powerpoint

Question 1

who IS recognized as a provider in part B of the social security act?

Answer 1

physicians, PA’s, NP’s, qualified psychologists, clinical social workers, certified nurse midwives, and certified registered nurse anesthetics

Question 2

the _____________ designates communites with unmet health care need as ______, ____, and _____

Answer 2

the dept of health and HRSA (health resources and services administration)

MUAS – medically underserved areas
MUPS – medically underserved populations
HPSAS – health professional shortage areas

Question 3

define MUAS (medically underserved areas)

Answer 3

geographic areas that have too few primary care providers, high infant mortality, high poverty, and a high elderly population

Question 4

define MUPS (medically underserved populations)

Answer 4

takes into account the same factors used to identify MUAs, but focuses on specific population groups with the same characteristicsd

Question 5

define HPSA

Answer 5

health professional shortage areas – areas with shortages of primary medical care, dental, or mental health providers

Question 6

BPS is a division of______ it was established in _____

Answer 6

BPS is a division of the APHA
established in 1976

Question 7

who provides speciality certification for pharmacists?

Answer 7

BPS

Question 8

how many pharmacy specialties are there?

Answer 8

14

Question 9

who are the “big 3” wholesalers

Answer 9

ABC (amerisourceBergen corp)
cardinal health (CAH)
mckesson corporation

Question 10

name the 14 pharmacy specialties, recognized by BPS

Answer 10

1. ambulatory care
2. cardiology
3. compounded sterile preparations
4. critical care
5. emergency medicine
6. geriatric
7. infectious disease
8. nuclear
9. nutrition support
10. oncology
11. pediatric
12. pharmacotherapy
13. psychiatric
14. solid organ transplantation

Question 11

give the definition of a PBM

Answer 11

companies that manage prescription drug benefits on behalf of health insurers, medicare part D drug plans, large employers, and other payers

another def: “a third party administrator of prescription drug programs for commercial health plans, self-insured employer plans, medicare part D plans, the federal employees health benefits program, and state government employee plans

Question 12

PBMs are primarily responsible for ____, ____, ____, and ____

Answer 12

developing and maintaining the formulary, contracting with pharmacies, negotiating discounts and rebates with drug manufacturers, and processing and paying prescription drug claims

Question 13

what 3 entities does a PBM negotiate with ? explain

Answer 13

pharmacy, insurance company, and manufacturer

the insurance company pays the PBM to manage its drug costs and get rebates from the manufacturer (PBM gets some of the rebate)

PBM negotiates prices with the manufacturer. manufacturer pays rebates to the PBM in exchange for the PBM making them the preferred placement on a plan’s formulary

PBM negotiates with the pharmacy over reimbursement for drugs and dispensing fees

Question 14

who does the pharmacy negotiate with?

Answer 14

the PBM and the manufacturer

Question 15

who sets the copays, coinsurance, and determines out of pocket costs?

Answer 15

the PBM

Question 16

name 5 ways in which PBMS help to cut drug costs

Answer 16

1. mail order medications and creating networks of cost effective and affordable pharmacies
2. encourage use of generics
3. manage high cost specialty meds
4. reduce waste and improve adherence
5. compliance building, utilization management, disease management, and DUR programs

Question 17

what is the AWP

Answer 17

average wholesale price

average price paid by a retailer to buy a drug from the wholesaler

a BENCHMARK number for pricing and reimbursement of prescription drugs. not a true representation. usually inflated around 20%

“LIST PRICE OR STICKER PRICE” elevated price. rarely paid

Question 18

managed care pharmacists serve on ____ committees

Answer 18

p & t committees (pharmacy and therapeutics)

Question 19

what is the purpose of a formulary

Answer 19

to support a healthcare organizations cost and quality of care objectives

Question 20

what is tier 1-4 of formularies

Answer 20

tier 1 - generics
tier 2 - preferred
tier 3 - non-preferred
tier 4 - specialties

Question 21

what are the 3 types of DUR? explain them

Answer 21

prospective — evaluation of a patients drug therapy before the medication is disepensed

concurrent — ongoing monitoring of drug therapy during the course of treatment

retrospective — review of drug therapy after the patient received the medication

Question 22

what is the estimated cost of drug development? break it down

Answer 22

2.6 billion

1.4 billion for out of pocket costs

1.2 billion for time costs

Question 23

what is an NDC
explain the numbers

Answer 23

national drug code.

10 digit or 11 digit 3 segment number. a universal product identifier for human drugs in the US

1st set of numbers identifies the LABELER (manufacturer, repackager, or distributor)

2nd set is the product code — identifies strength, dosage form, and formulation of the drug

3rd set — package code. identifies package size and types

Question 24

what is medwatch

Answer 24

FDA program that collects reports of safety alerts for products regulated by the FDA

Question 25

what does RCT stand for

Answer 25

randomized controlled trials