop there. He immediately thought about the next layer of utilization management—the quantity limit. That shows he thinks like a PBM pharmacist. The final comment about considering outreach on prophylactic therapy is a home run. It shows he’s thinking about total patient care and long-term cost management, not just a single transaction. He’s a keeper.”

Analysis: Alex’s response is exceptional because it demonstrates multiple levels of thinking. He shows he can follow the rules (approving because the step-therapy was met) but also that he understands the strategic intent behind the rules (quantity limits to control cost and prevent overuse). The final clinical recommendation elevates him from a reviewer to a strategic clinical partner.

• “What does success look like in this role in the first 90 days?”
• “What are the key performance indicators (KPIs) for this position?”
• “What is the biggest challenge the person in this role will face?”

• “Can you tell me about the team I’d be working with? What is the dynamic like?”
• “How does your team handle disagreements or differing clinical opinions?”
• “What is your leadership style?” (Asked to your potential manager)

• “What are the biggest challenges the company is facing right now in the specialty drug space?”
• “How does this role contribute to the company’s broader strategic goals for this year?”
• “Where do you see the clinical operations team evolving in the next 2-3 years?”