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Health Care - Test 1 Points
Temple University School of Pharmacy - Y1S2
Terms in this set (80)
-Clinical Decision Support
-Checks for formulary, allergies, interactions, unusually high doses, and clinical conditions upon the writing of a prescription
-Typically given as a doctor is writing an E-script, due to the prescription data being readily accessed by the computers' DUR protocols
-Suggests appropriate doses
-Average Wholesale Price (Controversial--too high)
-Originally intended to represent the average price that wholesalers used to sell medications to providers, such as physicians, pharmacies, and other customers.
-Often compared to the "list price" or "sticker price", meaning it is an elevated drug price, rarely what is actually paid
-Not a government-regulated figure
-Does not include buyer volume discounts or rebates often involved in prescription drug sales
-Is subject to fradulent manipulation by manufacturers or even wholesalers
-Average Manufacturer's Price (Controversial--too low)
-Used to determine amount that Medicare pays pharmacy providers for generic prescription pharmaceuticals
-An attempt to bring costs down, but may not actually support the providers
-It's a blend of what manufacturers charge to huge customers like warehousing chains
-Challenging to the majority of providers, who are not purchasing at the levels of mail order pharmacies or at the level of large chains, who can contract for lower costs
-Mail order pharmacies, etc, will cause the AMP numbers to be far below market pricing.
-The AMP number is far below market pricing. Then it multiples as dispensing fees are added to that number to get to a payment amount.
-Is an effort to phase out AWP
340B Drug Pricing Program
-Requires manufacturers to provide outpatient drugs to eligible health care organizations at reduced prices.
-Functions to stretch scarce Federal resources
The Technician/Pharmacist Golden Ratio
-A mandated proportion of how many techs are permitted for each pharmacist.
-State-mandated, but 30% of states have no regulation about this matter
-Rather irrelevant, since there's far more variables for efficacious pharmacy practice than the number of techs per pharmacist
How many people under 16 years old signed for government health insurance? (Discounts Medicare data: for those 65+)
How many young adults (18-34) signed for government health insurance? (Discounts Medicare data: for those 65+)
Financial incentives provided by the government to insurance companies who are forced to sign up new customers without requisite preliminary reports about pre-existing conditions.
-By offering financial help to insurers that sign up less-healthy people.
-The health law also encourages insurers to glean information about their enrollees . To maximize their revenue, insurers need to document patients' diagnoses.
-Insurers can use outreach calls to encourage enrollees to get tests, such as those for cholesterol and blood sugar, as well as to fill out health-risk assessments
Out of the $2.5 trillion US health care costs, how much is for prescription drugs?
10% ($250 billion)
Out of the $2.5 trillion US health care costs, how much is for hospitals
1/3 ($800 billion)
Out of the $2.5 trillion US health care costs, how much is for physician services?
1/4 ($600 billion)
Out of the $2.5 trillion US health care costs, how much is essentially wasted?
1/3 ($800 billion)
Primary drug THERAPY recommendation considerations
Primary drug (Singular) recommendation considerations
Board of Pharmaceutical Specialties
-Provides specialty certification
-Recognizes set (objective, independent) standards for specific clinical specialties
-Provides certification for specific clinical specialties
Board of Pharmaceutical Specialties has certification for:
-Ambulatory, Nuclear Pharmacy, Nutrition Support Pharmacy, Oncology Pharmacy, Pharmacotherapy (hardest one to get), Psychiatric
-Certified Diabetic Educator, Certified Pain Educator, Geriatric Pharmacist, Consultant Pharmacist
Board of Pharmaceutical Specialties has Upcoming certification for:
Critical Care, Pediatrics, Cardiology, Infectious Diseases
Board of Pharmaceutical Specialties has programs for:
o Anticoagulation, HIV, ID, Pharmacokinetics, Lipid Management
Do small business need to sign up for Obama's Affordable Care Act (PPACA)?
What is Medicare's involvement in the Affordable Care Act
-A buy-in option is permitted for those under 65
-Payments to physicians will lower
Does the Affordable Care Act guarentee choice of doctors and health plans?
What is Medicaid's involvement in the Affordable Care Act
Expansion (though payments to physicians will lower)
Of the Affordable Care Act, what are reasons for Public insurance option/exchanges?
-Move towards universal coverage
Does the government supply its own healthcare directly, according to the Affordable Care Act?
Yes, though as an option of last resort
Does the government invest in IT, according to the Affordable Care Act?
Yes, for electronic records, system interoperability, and computerized physician order entries
Does the government invest in R&D, according to the Affordable Care Act?
Yes, for developing a mechanism for comparative effectiveness research for new techniques, procedures, and medicines
Insurance reforms and regulations by the Affordable Care Act
a. Ban on preexisting conditions (medical underwriting)
b. Eliminating premium markups based on health status
c. Minimizing premium variation based on age
d. Capping admin overhead and profits
e. Standardizing coverage
The most common chronic diseases cost how much?
More than $1 trillion annually
Obesity increases healthcare costs--
Obesity increases prescription costs--
Smoking results in an estimated ___ increases in medications
Up to how much of US health care expenditures goes towards administrative costs?
Reasons for high costs of health care
- Malpractice lawsuits
- Up to a third of US health care expenditures goes towards administrative costs
- Duplication of services
- Insurers would rather pay to treat a disease than prevent one
- Doctors are paid for how much they do for you―not for how well he or she cares for you (fee for service)
- Health manpower in short supply in some areas
Cost of non-compliance ($)
Cost of non-compliance (lives)
At least ____ of prescriptions filled each year are not taken correctly
Are reminders effective for compliance?
Unintentional pregnancies in the US cost--
o Walgreens' data shows ____ of all prescription claims are not adjudicated on the first attempt. That is, they don't go through successfully.
Is mail order becoming more popular?
`How many people will be given health care and access to insured prescription meds by the Affordable Care Act?
Is health care reform really legal reform?
No, it's insurance reform
Recent changes in general pharmacy practice
o Today's pharmacists access, monitor, initiate , and modify medication use for safe and effective drug therapy regimens
DHHS recognizes pharmacists' role in 4 areas:
o Vaccine education and mobilization
o Vaccine distribution
o Vaccine access and administration
o Vaccine registries and tracking systems
Up to ___ of Americans do not have or use a primary care physician
MTM services by the pharmacist:
Adherence (Enhance patient understanding)
Safety and efficacy (Detect adverse events and gaps in therapy)
Comprehensive Reviews (CMR)
Who gets MTM services?
- Mandated for Medicare Part D patients, but expanding to other payers: State Medicaid, Commercial
Uses of compounding
o Allergic reactions to dyes, preservatives, or binders in commercial products
o Tailored dosage strength
o Potential for increased compliance
o Topical pain management
o Bioidentical hormone replacement therapy
- W/ prescriber approval, replacing originally prescribed medication for a single patient w/ a therapeutically equivalent drug at lower cost
- Patient would be expected to achieve similar or improved outcomes w/ replacement drug
Therapeutic interchange has been used in:
-Pharmacy Benefit Managers
General and Community hospitals
Latter is often smaller and usually more personalized
Fastest-rising segment of the nation's health care bill
Daily room charges exceed ____ in some NJ hospitals
Preventable errors no longer covered by Medicare
- UTIs from catheters
- Injuries from falls, bed sores, or pressure ulcers
- Objects left in patient during surgery
- Blood stream infections from using catheters
- Giving a dangerously wrong blood type
- Mediastinitis following heart surgery
- Air embolism
What to Hospital Pharmacies need to operate?
Institutional Pharmacy Permit
- Centralized model
o Typical hospital pharmacy; one that handles all of the pharmacy-related activities of the hospital
o Can have robotic system sending drugs to various parts of the hospital
- Decentralized model
o Satellite pharmacy is an example of one
o Administration offices, bulk IV prep, bulk unit dose, oncology pharmacy, surgery pharmacy, etc, can be available
o Pharm D's can spend more time on rounds, working w/ medical doctors
Hospital pharmacist staffing
- Director of Pharmacy
- Assistant Director of Pharmacy
- Clinical Coordinator
- Clinical pharmacist
- Staff pharmacist
- Chemotherapy pharmacist
- Parenteral nutrition pharmacist
- Drug Info pharmacist
Hospital pharmacy technician
- Performs many pharmacy-related functions
- Assists in preparing IV products
- Manages robotics systems, bar-coding prep
- Makes deliveries to patient care areas
- Stocks and orders medication inventory
- Maintains ADCs (Automated Dispensing Cabinets)
o The pharmacy at the hospital should have 24-hour service according to the--
MD-Owned health care
Has been decreasing since 2002, becoming overtaken by Hospital
Are consultant pharmacists usually accountable for the advice that they deliver?
What laws does NJ have pertaining to consultant pharmacy?
A consultant pharmacist must not be the same person who is selling the medication (Provider)
A consultant pharmacist can be responsible for the following unexpected tasks:
Distribution, storage (eg is packaging/labeling appropriate?), administration (Medication Pass), documentation
-Assure medication is administered accurately (right meds, right patient) and within proper time frames to resident (within 1 hr of the prescribed time)
-Follow MD order, facility policy, or common sense
Drug Regimen Review
-"DRR" = MRR = MTM
-Pharmacist's comments must be acknowledged, not necessarily accepted
Emergency Kit storage
-Readily accessible, secured but not locked
-Accountibilty to the Medical Director
New Jersey Department of Health and Senior Services
-State agency responsible for regulating LTC facilities under OBRA/CMS
-Regulates health care facilities for licensor under state regulations
Advisory consultant pharmacist certification is given by:
The Joint Board of Certification of Consultant Pharmacists
Definition of a Healthcare System
All organizations, institutions and resources devoted to producing actions whose primary intent is to improve health.
-Always affiliated with a medical school, which means patients have access to highly skilled specialists who teach at the school and are familiar with up-to-the-minute technology.
-The sophisticated equipment and specialized treatment at teaching hospitals can be very expensive, and it is not cost-effective to pay for such services unless you can benefit from them.
Levels of healthcare: Primary
Family doctor or outpatient clinic
Levels of healthcare:Secondary
Routine testing and services
Levels of healthcare: Tertiary
Most specialized; acute medical care
How often does the Pharmacy and Therapeutics Committee (P&T) meet?
Pharmacy and Therapeutics Committee tasks
-Primary, formal communication link between the pharmacy and medical staff pertaining to all matters pertaining to the use of medications within the institution and which need committee review.
-Eg reviews formulary data
Relatively comprehensive list of drugs and usually contains few if any restrictions on providers, does very little to meet the goals to control utilization and expenses. Physicians can essentially order anything they want and get it
Limited list of drugs chosen by the P&T committee, typically contains 300 to 1,000 drug dosage forms. Only medications on this closed list will be dispensed by the pharmacy. This list generally offers several choices in each therapeutic category
Institutional Review Board (IRB)
-=Independent ethics committee (IEC) or ethical review board (ERB)
-Approves, monitors, and reviews biomedical and behavioral research involving humans with the aim to protect the rights and welfare of the research subjects
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