Iphc Final Exam Review

Front 1

As a pharmacist, using the “teach back” technique when counseling on a new medication requires what?

Back 1

Requires having the patient summarize/demonstrate what they understand about the medication that you presented to them

Front 2

Qualities of patient-centered care include

Back 2

1. Providers respect patient values
2. Care is coordinated across different providers
3. Patients are involved in the decision making process when planning treatment

Front 3

T/F Health-related quality of life is now one of the outcomes measured in the drug approval process?

Back 3

True

Front 4

In 1900, the leading causes of death in comparison with today were attributed to:

Back 4

More infectious diseases and less chronic diseases

Front 5

T/F . 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.

Back 5

True

Front 6

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?

Back 6

1. In the last survey (1999-2000), about half of the people with HTN were successfully treated.
2. There has been a steady increase in the percentage of people who are aware of their blood pressure
3. Over the last several decades, less than half of the people with HTN were successfully treated.
4. The survey demonstrates the need for more effective HTN medications to be developed.

Front 7

SHINE is a community resource available to MAC that was mentioned in the discussion. SHINE, would provide Mac with what type of support?

Back 7

Free instruction and help with Medicare Part D

Front 8

Which aspect of patient-centered care allows the patient to make decisions regarding their treatment plans?

Back 8

Autonomy

Front 9

Which aspect of patient-centered care requires that you help individuals maintain self-respect and feel valued as a person?

Back 9

Dignity

Front 10

Direct-to-Consumer advertising on television is regulated by

Back 10

The Food and Drug Administration

Front 11

The “state of complete physical, mental, and social well-being and not merely the absence of disease or infirmity” refers to the:

Back 11

Definition of health by the World Health Organization

Front 12

When providers over-treat or over-prescribe because health care costs are covered is an example of _______.

Back 12

moral hazard

Front 13

Group policies are:

Back 13

Less expensive than individual insurance

Front 14

Payment of health care expenses until a specified amount has been paid out-of-pocket over a period of time.

Back 14

Deductible

Front 15

T/F 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

Back 15

True

Front 16

If at price P there is a shift in demand to the right, then what is the impact on quantity demanded?

Back 16

There is an increase demanded

Front 17

What is a characteristic of risk in health insurance ?

Back 17

Generally measurable
Generally quantifiable

Front 18

At the price point P quantity supplied is to the right of quantity demanded. This means there is what?

Back 18

Surplus

Front 19

T/F Economics is defined as “the study of how individuals and societies allocate their limited resources in attempts to satisfy their unlimited wants.”

Back 19

True

Front 20

Mac was newly diagnosed with what disease state in Case 2?

Back 20

Type II diabetes

Front 21

On the Supply-Demand Curves, the equilibrium point refers to

Back 21

When demand equals supply

Front 22

What federal legislation mandated that pharmacy offer counseling to Medicare patients?

Back 22

Omnibus Budget Reconciliation Act

Front 23

What does Medicare Part A cover ?

Back 23

1. Home health care
2. Skilled nursing facility services
3. Hospice

Front 24

Which type of managed care organization employs everyone who delivers health care to the plan's patients?

Back 24

Staff Model HMO

Front 25

T/F Medicaid coverage varies from state to state?

Back 25

True

Front 26

FDA responsibilities include(s):

Back 26

1. Drugs
2. Food
3. Cosmetics

Front 27

Advantages of three-tier prescription benefits include(s):

Back 27

1.Generic dispensing rate increases
2.Consumer incentive to choose cost-effective drugs
3.Allows access to an open formulary that allows “choice”

Front 28

When looking at the poorest US citizens, the majority of their health related services is funded by?

Back 28

Medicaid

Front 29

Based on the World Health Report 2000 of health measures, the country(ies) ranking lower than the United States is:

Back 29

All the countries listed ranked higher than the United States:
Germany
Singapore
Canada
Japan

Front 30

Which Medicare service is largely financed through payroll tax deductions?

Back 30

Part A

Front 31

Stores like Wal-Mart and Target are classified as mass merchandisers because?

Back 31

Their primary business is not pharmacy

Front 32

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?

Back 32

Pharmacy chain

Front 33

The vast majority of prescription drug products that are used in the US flow through?

Back 33

Outpatient Settings

Front 34

T/F The drug consumer’s mindset (beliefs) and the prescriber’s mindset about prescription drug use are usually the same

Back 34

False

Front 35

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?

Back 35

6 months exclusive rights to be the only distributor on the market

Front 36

Channels of legal distribution of prescription drugs include(s):

Back 36

1. Drug wholesaling
2. Direct from the manufacturer

Front 37

A medication that is classified as a blockbuster product must have annual sales of?

Back 37

$1 billion

Front 38

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?

Back 38

Primary wholesalers

Front 39

The process of relabeling or redefining a personal or social problem as a medical condition is called:

Back 39

medicalization

Front 40

T/F 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?

Back 40

True

Front 41

On average, what item has the greatest cost for dispensing a prescription drug in a community pharmacy?

Back 41

The drug product

Front 42

Which program was designed to provide services that will optimize therapeutic outcomes for targeted beneficiaries?

Back 42

MTM: Medication Therapy Management

Front 43

What does DRM stand for?

Back 43

Drug Related Morbidity

Front 44

What does DRA stand for?

Back 44

Drug Related Admission (to hospital)

Front 45

What does PDRA stand for?

Back 45

Preventable Drug Related Admission

Front 46

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?

Back 46

Drug Therapy Problem

Front 47

T/F Drug manufacturers can be classified as either a price maker or a price taker

Back 47

True

Front 48

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?

Back 48

50%

Front 49

Any circumstance during therapy that a competent professional would see as inconsistent with the objective of therapy is called?

Back 49

Drug therapy problem

Front 50

A person’s experience of not being well

Back 50

Illness

Front 51

An inference based on interpretation of subjective and objective data, usually from an ill person.

Back 51

Disease

Front 52

Inability to meet obligations or engage in desired “normal” activities

Back 52

Sickness

Front 53

T/F PBMs are a behind the scenes entity and they never have any direct contact with patients. They only deal with pharmacies and HMOs directly

Back 53

False

Front 54

T/F 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.

Back 54

False

Front 55

Gatorbait HMO has recently signed a contract with a new PBM, Medical Haven. The contract states that for all patients, Medical Haven will work to keep medication spending to only a 5% increase in spending over last year. Anything above the 5% increase will be paid for by Medical Haven and not by Gatorbait. This type of contractual relationship is called?

Back 55

Risk Sharing

Front 56

Rebates from drug manufactures are generally based on a PBM’s ability to?

Back 56

achieve market share targets for specific medications

Front 57

T/F 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.

Back 57

True

Front 58

T/F The most popular type of contractual relationship between PBMs and HMOs are capitation contracts?

Back 58

False- Fee-For-Service contracts are the most common contracts between PBMs and their clients.

Front 59

How have PBMs responded to the increasing pharmacy benefit costs :

Back 59

1.Contract pricing
2.Benefit design
3.Drug selection
4.Utilization management

Front 60

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?

Back 60

Medicare

Front 61

T/F Restrictions to access to drugs and of reimbursement tend to be stricter in a closed formulary system.

Back 61

True

Front 62

PBMs make money from all these sources

Back 62

1.Rebates from manufacturers
2.Fees for prescriptions claims processing
3.Sale of data containing patient prescription use

Front 63

JCAHO found that for most sentinel events the root cause could be attributed to?

Back 63

communication

Front 64

According to Dr. Winterstein, the following are true in regards to drug safety:

Back 64

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

Front 65

T/F Drug safety addresses the drug causing harm. We assume that drugs are safe when they are approved but they have side effects.

Back 65

True

Front 66

T/F 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

Back 66

True

Front 67

T/F 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?

Back 67

False

Front 68

T/F 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?

Back 68

True

Front 69

T/F There are 54 drug plans in Florida
There are 15 MA-PD plans in Alachua

Back 69

True

Front 70

It is a government program that contracts with private insurance carriers to offer it’s consumers choice and competition

Back 70

Medicare Part D

Front 71

T/F 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?

Back 71

False

Front 72

T/F There are several advantages to being a community pharmacist one being the strong interpersonal relationships that you build with your patients

Back 72

True

Front 73

T/F Some pharmacists are skeptical about the impact pharmacists can make upon a patient’s outcome

Back 73

True

Front 74

T/F Pharmacists can be replaced by dispensing machines

Back 74

True

Front 75

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?

Back 75

100%

Front 76

A law enacted by Congress that limits the amount of time a preexisting condition may be excluded from coverage to one year, requires insurance companies to sell health insurance policies to small employers and individuals who lose coverage without regard to their health history, requires insurance companies to renew policies they sell to groups and individuals, and outlines standards for patient confidentiality.

Back 76

Health Insurance Portability and Accountability Act of 1996 (HIPAA)

Front 77

A Clinton administration proposal that would have imposed and employer mandate and established manged competitions in which health providers would compete for patients based on cost and value.

Back 77

Health Security Act

Front 78

The ability of a product to produce and effect in real-world practice, typically outside of the well-controlled setting of clinical trials.

Back 78

Effectiviness

Front 79

The ability of a product to produce and effect, typically demonstrated in randomized controlled clinical trials.

Back 79

Efficacy

Front 80

A model in which the focus of the practitioner shifts form disease orientations (the body) to the person as a whole. Practitioners are encouraged to view the illness from the patient's eyes.

Back 80

Patient-centered model of care

Front 81

A situation that occurs when the market price is below the equilibrium price.

Back 81

Shortage

Front 82

A situation in which the market price exceeds the equilibrium price, resulting in a quantity supplied that is greater than the quantity demanded.

Back 82

Surplus

Front 83

A situation in which individuals or companies purchase insurance only when they expect a loss.

Back 83

Adverse Selection

Front 84

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.

Back 84

Co-insurance

Front 85

A form of patient cost sharing that requires patient to pay a specified dollar amount every time a service is received (eg. $50 per hospital admission or $ 5 per prescription)

Back 85

Co-payment

Front 86

A method of setting insurance premiums based on the insurance company's overall expenses for a specific geographic area during the previous year.

Back 86

Community Rating

Front 87

Insurance plans sponsored by employer groups for employees and their dependents. They are usually less expensive than individual policies because they are less subject to adverse selection and because they are less expensive to sell and administer.

Back 87

Group policies

Front 88

An evaluation of the use of one or more drugs prescribed for one or more diseases or conditions within the context of quality assurance and risk management procedures.

Back 88

Drug Use Evaluation (DUE)

Front 89

the review of physician prescribing, pharmacist dispensing, and patient use of drugs with the goal of ensuring that drugs are used appropriately, safely, and effectively. May be conducted prospectively or retrospectively.

Back 89

Drug Utilization Review (DUR)

Front 90

A form of PPO in which no coverage is provided for care received outside the provider network.

Back 90

Exclusive Provider Organization (EPO)

Front 91

A list of medications complied by a hospital or PBM that contains either those drugs approved for use within the hospital or for reimbursement by the PBM. Medications are included based on the relative clinical benefit and cost for the medication as compared to other agents within a similar therapeutic class.

Back 91

Formulary

Front 92

A type of HMO characterized by contracts with large, multispeciality medical groups offering services exclusively to the HMO on a capitated basis.

Back 92

Group-Model HMO

Front 93

A type of managed care organization that shares risk with a network of health care providers by requiring that the providers assume some risk, either directly or indirectly, and that generally does not provide coverage for medical care that is received outside the network.

Back 93

Health Maintenance Organization (HMO)

Front 94

An organization designed to manage the cost and quality of a health insurance program. The differentiating feature of managed care plans versus fee-for-service plans is the use of a provider network. They are categorized by their degree of risk sharing, provider exclusivity, out-of-network coverage, and physician autonomy and organization.

Back 94

Managed Care Organization (MCO)

Front 95

A type of HMO characterized by nonexclusive contracts with large medical groups. While networks typically bear risk, the non exclusivity of the arrangement reduces the influence of the risk on the physician's behavior.

Back 95

Network-model HMO

Front 96

A specialized company that adjudicates prescription drug claims and manages the prescription drug coverage for a third- party payer by containing costs and influencing the quality of services provided.

Back 96

Pharmacy Benefit Manager (PBM)

Front 97

Quality of care considerations that typically include both assessment of care and a feedback loop to the health care organization that recommends either a continuation or a change in care.

Back 97

Quality Assurance

Front 98

An outcome measured as life-years gained adjusted for patient preference or another means of weighting/adjusting gains in life-years.

Back 98

Quality-adjusted life-years (QALYs)

Front 99

A type of patient cost sharing that specifies multiple co-payment levels that are designed to encourage the use of preferred drug products, such as generics and lower cost brand name drugs.

Back 99

Tiered co-payments

Front 100

A provision established by the Omnibus Budget Reconciliation Act (OBRA) of1981 that allows states to apply for exceptions to federal Medicaid guidelines for the purpose of either establishing Medicaid managed care plans or creating new initiatives to curb costs or improve delivery of Medicaid services.

Back 100

Medicaid Waver

Front 101

a 1988 proposal to expand Medicare Part B coverage to include outpatient prescription drug coverage.

Back 101

Medicare Catastrophic Coverage Act

Front 102

A chemical entity that shows promise as a potential new drug and has been approved by the FDA for clinical testing.

Back 102

Investigational New Drug (IND)

Front 103

The application submitted by a pharmaceutical manufacturer to the FDA for approval of a drug product that has completed the FDA's clinical testing requirements.

Back 103

New Drug Application (NDA)

Front 104

The Greek term for "drug", meaning remedy, poison, or magical charm

Back 104

Pharmakon

Front 105

The act of consumers selecting and using products or processes to treat health ailments without the supervision of a health care professional.

Back 105

Self-care

Front 106

What are the four major strategies to influence medicines use?

Back 106

1. Creating an efficient drug distribution network
2. Controlling patient behavior
3. Controlling physician behavior
4. Promoting best practice

Front 107

85%of outpatient prescription are filled by whom?

Back 107

Pharmacies owned by MCOs and community-based retail pharmacies

Front 108

12% of retail prescriptions are filled by whom?

Back 108

mail service pharmacies

Front 109

PTC stands for?

Back 109

Pharmacy & Therapeutics Committees
They formulate the formularies in hospitals

Front 110

Allow many drug products and those that are not listed are generally available and reimbursed.

Back 110

Open Formulary

Front 111

Contain fewer drug products than an open one. Those drugs that are not listed are generally not available nor reimbursed.

Back 111

Closed Formulary

Front 112

Drug products are explicitly listed for coverage or reimbursement

Back 112

Positive Formulary

Front 113

Drugs are specifically identified for exclusion.

Back 113

Negative Formulary

Front 114

Is an approach to patient care that coordinates resources across the entire healthcare delivery system and throughout the life-cycle of a disease.

Back 114

Disease Management

Front 115

Systematically developed statements to assist practitioners and patient decisions about health care for specific clinical circumstances.

Back 115

Practice Guidelines

Front 116

PBMs obtain their money from whom?

Back 116

Clients, mail-order pharmacies, and manufacturers

Front 117

T/F Rebates must be disclosed to the PBM clients and forwarded to them unless they enter into a rebate sharing agreement with the PBM

Back 117

True

Front 118

With these contracts the PBMis paid for claims processing and retains the manufacturer-paid administrative fees and some percentage of the rebates. In this arrangement, the client assumes all risk for the cost of the drug dispensed.

Back 118

Fee-for-Service Contract

Front 119

PBM and MCO/Employer agree on target PMPM. If actual PMPM> target cost, then PBM will share in the overrun and refund $; otherwise PBM shares in savings

Back 119

Risk Sharing Contract

Front 120

PBM agrees to provide all PC for fixed PMPM

Back 120

Capitation Contract

Front 121

What is the term used to express the combination of the drug industry with PBM companies and pharmacy chains?

Back 121

Vertical Integration

Front 122

What relationship is key to producing savings and also often revenues to PBMs?

Back 122

Manufacturer-PBM relationships

Front 123

PBM quality, safety and cost-containment programs require what of pharmacies?

Back 123

Additional administrative task by the pharmacies

Front 124

What are the two key elements of Pharmacy reimbursement?

Back 124

1. Average Wholesale price (AWP) for the drug ingredient(s)
2. Dispensing fee for the pharmacist services

Front 125

What improves patient safety, increases generic prescribing, and reduces drug costs for both plan sponsors and consumers?

Back 125

E-prescribing

Front 126

The Medicare Electronic Medication and Safety Protection Act of 2008 did what?

Back 126

Offers financial incentives to physicians who use qualified e-prescribing methods. Also imposes financial penalties beginning 2012 for doctors who do not e-prescribe.

Front 127

What is the most commonly used cost sharing approach between PBMs and the patient?

Back 127

Three-tier plan design

Front 128

Express Script found that three-tiered drug plans did what for the customer?

Back 128

Found that the groups with the three-tier co-pay experienced lower prescription use and reduced net costs with no increase in the use of their medical benefit. Also found that their was decreased utilization of drugs which could lead to long-term medical cost to go up.

Front 129

What is the Drug cap value in Florida?

Back 129

4 brand name drugs only excluding HIV/AIDS drugs, mental health drugs, insulin, and diabetic supplies

Front 130

Patients who regularly took more than 3 medications at base line during the period of drug cap had what occur?

Back 130

They had 2x the risk of admission to a nursing home and 1.2 times more likely to enter the hospital.

Front 131

Generating data on MD prescribing and comparing MDs to expected prescribing patterns for select drug categories.

Back 131

Provider Profiling

Front 132

What are the two types of DURs and which one provides the most savings?

Back 132

Retrospective and Concurrent
Retrospective provides the most savings.

Front 133

Dispensing of a drug product that contains the same active ingredient(s) and is chemically identical in strength, concentration, dosage form, and route of administration to the drug product prescribed.

Back 133

Generic Substitution

Front 134

Interchange of therapeutically equivalent but chemically unique drugs in accordance with established policies and procedures within a healthcare system's evidence-based formulary.

Back 134

Therapeutic Substitution or Interchange

Front 135

What are the three outcomes found in Disease Management?

Back 135

Process, Intermediate, and Health Outcomes

Front 136

Is the application of epidemiologic reasoning, methods, and knowledge to the study of the uses and effects of drugs in human populations. It aims to describe, explain, control, and predict the uses and effects of pharmacologic treatments in a defined time, space, and population.

Back 136

Pharmacoepidemiology

Front 137

Indirectly related to medical intervention: no therapy, underdose

Back 137

Errors of omission

Front 138

Directly related to medical intervention: overdose, contraindicated therapies

Back 138

Errors of comission

Front 139

Medicare Drug Plan
$0-$295.00

Back 139

Deductible

Front 140

Medicare Drug Plan
$2700-$6153.75

Back 140

Doughnut hole

Front 141

Medicare Drug Plan
> $6153.75

Back 141

Catastrophic Phase

Front 142

What is the annual enrollment period for Medicare's Drug Plan?

Back 142

Nov. 15th to Dec. 31st

Front 143

Other prescription drug coverage that meet or exceed the requirements of Medicare Part D

Back 143

Credible Coverage

Front 144

What is the Federal Poverty Level for a single person?

Back 144

$10,400 per year

Front 145

What is involved in Continuous Quality Improvement (CQI)?

Back 145

Delivering patient-centered care
Working as part of interdisciplinary team
Practicing evidence-based medicine
Focusing on quality improvement
Using information technology

Front 146

Degree to which health services for individuals and populations increase the likelihood of desired health outcomes and are consistent with current professional knowledge.

Back 146

Quality Medical Care

Front 147

What are the key features of quality?

Back 147

High quality decision making
High quality performance
Evidence based Medicine
Patient's preferences

Front 148

How is quality measures?

Back 148

Structure
Process
Outcomes

Front 149

What makes up indicators?

Back 149

Recognizable
Foreseeable
Identifiable
Controllable

Front 150

Identifying and eliminating the "perpetrator(s)" will remove the outlier

Back 150

Quality Assurance

Front 151

Focuses on the average performance: what happens most often rather than what happens relatively rarely.

Back 151

Quality Improvement

Front 152

A hospital patient can expect how many medication errors while in the hospital?

Back 152

1 med error per day

Front 153

What is the leading error in community pharmacies?

Back 153

Wrong label instructions and inspection

Front 154

In the hospital Medication Use System where do the most errors occur?

Back 154

Administer

Front 155

In the hospital what is the rate that people are hurt due to medical error?

Back 155

One person hurt every 1.5 days

Front 156

16-24 hrs without sleep is equal to what?

Back 156

Alchol blood level of .05-.1 mg/%

Front 157

What are the first five traits displayed by professionals?

Back 157

1. Knowledge skills, and behavior of a profession
2. Commitment to self improvement of skills and knowledge
3. Service Orientation
4. Pride in the Profession
5. Covenantal Relationship with the client

Front 158

What are the last five traits displayed by professionals?

Back 158

6. Creativity and innovation
7. Conscience and trustworthiness
8. Accountability for his/her work
9. ethically sound decision making
10. leadership

Front 159

Newest Journal Articles

Back 159

Primary Literature

Front 160

Search engines that find new journal articles or papers that quote newest journal articles.

Back 160

Secondary Literature

Front 161

Textbooks

Back 161

Tertiary Literature

Front 162

Cause and Effect
Randomized Controlled Trials (RCTs)

Back 162

Experimental Studies

Front 163

Association Only
Cross Sectional
Case Control
Cohort

Back 163

Observational Studies

Front 164

A methodology for evaluating the validity of research in clinical medicine and applying the results to the care of individual patients

Back 164

Evidence-Based Medicine