Obra '90

Front 1

Rebate definition

Back 1

The manufacturer provides drug to Medcaid, which is sold at the best price

Front 2

How is selling the "best price" possible?

Back 2

The drug manufacturers pay the state the difference between the average manufacturer price and the lowest price

Front 3

What is the goal of OBRA '90

Back 3

Decrease costs by improving patient care

Front 4

What was OBRA '90 the first to do?

Back 4

Establish law that defined pharmacy standards (using the pharmacy practice care model). It lt also introduced pharmacists as people that could improve patient outcomes and therapy

Front 5

What must a state do in order to be eligible for Medicaid?

Back 5

Establish expanded practice standards for pharmacists

Front 6

Demonstration projects?

Back 6

These were projects that tested whether DUR worked at improving patient outcomes while decreasing costs

Front 7

DUR
a.) the components (3)

Back 7

1.) Retrospective -medication use over time vs ideal = suggestions for improvment
2.) Educational programs - for professionals on how to improve medication use
3.) Prospective - How to apply meds properly/ consider prescribed therapy

Front 8

Retrospective DUR
a.) who does what?
b.) powers of the board (2)

Back 8

a.) the state establishes a DUR Board made up of physicians and pharmacists
b.) they compare past medication review to the ideal/ target criteria. they can also give out educational programs to those providers that do not reach target criteria

Front 9

Prospective DUR
a.) what are the elements in a prospective DUR? (3)

Back 9

1.) screen prescriptions before dispensing
2.) counsel patient
3.) document any important patient information BEFORE dispensing

Front 10

Patient counseling
a.) falls under which DUR component?
b.) waiver rule
c.) what is there no record of refusal?

Back 10

a.) prospective DUR
b.) if a patient refuses counseling, a written waiver is REQUIRED in Illinois. It is not required in OBRA'90
c.) it is presumed that the patient received counseling

Front 11

Medicare Parts
a.) part A
b.) part B (3)
c.) part C
d.) part D

Back 11

a.) hospitalization
b.) general physician/ outpatient services, some drugs that can't be self-administered, some oral anticancer drugs
c.) alternative to part B. "Medicare Advantage." A managed care plan
d.) prescription drugs

Front 12

MTM
a.) what is required?

Back 12

a.) all MTM programs must be covered under part D of Medicare

Front 13

Conditions for participation
a.) how to participate?
b.) what is the condition?

Back 13

a.) in order for hospitals to accept Medicare patients, the hospitals must follow certain conditions
b.) a pharmacist must supervise the pharmacy and all pharmacy services must follow the law and standards of practice

Front 14

How does the FDA regulate hospitals?

Back 14

It allows hospitals to reconstitute drugs without being labeled as a manufacturer. It also gives hospitals unique labeling for unit-dose drugs

Front 15

How does the DEA regulate hospitals?

Back 15

It doesn't really. If an inpatient has a chart order for a controlled substance, the order doesn't need to follow prescription rules of DEA regulation

Front 16

Who funds Medicaid?

Back 16

It is JOINTLY funded by BOTH federal and state government

Front 17

1975 Maximum Allowable Cost Program
a.) program involved
b.) what
c.) how were multisource drugs reimbursed?

Back 17

a.) Medicaid
b.) limit on high reimbursement of multisource drugs, encouraging generic substitution
c.) MAC (maximum allowable cost) + dispensing fee

Front 18

Stark law
a.) AKA

Back 18

a.) physician anti self-referral law
b.) physician can't direct patients to health care providers that they have financial relationships with

Front 19

Federal regulation of LTCF
a.) what is required?
b.) LTCF error rate goal
c.) when to do a drug regimen review?

Back 19

a.) the multidisciplinary team figures out if the patient can self-administer. the team also does a health & drug assessment
b.) less than 5%
C.) at least once a month