New Material

Question 1

Medicare

Answer 1

Health insurance for > 65 years old or certain disabilities

Question 2

Who is Medicare administered by?

Answer 2

Centers for Medicare and Medicaid Services (CMS)

Question 3

What are the four components of Medicare?

Answer 3

1. Hospitalization
2. Physician services
3. Alternative to B (Medicare Advantage)
4. Rx drug coverage

Question 4

What certain drugs are excluded from coverage?

Answer 4

OTC, weight loss, fertility, cosmetics, ED

Question 5

What do Medicare plans have to do when there are drug changes?

Answer 5

Notify CMS, providers, and patients

Question 6

What must the pharmacy provide to the patient when a prescription cannot be covered at the point of sale?

Answer 6

Printed notice

Question 7

Medication Therapy Management (MTM)

Answer 7

Ensures drugs are being used appropriately, optimizes therapeutic outcomes, and reduces adverse effects

Question 7

Medicare Part D

Answer 7

May use formularies that incorporate tiers with variable copays, DURs, prior authorizations, quantity limits, and other restrictions

Question 8

Plans may not require more than __ chronic diseases for a beneficiary to qualify for MTM services.

Answer 8

3

Question 9

Plans must target ___ out of ___ core chronic conditions.

Answer 9

5, 9

Question 10

Medicaid

Answer 10

Provides healthcare costs for certain
categories of indigent patients and is
administered by the state, jointly funded by the federal government and the state, with each state program subject to federal approval and federal regulation

Question 11

Medicaid prescriptions

Answer 11

Must be written on
tamper-resistant prescription pads

Question 12

False Claims Act

Answer 12

Prohibits knowingly presenting or causing to be presented
a false or fraudulent claim for payment or approval; it prohibits
knowingly making, using, or causing to be made or use a false
record or statement material to a false or fraudulent claim

Question 13

Anti-Kickback Statute

Answer 13

Prohibits anyone from knowingly and willfully soliciting, receiving, offering, or paying any remuneration (including any
kickback, bribe, or rebate) in exchange for inducing referrals or for furnishing any goods or services paid for by Medicare or Medicaid

Question 14

Stark Law

Answer 14

Prohibits certain healthcare providers from referring Medicare or Medicaid patients to certain entities in which the
healthcare provider (or an immediate family member) has a financial relationship.

Question 15

Proof of a Stark violation

Answer 15

Does not require intent or that the
defendant acted willfully or knowingly

Question 16

340B law

Answer 16

Requires that drug manufacturers
provide outpatient drugs at special reduced prices to
designated covered entities serving underserved and
uninsured populations

Question 17

Federal law makes what illegal for the covered entity or
pharmacy to dispense or sell?

Answer 17

A 340B drug other than
to an eligible 340B beneficiary

Question 18

The Patient Safety and Quality Improvement Act (PSQIA)

Answer 18

Creates a voluntary program through which healthcare providers can share information related to patient safety events with PSOs, and this information
is privileged and confidential

Question 19

When did self-regulation of the pharmacy profession begin?

Answer 19

In the late 19th century

Question 20

Self-governance continues at the what level?

Answer 20

State level, which limits the
federal authority over the practice of pharmacy.

Question 21

In the United States, pharmacy is regulated through _________.

Answer 21

Licensure

Question 22

What does licensure help?

Answer 22

Increase the quality of healthcare, reduce the cost of healthcare, and inhibit the criminal abuse of drugs

Question 23

What do state laws that regulate the practice of pharmacy create?

Answer 23

State boards of pharmacy

Question 24

Pharmacy Boards

Answer 24

Responsible for granting licenses to pharmacists and pharmacies

Question 25

What do pharmacy boards do?

Answer 25

Helps ensure the competence and appropriateness of those
practicing pharmacy and the facilities they practice in

Question 26

Licensure by the state boards of pharmacy heavily emphasizes what?

Answer 26

Structure and process, with less attention to the outcomes of drug therapy

Question 27

What does the state board require to become licensed as a pharmacist?

Answer 27

Requires specific criteria, including
graduating from a pharmacy school, completing internship requirements, passing licensure exams, and being of good moral character

Question 28

CPE Monitor

Answer 28

Electronically tracks CPE and can be accessed for auditing purposes by pharmacy boards

Question 29

NABP

Answer 29

Has an accreditation
process (VIPPS), which requires an active pharmacy domain

Question 30

Most states require pharmacists and pharmacies licensed in other states to _________ any discipline.

Answer 30

Self-report

Question 31

Grounds for discipline include what?

Answer 31

Providing false information on applications, violation of any statutes or rules pertaining to the practice of pharmacy, court convictions, moral turpitude, unprofessional conduct, and incompetence

Question 32

Practice of Pharmacy

Answer 32

Professional service-focused, the broader definition provides the state board with more latitude to implement regulations expanding the practice
and is important to establishing professional identity to courts and society

Question 33

Ancillary Pharmacy Personnel

Answer 33

Authorized by state laws to enable pharmacists to perform professional services

Question 34

Most states recognize pharmacy students as ______.

Answer 34

Interns ; this allows them to perform pharmacist-only functions under the direct supervision of the pharmacist

Question 35

To prevent errors, some state laws require that employers allow pharmacists at least a meal break of
usually _________.

Answer 35

30 minutes

Question 36

Continuing Pharmacy Education

Answer 36

Required in every state, most states require 15 hours annually/30 hours biannually

Question 37

Most states allow a pharmacist to engage in _________ ______ __________ with a physician and to initiate and/or adjust a patient’s drug therapy.

Answer 37

collaborative practice agreements