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203 Cards in this Set

  • Front
  • Back
Which aspect of patient-centered care allows the patient to make decisions regarding their treatment plans?
Autonomy
What does PC stand for?
Prescription cost
What does PMPM stand for?
Per member per month
In 1900, the leading causes of death in comparison with today were attributed to:
More infectious diseases and less chronic diseases
Professor Angaran spoke about how well the system was doing in terms of HTN treatment. The trends in awareness, treatment and control of high blood pressure suggests that?
a. Over the last several decades, less than half of the people with HTN were successfully treated.*
b. There has been a steady increase in the percentage of people who are aware of their blood pressure*
c. In the last survey (1999-2000), about half of the people with HTN were successfully treated.*
d. The survey demonstrates the need for more effective HTN medications to be developed.*
The “state of complete physical, mental, and social well-being and not merely the absence of disease or infirmity” refers to the:
Definition of health by the World Health Organization*
Direct-to-Consumer advertising on television is regulated by?
FDA
As a pharmacist, using the “teach back” technique when counseling on a new medication requires what?
Requires having the patient summarize/demonstrate what they understand about the medication that you presented to them
True or False:
Health-related quality of life is now one of the outcomes measured in the drug approval process?
True
True or False:
In implementing the goals of pharmaceutical care, the American Council on Pharmaceutical Education (ACPE) mandated the doctor of pharmacy, a six-year degree program as the entry level requirement.
True
List the 3 qualities of patient-centered care.
a. Providers respect patient values
b. Care is coordinated across different providers
c. Patients are involved in the decision making process when planning treatment
SHINE is a community resource available to MAC that was mentioned in the discussion. SHINE, would provide Mac with what type of support?
Free instruction and help with Medicare Part D
When providers over-treat or over-prescribe because health care costs are covered is an example of _______.
Moral hazard
On the Supply-Demand Curves, the equilibrium point refers to:
When demand equals supply
At the price point P quantity supplied is to the right of quantity demanded. This means there is what?
Surplus
If at price P there is a shift in demand to the right, then what is the impact on quantity demanded?
There is an increase demanded
True or False:
Economics is defined as “the study of how individuals and societies allocate their limited resources in attempts to satisfy their unlimited wants.”
True
Mac was newly diagnosed with what disease state in Case 2?
Type II diabetes
True or False:
By decreasing patients’ out-of-pocket expenses, health insurance has encouraged patients to consume more health services than they would if they were bearing the full cost of the product and service.
True
What are the characteristics of risk in health insurance?
Can be attributed to a certain event
Likelihood cannot be determined at the individual level
Generally measurable
Generally quatifiable
Payment of health care expenses until a specified amount has been paid out-of-pocket over a period of time.
Deductible
Group policies are _________ than individual insurance.
Less expensive than individual insurance
What federal legislation mandated that pharmacy offer counseling to Medicare patients?
Omnibus Budget Reconciliation Act
What services are covered by Medicare Part A? (3)
Home health care
Skilled nursing facility services
Hospice
Which type of managed care organization employs everyone who delivers health care to the plan's patients?
Staff Model HMO
True or False:
Medicaid coverage varies from state to state.
True
The FDA approves what 3 things?
Food, drugs, and cosmetics
What are the advantages of three- tiered presciption benefits? (3)
Generic dispensing rates increase
Consumer incentive to choose cost- effective drugs
Allows access to open formulary that allows "choice"
When looking at the poorest US citizens, the majority of their health related services is funded by?
Medicaid
Based on the World Health Report 2000 of health measures, the country(ies) ranking lower than the United States is:
a. Germany
b. Singapore
c. Canada
d. Japan
None of these :/
Which Medicare service is largely financed through payroll tax deductions?
Part A
Stores like Wal-Mart and Target are classified as mass merchandisers because?
Their primary business is not pharmacy
After graduation you open up your own independent pharmacy – Gator RX Cares. Five years later you are preparing to open your fourth Gator RX Cares. How would you classify your collection of Gator RX Cares stores?
Pharmacy Chain
The vast majority of prescription drug products that are used in the US flow through?
Outpatient settings
True or False:
The drug consumer’s mindset (beliefs) and the prescriber’s mindset about prescription drug use are usually the same.
False
The US Government affords the first manufacturer to bring to market a generic version of a medication some market exclusivity. What is the major benefit of this exclusivity?
6 months exclusive rights to be the only distributor on the market
Channels of legal distribution of prescription drugs include: (2)
Drug wholesaling and direct from manufacturer
A medication that is classified as a blockbuster product must have annual sales of?
$1 billion
McKesson, Cardinal Health and Amerisource Bergen account for the majority of drug product sales in the United States. These three organizations would be classified as?
Primary wholesalers
The process of relabeling or redefining a personal or social problem as a medical condition is called:
Medicalization
On average, what item has the greatest cost for dispensing a prescription drug in a community pharmacy?
The drug product
True or False:
There are cases where a patient must be injured to obtain a desired therapeutic outcome and so this would not be classified as a drug related morbidity?
True
Which program was designed to provide services that will optimize therapeutic outcomes for targeted beneficiaries?
MTM
A patient with a UTI that is currently on an antibiotic for treatment is still symptomatic after 3 days of continuous treatment. This can be classified as a?
Drug therapy problem
True or False:
Drug manufactures can be classified as either a price maker or a price taker
True
Any circumstance during therapy that a competent professional would see as inconsistent with the objective of therapy is called?
Drug therapy problem
According to Dr. Hepler the take home message about drug related admissions/drug related morbidity is that according to research what percent are considered preventable?
50% ?
A person’s experience of not being well
Illness
An inference based on interpretation of subjective and objective data, usually from an ill person
Disease
Inability to meet obligations or engage in desired “normal” activities
Sickness
Which highly directed, highly individualized, post graduate program is designed to prepare the participant to become an independent researcher?
Fellowship
True or False:
Restrictions to access to drugs and of reimbursement tend to be stricter in a closed formulary system.
True
How do PBMs responded to the increasing pharmacy benefits costs? (4)
Contract pricing
Benefit design
Drug selection
Utilization Management
Rebates from drug manufacturers are usually based on a PBM’s ability to?
Acheive market share targets for specific medications
True or False:
PBMs are a behind the scenes entity and they never have any direct contact with patients. They only deal with pharmacies and HMOs directly.
False
True or False:
Not only do the majority of employers offer access to mail order pharmacies but there are some that require certain medications to be dispensed by a mail order service.
True
True or False:
Literature suggests that one of the best ways to improve patient care and reduce overall health care costs is to implement formularies to help health care providers determine what medications to prescribe.
False
True or False:
The most popular type of contractual relationship between PBMs and HMOs are capitation contracts.
False
True or False:
Restrictions to access to drugs and of reimbursement tend to be stricter in a closed formulary system.
True
Dr Segal talked about the players involved in the payment of prescriptions in the US and noted that in fact one new player was missing from his slide in his PBM I lecture. Who is the new player now involved in paying for prescription medications that he had not included in his slide?
Medicare
JCAHO found that for most sentinel events the root cause could be attributed to?
Communication
2. According to Dr. Winterstein, the following are true in regards to drug safety:
1. Before the thalidomide disaster, drug companies did not have to prove drug efficacy
2. Shands was one of the first institutions to implement a drug monitoring program
3. Drug companies always had to prove safety of their medications just not efficacy
Choices 1 and 2
True or False:
Drug safety addresses the drug causing harm. We assume that drugs are safe when they are approved but they have side effects.
True
True or False:
Drug safety and patient safety are equivalent, it is near impossible to differentiate between the two.
False
True or False:
Patient’s safety has to do with medical error, patients may be exposed to harm because providers make errors such as using the drug in an inappropriate fashion
True
True or False:
In Florida if a health care professional apologizes for any type of mistake that apology can be used as proof of liability in the committing the error.
False
True or False:
Preclinical toxicity testing of medications introduced in the 1938 Food Drug and Cosmetic Act referred to testing of medication toxicity on animals before testing on humans.
True
There are _____ drug plans in Florida and _____ MA-PD in Alachua.
54
15
True or False:
Medicare part D is a government run program that offers a single universal program for all its members: one program fits all
False
True or False:
Medicare part D is a government program that contracts with private insurance carriers to offer it’s consumers choice and competition
True
True or False:
When an eligible member turns 65, they are automatically enrolled in Medicare Part D
False
True or False:
8. Flynn and Barker showed that when looking at Automation in community pharmacies the effects on errors in the pharmacy was always reduced no matter the setting.
False
True or False:
There are several advantages to being a community pharmacist one being the strong interpersonal relationships that you build with your patients
True
True or False:
Some pharmacists are skeptical about the impact pharmacists can make upon a patient’s outcome
True
True or False:
Pharmacists can be replaced by dispensing machines
True
10. When a patient with Medicare Part D hits the “Donut Hole” in their coverage, how much will they be paying for medications out of pocket?
100%
What is the name of the companies that administer drug benefit programs for employers and health insurance carriers?
Pharmacy Benifit Managers
PBM
How many major PBMs are there?
Roughly 60
About how many pharmacies in an area are networked with PBMs?
90%
A PBMs primary business used to be?
Rx drug claims processing
Todays PBMs business include?
Comprehensive clincal Rx management, diversification of business
What is determined in a benefit design?
Which drugs to cover, the member's cost sharing requirements, and pharmacy network access
What is defined as a "set of attitudes and behaviors believed to be appropriate to a particular occupation"?
Professionalism
Demonstrating concerns for the welfare of others, using skills and knowledge to improve qualities of life, and sharing oppurtunities for recognition with others is known as what trait of professionalism?
Service oriented/ Altruism
Dedication, upholding competent delivery of health care services, addressing lack of knowledge or skill in self or others is known as what trait of professionalism?
Pride of professionalism
Non judgemental, empathetic and responsiveness to the needs of the patient and their family, and maintaining appropriate boundaries refers to what trait of professionalism?
Covenantal Relationship with Patient
Contributing to quality improvements and developing of new knowledges and practices that advance pharmaceutical care are categorized under what professionalism trait?
Creativity and innovation
What trait of professionalism includes confronting individuals who demonstrate unprofessional behavior?
Accountability
Demonstrating an awareness of professional norms, laws, and behavior and prioritizing responsibilities properly falls under what trait of professionalism?
Ethically Sound Decision Making
Contributing, being proactive, embracing, and promote the culture of professionalism is known as what triat of professionalism?
Leadership
"As a student of pharmacy, I believe there is a need to build and reinforce a professional identity founded on integrity, ethical behavior, and honor. This development, a vital process in my education, will help to ensure than I am true to the professional relationship I establish between myself and society as I become a member of the pharmacy community. Integrity will be an essential part of my everyday life and I will pursue all academic and professional endevors with honesty and commitment to service" is known as what?
Pledge of professionalism
The pledge of professionalism was adapted by whom?
University of Illinois COP pledge of professionalism in 1993
When was the pledge of professionalism developed and adopted by the student APSA?
1994
50% of the PBM market belongs to what 3 companies?
Medco, CVS, Express scripts
How do PBMs increase savings in the dispensing process to increase reviews?
Opening their own mail-order pharmacies
Clients are charged with what for claims processing and basic services?
Administrative fees
What is the most common contract between PBMs and their clients?
Fee for Service
What contractual arrangement between the PBM and client is when the client assumes all risk for the cost of the drug dispensed?
Fee for Service
When the PBM and client agree on a target PMPM and the PMPM>target costs and the PBM shares the overrun and refund or shares the saving is known as what contractual arrangement?
Risk sharing
When the PBM agrees to provide all PC for fixed PMPM, the PBM and client are using what contractual arrangement?
Capitation Contract
What are some problems with PBMs?
HMO may refuse payment for drug not on formulary, lack of consistency, may have ownership ties with pharmaceutical companies, and safeguarding Rx info
The merging of Merck buying Medco was known as what?
Vertical integration
Offering customers a choice between open and closed formularies to prevent favored drug company drug status and creating a firewall were referred to as what by the FTC?
Anti competetive effects of the merger
How does the PBM manage utilization controls on patient behavior?
co payments, tiered programs, drug caps, education
By instilling prior authorization, formularies, therapeutic interchanges, DUR, provider profiling and penalties for prescribing, the PBM is controlling what?
Physician behavior
True or False:
Rebate revenues should be transparent, or known by others.
True
What are the 2 elements of pharmacy reimbursement?
Average wholesaler price (AMP) for the drug ingredients and dispensing fee for the pharmacists services
What company is technology based formed by Advance PCS, Express scripts, and Medco?
RxHub
What are the benefits of RxHub?
Links all health care professionals and PBMs
Develope a standard electronic Rx process
Will work with industry standard setting organizations
An employer requiring maintainance meds to be dispensed by a mail- service pharmacy is known as?
Mandatory mail
Why are physicians reluctant to implement E- prescribing?
Its costly and lacks reimbursement
Why do employers establish drug plans?
To share some portion on drug cost with members
What are drug costs in a drug plan usually based off of?
Amount for each tier or drug category
True or False:
75% of tiered drug plan designs contain three or more tiers
True
True or False:
25% of tiered drug plan designs contain three or more tiers
False
Why is the price of mail order so much greater than retail pharmacies?
Mail is dispensing a 3 month supply oppose to a 1 month in retail
What is a copay?
A form of patient cost sharing that requires patients to pay a specified dollar amount every time a service is received
What is coinsurance?
A form of patient cost sharing that requires patients to pay a specified percentage (usually 20%) of the cost of covered services; the plan pays the remainder.
Sharing the cost of Rx with patients to reduce cost of products to health plan, using financial incentives to use the MCO preferred drugs and reducing the number of Rx dispensed are all drivers for what?
Cost sharing
In a study done by Express scripts, it was found that the group with the 3-tiered copayment experience _________ Rx use and reduced net cost with NO _________ in the use of their medical benefits
Lower, increase
If a copay is "benefit based" for any give drug, the patient would most likely benefit from having?
A lower copay
Based off what system would providing financial incentives to members to prioritize out of pocket drug expenditures based on the value of their medication, not the price?
A "benefit based" system
Medicaid uses this stragedy that only allows a certain # of Rx per month with a certain # brand Rx limit.
Drug caps
True or False:
Florida Medicaid has a 4 Rx limit on brand drugs no matter what condition the drug is for.
False
Generating data on MD prescribing and comparing MDs to expected prescribing patterns for select drug categories is known as?
Provider profiling
What is the monitoring for patient specific drug problems through concurrent or retrospective review?
DUR- drug utilization review
A list of drugs classified by therapeutic category or drug class that are considered preferred for a given MCO population is known as?
Formulary Management
What kind of formulary means that the medications that are not listed are still a covered benefit?
Open formularies
50% of formularies in 2003
What formulary only allows specific drugs in each therapeutic class to be covered while others no listed are not covered and the patient must pay?
Closed formulary
Virtually nonexistent now
30% in 2003
What formulary requires members to pay more for expensive drugs instead of limiting access to therapies?
Tiered formularies
90% of formularies today
Dispensing of a drug product that contains all the same active ingredients and is chemically identical in strength, concentration, dosage form and route of administration to the product prescribed is known as?
Generic Substitution
What is known as the interchanging of therapeutically equilvalent but chemically unique drugs in accordance with established policies and procedures within a healthcare systems evidence based formulary.
Therapeutic Substitution or Interchange
How does employing a proactive message in a community pharmacy encourage voluntary compliance?
This message alerts the pharmacist to contact the prescriber and attempt to the drug to a preferred agent
What is the approach to patient care that coordinates resources across the entire healthcare delivery system and throughout the lifecycle of the disease?
Disease Management
An ideal DSM program systematically develops statements to assist practioners and patient decisions about health care for specific clincal circumstances such as?
Reducing unnecessary variationd in medical practices
Reducing inappropriate care (over and under use)
Eliminating or reducing unneccesary health care costs
Facilitating care based on scientific knowledge and new technology
Improving quality and outcome of care
What are collaborative guides that identify, time, and provide a sequence for the major invention of health care that is provided for a patient group based on a DS or procedure?
Clinical Pathway
This can be helpful in ensuring proper treatment of patients with diseases that put a high cost burden on the medical benefit.
Health/ Care Management
True or False:
Pharmaceutical care is Medication therapy management.
True
By creating a documentation system that logically leads one through the process of delivering care, what becomes easier?
Implementing MTM
True or False:
The physician cooperation, pharmacists compentency, patients interest in the services and adherance to recommendations are current hurdles present in the develop of DSM.
True
What is the difference between drug safety and patient safety?
Patient safety results in consequences
The 1938 Food Drug and cosmetic act was passed requiring what after the sulfanilimide elixer disaster?
Preclinical toxicity testing
The Kefauver- Harris Amendments were passed in 1961 in response to what disaster in the UK?
Thalidomide
Preclincial studies, premarketing clinical studies, spontaneous reporting, and postmarketing studies experimental and observational are involved in?
The National Drug Safety Mechanism
Long term effects, low frequency effects, relative effectiveness and safety in customary practice, and efficacy are all inquiries regarding?
Post- Market studies
What drug was not caught by the system in post marketing studies?
Vioxx
With what act was the FDA required to monitor the progress of the post marketing mandatory phase 4 study?
Modernization Act of 1997
What is the application of epidemiologic reasoning, methods, and knowledge to they study of the uses and effects of drugs in human population?
Pharmacoepidermiology
In the Dana Farber Incident, what medication error occured?
Massive overdose resulting in cardiotoxicity
A medical error that is considered slips and lapses includes what kind of effects?
Overdoses, wrong amputated leg
What medical error is not following clinical guidelines or best practices?
Suboptimal care
When a medical error results from indirect medical intervention such as no therapy or underdosing, it is known as what type of error?
Errors of omission
What is a directly related medical intervention such as an overdose or contradiction therapies?
Errors of commission
Clinically manifested errors are known as what type of events?
Preventable adverse drug events
True or False:
Patients with general and family practice physicians as primacy care providers had lower medical error rates.
True
What is FL's rank in heath care in comparison to the rest of the states?
41st
True or False:
In 1965, you had to opt out of medicare.
True
What act is behind Medicare part D?
Medicare prescription drug, improvement, and modernization act of 2003
True or False:
Medicare D eligible are charged a 1%/month penalty for every month they dont opt in for Medicare part D.
True
The amount reached before the patient reaches the 25% of cost mark is known as?
Deductibile, 100% till reached
The last 5% of cost after the donut hole is known as what phase?
Catestrophic phase
How many Precription drug plans (PDP) are in Florida?
54
PDP's cover what?
Only drugs
How many MA-PD are there in Alachua county?
15
MA-PD (Medical advantage- part D) covers?
Medical care and drugs
True or False:
An individual can sign up for PDP's anytime of the year whenever they want.
False, Annual enrollment period (Nov-Dec end)
True or False:
If you dont sign up for a PDP as soon as you qualify, you are penalized when you do eventually sign up.
False
What are the majority of ways seniors pay for their drugs? (3)
Stand alone PDP's, Dual eligible PDP's, and MA-PD
What does TrOOP stand for?
True out of pocket costs
What refers to how much of a drug you can recieve at one time?
Quantity limits
The concept of oldest cheapest before newest expensive relates to what?
Step care
Prior Authorization means?
Drug must meet certain criteria before prescribing
When choosing a coverage, what should you look for if youre drug is covered? (3)
Drug cost via copay or coinsurance, the tier, and the category
Does the cheapest premium always guarantee the cheapest overall cost?
No
Is it safe to assume last years plan will be the best plan next year?
No
What kind of factors change in drug plans each year? (4)
Premiums, formularies, drug cost from insurance plans bargaining with manufacturers, annual costs
The "degree to which health services for individuals and populations increase the likelihood of desired health outcomes and professional knowledge" is known as?
Quality medical care
What are the 4 key features of quality?
High quality decision making
High quality performance
Evidence based medicine
Patient's preference
What does JCAHO stand for?
Joint Commission on Accreditation of Healthcare Organizations
What does AHRQ stand for?
Agency for Healthcare Research and Quality
What does URAC stand for?
Utilization Review Accreditation Commission
True or False:
Structure, Process, and Outcomes are all aspects of measuring quality.
True
Recognization, foreseeable, identifiable, and controllable are all aspects used in?
Indicator developement
In the indicator development process, what does the literature review consist of?
A list of 50 clinical scenarios
In indicator development processing, who is present in the Delphi panel?
6 physicians and one clinical pharmacist
Total of 7 members
This indicator development process determines whether measurements of a risk factor is possible in the study database.
Operationalization
Logistic regression to determine statistical significance refers to?
Criterion validation
Humana developing a Pay for Performance (PFP) program and pharmacists recieving incentives for increasing generic dispension rates (GDR) are examples of what?
Pharmacy process performance indicators
CQI stands for?
Continuous quality improvement
The percent of time a pharmacist dispenses a generic drug when a generic available is known as?
Generic dispensing
What is the equation for generic efficiency?
# generic Rx dispensed/
# generic Rx available
What are the advantages to the pharmacist with implementing the generic dispensing measure?
Pharmacist not put in the position of requesting therapeutic interchange and it avoids potential conflict with various states and federal laws governing generic subs
What is the application of DAW codes and DUE alerts to report oppurtunities for intervention and actual interventions employed by pharmacists when presented with Rxs for brand drugs when generic alternatives are available known as?
Generic intervention oppurtunity
What is the equation for intervention oppurtunity index?
# successful pharmacist interventions/ # of opportunity for interventions
What do the 0-5 DAW codes stand for?
0- None
1- Physician
2- Patient
3- Pharmacist
4- Out of stock
5- Brand as generic
What does each DUE alert code stand for?
NA, NC, NF, PS, PP, PR, SE
NA- Drug not available
NC- Non covered drug
NF- Non formulayr
PS- Product selection opp
PP- Plan protocol
PR- Prior adverse reaction
SE- Side effects
The time lapse between first market entry of generic alternative product and first use of generic alternative refers to?
The speed to uptake of new generic oppurtunities
The percentage of patients recieving an oral hypoglycemic agent at higher than recommended daily doses is known as?
Medication overuse in dosing
The classification of all medicines in the categories of: sulfonylureas, meglitinides, biguanides, thiazolidinediones, etc.
Oral hypoglycemic agents
Percentage of patients who were dispensed two or more medications in the same therapeutic class is known as?
Medication overuse: duplication of therapy
What class is the categorization of medications described by the mechanism of action in the FDA approved label?
Therapeutic class
What is defined as the percentage of patients dispensed medications for diabetes and hypertension who are not recieving an ACEI or ARB?
Suboptimal treatment regimen
True or False:
Pharmacies that do not reach GDR targeted levels in Humana's PFP will be penalized.
False