Study sets, textbooks, questions
Upgrade to remove ads
Terms in this set (91)
Prior to dispensing a medication, what are the seven things a pharmacist needs to review? (write these out)
1) over-utilization or under-utilization
2) therapeutic duplication
3) drug-disease state contradictions
4) drug-drug interactions
5) incorrect drug dose or duration of treatment
6) drug-allergy interaction
What is the only thing pharmacists are required by law to do?
Prospective drug utilization review
How far back into the OARRS report must a pharmacist look when dispensing an OARRS drug?
What is one instance in which you are required to run an OARRS report?
when the patient has received prescriptions for OARRS drugs from more than one prescriber in the previous 3 months.
What are the three things that are exempt from HIPAA?
2) Healthcare Operations
Who is responsible when someone reports a HIPAA violation?
the employee AND the employer
Is mailing a refill reminder to a community pharmacy's patients considered marketing?
No, refill reminders are treatment.
Can the pharmacist announce over the loud speaker, "Mr. Taylor, your prescription is ready"
No, Cannot use patients name and prescription in the same sentence
Any area or room where prescriptions are filled, or where dangerous drugs, or poisons are compounded, sold, offered or dispensed
An article USP recognized for use in diagnosis, cure, treatment or prevention of disease in man or animals
Any prescription drug or injectable drug
Any prescription drug
Drug of Abuse
Written, oral, fax or electronic(if board approved)
Pharmacy that dispenses (sells) drug at retail. (Other than own use as with a practitioner) This includes laboratories.
Sell, leave with, dispose of, give away, or deliver
Pharmacist must be in the prescription department in full and actual charge
What are the two conditions under federal law that label something a "prescription drug"?
1) habit forming
2) unsafe for use except under supervision of a practicioner
All prescription drugs must have: "Federal Law Prohibits Dispensing Without a Prescription" or "Rx only" on the stock bottle.
How long after you change your name do you have to notify the board of pharmacy?
How long after you change your address do you have to notify the board of pharmacy?
How long after you change your place of employment do you have to notify the board of pharmacy?
How long after there is a change in the responsible pharmacist do you have to notify the board of pharmacy?
When do you have to notify the board of pharmacy if you are discontinuing your business?
14 Days Prior
When do terminal distributors need to renew their licenses?
When do wholesalers need to renew their licenses?
When do pharmacists need to renew their licenses?
When do pharmacy interns need to renew their licenses?
Does the full name of the nurse need to be on the prescription if she faxes it to the pharmacy for the doctor?
Are computer to fax prescriptions allowed for controlled substances?
Does the doctor have to manual sign a computer to fax prescription?
No, he can electronically sign but the prescription must state "prescription has been electronically signed"
How long will a patient stay in a facility that delivers long-term care?
more than 30 days
What is an example of acute care and how long does a patient usually stay there?
hospital-less than 30 days
Which type of service handles a wide range of medical and/or surgical cases?
Which type of service focuses on a disease state or a specific group of people?
What are some reasons for growth in ambulatory care services?
-outpatient care costs less
-new diagnostic and treatment procedures developed
-trying to shift from high cost center (hospital) to low cost center (out patient facility)
-anyone can be seen
What are two settings in which ambulatory care can be delivered?
private physician practice and in hospitals(out patient clinics)
Who would be enrolled in a long-term care service?
people who can't care for themselves independently due to chronic illness, or mental or physical disability
Who are the primary users of LTC facilities?
What are pharmacists roles in LTC?
-Medicare Part D MTM
-Drug Utilizations Reviews (DUR) and Drug Utilization Evaluations (DUE)
What was the first form of health insurance?
Workers compensation - workers were paid cash for lost wages due to sickness and/or job-related injuries
Explain how private health insurance evolved?
-Private health insurance was the only form of insurance available in the early 1900s
-The first health care plan to cover physician services originated in the 40s
-Around WWII health insurance became apart of employee benefits
When was public health insurance introduced?
-In the 60s, before that private was the only way to get insurance
-Since there were no programs for the elderly, poor and uninsured, Medicare(age) and Medicaid(income level) were developed
What are the four principles of insurance?
1) difficult to predict risk for individuals
2) easier to look at patterns and trends for groups of people and predict risk more accurately
3) insurance helps to shift risk from an individual to a group
4) the insured group shares in any losses
If you have insurance, you are more likely to use healthcare goods & services than if you had to pay price out-of-pocket
Health care providers have the ability to create demand for healthcare goods and services
What can provider-induced demand and moral hazard result in?
-inefficient and inappropriate use of healthcare goods and services
-wasted health care resources
-increased health care expenditures
This type of account can help employees set aside pre-tax dollars for eligible healthcare expenses that they will have during a calendar year.
Flexible Spending Account (FSA)
Traditional health care payment system under which physicians and other health care providers are reimbursed for each service preformed
-created incentive to preform more services to bring in more revenue
What was the origin of managed health care in the US?
-In the 1890s we paid physicians for medical care in advance
-Clinics opened that offered pre-paid medical care to employer groups
What are the principles that govern managed care?
-contracts with providers and networks of providers
-prepaid health plans
-financial incentive for patients to use networks
-financial risk shifted from insurance company to managed care organization providers
What are some factors that have contributed to the development of managed health care in the US?
-medical arms race- physicians and hospitals competing for patient business
-government investment research, facilities, providers and health care financing
-healthcare work force shortages
-aging of the population
A person who is responsible for determining a patient's primary services and coordinating the care so that appropriate services are given.
The providers, facilities (e.g. hospitals), pharmacies, etc. that your health insurance plan has contracted with to provide healthcare services/goods.
Healthcare providers are prepaid for providing care to a group of patients
Capitated Provider Reimbursement
A system whereby a provider agrees to provide services on a fee-for-service basis, but with the fees discounted by a certain percentage from the physician's usual charges.
Discounted Fees Reimbursement
A health insurance to which subscribers pay a predetermined fee in return for a range of medical services from physicians and healthcare workers registered with the organization.
Health Maintenance Organization (HMO)
A type of managed care organization that allows patients to receive care outside of the provider network, but they will pay less if they receive care in the network.
Preferred Provider Organization (PPO)
Allows patients to select providers at the time the service is needed rather than when the patient joins the plan.
What are some ethical issues in managed care?
-sanctity of physician-patient relationship
-ethics of medicine
-quality of care
-freedom of choice for patients
Which part of the medicare plan covers inpatient hospital, psychiatric, skilled nursing facilities, home health and hospice care (Hospital Insurance) ?
Which part of the medicare plan coveres outpatient physician care, physician services, X-ray and laboratory tests, PT and OT, drugs that cannot be self administered, preventative services, durable medical equipment and ambulance services (Medical Insurance) ?
What part of the medicare plan includes the medicare advantage program which creates managed health care plans for medicare enrollees?
Which part of the medicare plan covers prescription drugs?
What did the Medicare Prescription Drug Improvement and Modernization Act (MMA) of 2003 establish?
Medicare Part D
Who is eligible for medicare part D?
all people with medicare
Who pays for Medicare Part D?
-federal government pays ~83% of program costs
-enrollees pay ~10%
-state government pays ~8%
How does Medicare Part D control prescription drug costs?
-step therapy-encourages use of similar, lower drug costs
-prior authorization-physician writes letter of medical necessity to part D plan to get drugs covered that are not on formulary
-quantity limits - 30 day supply
-tiered formularies - different copays for brand and generic drugs, tiers for high cost specialty drugs
After prescription costs exceed a certain number, the patient starts paying significantly more until they reach a certain limit and catastrophic coverage kicks in and begins to significantly reduce all prescription costs for the rest of the year
Standard Benefit under Medicare Part D
A person who works with insurance companies, MCOs and government programs who's goal is to decrease prescription costs, improve health care quality and patient outcomes
Pharmacy Benefit Manager (PBM)
A list of prescription drugs covered by a prescription drug plan or an insurance plan that offers prescription drug benefits.
What are the types of services the PBMs offer?
-administrative functions - pharmacy network development
-drug benefit design - formulary management
-clinical programs - MTM
What are some pharmacists roles within a PBM?
What are the goals of health care reform?
-expand coverage (access)
-control health care costs
-improve quality/health system performance
Intent of the Law is to expand coverage/access to many citizens of the United States, control healthcare costs, and improve quality/healthcare system performance.
Patient Protection and Affordable Care Act (ACA)
What are some changes that have occurred since ACA was implemented?
-children can stay on their parents insurance up to age 26
-if you get sick your insurance cannot just drop you
What is the first things companies submit to the FDA in the pre-clinical stage of the drug development process?
Investigational New Drug (IND) application which helps determine whether a drug is reasonably safe for testing in humans
What is the main goal of Phase 1 in the drug development process?
focusing on safety in humans
What is the main goal of phase 2 of the drug development process?
focusing on the assessment of safety, efficacy and risks in a small group of patients
what is the main goal of phase 3 in the drug development process?
focusing on clinical trials and serving as the final check on safety and effectiveness
What is the only thing a generic drug has to prove before being accepted into the market?
that it has bioequivalence of the brand name product
This act prohibited the interstate commerce of adulterated (not pure) food and drugs
1906 Pure Food and Drug Act
Amendment that prohibited false and misleading claims for drug products
1911 Shirley Amendments
This act states that there must be scientific proof of safety before a drug could be marketed
1938 Federal Food, Drug and Cosmetic Act
created two classes of products prescription and over the counter
1951 Durham-Humphrey Amendment
Amendment that required scientific proof of efficacy
1962 Harris-Kefauver Amendments
gave economic and tax incentives for pharmaceutical manufacturers to develop drugs for rare disesases
1983 Orphan Drug Act
How many steps are there in the medication use process?
Where do most medication errors occur?
When is root cause analysis preformed?
after a medication error has occurred
Who is evaluated in a root cause analysis?
individuals at every level within the pharamcy
What are the five R's of medication error prevention?
Sets with similar terms
Pharmacy billing, insurance, technology
Ch. 11, 12, 13
Pharmacy Practice Block 2
Other sets by this creator
MPJE Law facts
Other Quizlet sets
TJ History Exam
Biological Anthropology Exam I