jurisprudence#2-FINAL EXAM Flashcards
(def): website provides information on the various drug programs covered or reimbursed by the Ontario Drug Benefit (ODB) Act, including the ODP Plan, which has a formulary (list of covered products) available online.
The Ontario Public Drug Programs (OPDP)
Formulary (list of covered drugs) under the Ontario Drug Benefit (ODB) program is updated throughout the year and kept current on ____ website
Ontario Public Drug Programs (OPDP)
The ODB Act uses principles from ______ to meet the Ministry of Health and Long-Term Care’s goals for savings and cost-effectiveness.
DIPA (Drug Interchangeability and Dispensing Fee Act)
The _____ replaces the Minister of Health for the purpose of administering both the ODBA and Drug Interchangeability and
Dispensing Fee Act.
Executive Officer
who is eligible for the Ontario drug benefit (ODB) coverage?
(DEF): ODB provides community-based, OUT-PATIENT drug benefits
Criteria:
-Must be eligible for Ontario Health Insurance Plan (OHIP)
coverage.
- People 65 years of age and older.
-People receiving benefits under the Ontario Disability Support Program or Ontario Works.
-People residing in Homes for Special Care or long-term care homes.
-People receiving professional services under the Home
Care Program.
-Registrants in the Trillium Drug Program.
formulary composition?
a.)Part III-A: provides a list of benefits through a web link to the
searchable ODB e-Formulary on the ministry’s website.
b.)Part III-B: Off Formulary Interchangeability (OFI) is the application of
interchangeable designations to drug products where the original (i.e.
brand name) products are not listed as ODB benefits in the Formulary.
(def): contains index of the pharmacologic-therapeutic classification (ie., anti-histamine, anti-infective, cardiovascular drugs)
index of pharmacologic-therapeutic classification
(def): allows for drug reimbursements for individuals that are not normally covered?
facilitated access to individuals & exceptional access program (EAP) for drug reimbursement
The trillium drug benefit program provides benefits to eligible recipients who ______.
have drug expenses in relation to their income(*its an annual provincial government program for qualified individuals).
(*ODB covers seniors one day after they turn 65)
(def): requests coverage for products not listed as benefits under the ODB program.
Exceptional Access program (EAP)
conditions that must be met for natural products reimbursement
Nutritional benefits and diabetic resting agents are covered by the ODB when patients are presented with eligible prescription.
(def):drug products listed in the formulary with specific clinical criteria for use.
Limited use (LU)
For a no-sub to be used, a prescriber must complete, sign and forward to the pharmacy a copy of the _____.
Canada Vigilance Adverse Reaction Reporting Form
In order to apply to ODB to receive grants, pharmacy operators must apply to ____.
executive officer
An operator of a pharmacy may opt out of the ODB program by notifying the executive officer within _____ days.
90
Limits On Amounts paid?
- 35 day supply for Ontario works recipients
-100 day supply for all others - 2 claims of vacation-supply (2x 100)
-entire quantity specified in the prescription - if its a trial prescription: 30 day limit
(def): defined as the period of time where patients pay co-payments
Eligibility period
how is the Ontario work benefit regulated?
municipally; NOT provincially.
T/F: A pharmacy’s collection of the co-payment from the patient is mandatory
FALSE; NOT MANDATORY
how are deductibles paid by each patient estimated by ODB?
income
(For private plans, they determine that amount LOL)
when can we charge the patient extra?
If a patient wanted greater than a 100 day supply, the pharmacist is permitted to charge the patient for any additional quantity of drug and must explain the reasons and give the patient a choice.
(*this incident should be documented).
conditions for the reimbursement of compounded preparations?
-A preparation cannot be equivalent to a manufactured product on the market
-For example, could not prepare diclofenac 1.16% gel since it is already commercially available as Voltaren® Emulgel 1.16%.
-A topical preparation must contain an ODB formulary listed drug product and no other active ingredients except for those listed in the section for extemporaneous preparations such as menthol,
camphor, etc.
how does the executive officer estimate amount reimbursed for compounded products prepared by a compounding pharmacy?
-ODB sets the amount paid per minute of compounding time and the amount of time is dependent on the type of preparation compounded.
-ODB will reduce the amount of time being paid if they determine it is excessive for the type of compound that is submitted.
(def): drugs that have no restrictions in prescribing and dispensing
“open benefits”
(VS limited use (LU) code)
