The Business of Community Pharmacy

Question 1

Pharmacy Tech Business Responsabilities

Answer 1

• Nonprescription Sales
  
  • OTC drugs
  • Dietary Supplements
  • Medical Supplies
• Automation in the Pharmacy
  
  • Computers
  • Cash Register Management

Others that will be taught later

Question 2

Nonprescription Sales

Answer 2

• Front area of the pharmacy
• OTC drugs
• dietary supplements
• medical supplies
• other merchandise

Question 3

OTC drugs

Answer 3

• approved for sale without a prescription
• approved and regulated by the FDA only after the drug and dosage are generally recognized as safe and effective for the approved indication when taken according to labeled directions
• although these medications may be purchased without a prescription, the active ingredients are often the sam as those found in higher-strength prescription formulations
• also some refridgerated meds such as fast-acting regular insulins can be sold to a patient with or without a prescription
• sometimes (pediatric) prescriptions are received for OTC drugs. Generally OTC meds are not covered by insurance but for some pediatric cases they are. However if the OTC med is on sale, the pharmacy should direct the patient there vs. the more expensive prescription.

Question 4

OTC Benefits

Answer 4

• does not require the cost or inconvenience of a physician visit
• available for self administration immediately
• available for use in treatment of symptoms when insurance is lacking or does not cover
• huge importance is placed on product labeling to ensure the buyer is fully aware of indication and proper safe use

Question 5

OTC Labeling

Answer 5

• manufacturers must include all information necessary for the safe and effective use of theproducts by customers
• language must be understandable and readable
• information includes:
  
  • active ingredient
  • inactive ingredients
  • purpose or use of product
  • dosage & frequency of administration for different age groups
  • any precautions/warnings
  • special storage requirements
  • product’s expiration date
  • 1-800 number for any questions or concerns

Question 6

OTC Consumer Precautions

Answer 6

• products are to be used for restricted periods unless otherwise instructed by a dr
  
  • usually 7 days or less
• if pharmacist cannot identify the source of the problem or the pt has self-medicated for longer than 7 days, the pt should be referred to a dr
• no drug is completely safe, without side effects or adverse reactions
• OTC use of cough and cold medications for children under the age of 6 is strongly discouraged bc of risk of adverse reactions being greater than benefit of the medication
• dextromethorphan (DM) containing products can cause hearing and visual hallucinations in high doses and have history of abuse among adolesents = consumers must be 18yoa to purchase, must provide ID at time of purchase

Question 7

Role of Pharmacist in sale of OTC medications

Answer 7

• If customer seeks counsel with choosing OTC medication (ex. sugar free medication for diabetics) the pharmacist will step away from prescription filling duties to assess the problem and make appropriate drug product selections and also to counsel the patient
• Only pharmacists can address questions about drug product selection, indications, dosage and administration, expected therapeutic effect, side effects, contraindications, and interactions

Question 8

Role of Pharm Tech in sale of OTC meds

Answer 8

• selling
• stocking
• ordering inventory
• rearranging inventory
• removing stock when shelf life has expired or with a recalled product
• if customers approach tech with questions about the product if other than location in the pharmacy or price questions about the actions/indications etc. of the drug must be referred to the pharmacist

Question 9

Sale of Schedule V OTC drugs

Answer 9

• Schedule V is medication with a low potential for abuse and a limited potential for creating physical or psychological dependence
• Federal law allows the dispensing of Schedule V meds without a script, however ther are restrictions and requirements for the sale
  
  • drugs must be stored behind the counter in the prescription area
  • amt of cough syrups sold to a single customer is generally limited to a specific volume withing a 48 hr period (generally 120mL)
  • only a pharmacist or pharmacy tech under direct pharmacist supervision can make the sale
  • purchaser must be 18 years old and have proof of identity
• States and pharmacies may have more stringent rules
  
  • some states require a script from a physician
  • other state boards of pharmacy have reclassified some schedule V drugs as schedule III, and so they fall under those stricter dispensing guidelines
  • some pharmacies may require a script even if state law does not require one
• All sales of Schedule V OTC medications allowed without a prescription must be recorded in in the pharmacy
  
  • name and address of the purchaser
  • DOB of purchaser
  • date of purchase
  • name and quantity of the Schedule V drug sold
  • name and inititals of the pharmacist handling or approving the sale

Question 10

Sale of OTC Containing Pseudoephedrine and Epherine

Answer 10

• sale of these products are rescticted by federal and state laws
• including:
  
  • cold and sinus meds
  • ephedrine-containing tablets
  • metered-dose inhalers (MDIs)
• restrictions on the meds are in place because the ingredients in these medications have been used as raw products in illegal manufacture of methamphetamine
• all psuedoephedrine and ephedrine containing products must be stored behind the counter
• many states limit the purchase of these products to prescription only
• several states require the sale be conducted by a pharmacist only
• limits are placed on how many units of these drugs can be legally purchased at on time at one location
• pseudoephedrine limits are 3.6 grams in one day and 9 grams in 30 days
• written or computerised documentation must be made of each sale into a logbook similar to schedule V drugs
• documentation must be kept for minimum of 2 years
• Information required prior to sale:
  
  • valid and current photo ID (DL with number entered or scanned at point of sale)
  • proof of age (18 or older)
  • date and time of purchase
  • product being purchased
  • streed address, state and ZIP of customer
  • customers signature in the logbook or electronically

Question 11

smurfing

Answer 11

• when a patient is paid cash by and individual to illegally purchase pseudophedrine from one or more pharmacies
• these drugs are not for personal use but are illegally sold to individuals whose intent is to manufacture and sell methamphetamine
• if 3 or 4 patients come into the pharmacy at one time to purchase such products - be suspicious and refuse sale

Question 12

Emergency Contraceptives

Answer 12

• Plan B
• Next Choice
• direct buyers, especially teenagers, to the list of side effects on the packaging
• patients have any questions, they must be directed to the pharmacist
• all patients purchasing Plan B should be counselied by the pharmacist on appropriate use and expected side effects
  
  • the 2 dose drug must be taken within 72 hours of unprotected sex
  • the sooner it is taken, the more effective it is
  • efficacy is 75% - 90%
• some pharmacists may object to selling on religious grounds
• there are state laws governing actions for this moral and ethical dilemma

Question 13

Dietary Supplements

Answer 13

• can be a vitamin or mineral or an herbal product such as ginger, garlic, saw palmetto, glucosamine, or soy
• most customers do not realize that dietary supplements are not regulated by the FDA in the same stringent manner as OTC drugs
• primairly regulated by the DSHEA - the FDA does not approve these supplements they must be safe and accurately labeled
• dietary supplements indicates a serving size rather than a dose
• offers limited information about the product
• the amount of active ingredient in th supplement may not always match the labeled amount because of inconsistencies in quality control or product contamination
• if the label contains an indication that has not been approved by the FDA, the FDA can remove the drug from the market
• the FDA can also remove any dietary supplement that is deemed dangerous which has occured in the past with several “diet pills”

Question 14

DME

Answer 14

• durable medical equipment
  
  • hospital beds
  • wheelchairs
  • canes
  • walkers
  • crutches
  • prosthetics
  • orthotics
  • blood glucose meters

Question 15

Nondurable Medical Supplies

Answer 15

• consumable, disposable items that can only be used by one patient for a specific purpose
  
  • diabetic test strips
  • lancets

Question 16

Medical Suppliers

Answer 16

• some pharmacies are liscenced as medical suppliers with the ability to provide direct Medicare Part B insurance coverage for many medical supplies and drugs for patients over age 65
• pharmacies must meet quality standards and accreditation requirements set by the Centers for Medicare and Medicaid Services (CMS)
• these pharmacies may also cover
  
  • parenteral and enteral nutrition
  • home dialysis supplies
  • expensive injectable drugs for anemia and transfusion medicine
  • drugs used for nausea and vomiting caused by chemotherapy

Question 17

Diabetic Supplies

Answer 17

• matching the specific needs of the patient with the proper equipment and supplies is an important responsability of the pharmacist
• may pharmacists aquire speciality training and certifications in this particular area
• pharmacy techs can also gain diabetic certification for patient education for diabetics
  
  • these skills are considered valuable and may enhance hourly pay

Question 18

glucometer

Answer 18

• DME device that measures blood glucose levels
• avail from diff manufacturers in different sizes
• vary at to amt of blood needed to make a reading, the time necessary to provide results, memory capacity, and ability to interface with a computer
• can be purchased with generous rebates that negates a majority of the original purchase price
• are frequently updated and products requireing constant education by pharmacist and tech to stay abreast of

Question 19

Insulin Syringes

Answer 19

• required by diabetics for self-administration of daily insulin shots
• policy of sale varies from state to state inorder to prevent their use in illegal drug administration
• many pharmacies stipulate that no syringes may be sold unless the patient is a known diabetic or is known to the pharmacy
• Insulin syringes and needles come in different sizes
  
  • 0.3 mL
  • 0.5 mL
  • 1 mL
• Insulin syringes are marked in units rather than mLs for a more accurate insulin dose administration
• most needles are short for easier and less painful injection under the skin rather than into the muscle
• portable insulin pens require a separate purchase of pen needles

Question 20

Pen Needles

Answer 20

• for insulin pens
• available in smaller sizes of 1/2 inch or less in length and guage from 29-32
• commercially available as:
  
  • originao - 12.7 mm or 1/2 inch
  • short - 8 mm or 1/3 inch
  • mini - 6 mm or 1/4 inch
    
    • 5 mm or 1/5 inch
  • nano - 4 mm or 1/6 inch
• least pain is commonly reported with the shortest needle with 32 guage lumen

Question 21

Test Strips, Lancets, Alcohol Wipes

Answer 21

• disposable test strips are needed with the glucometer
  
  • are machine specific and must be matched for type of glucometer the patient is using
  • some test strips come with a computer chip that must be inserted before using strips from that bottle
  • failure to insert the computer strip lot number strip before test strip use will result in an error in glucose readings
  • being used as many as 6 times daily, they can become expensive if the patient does not have insurance
  • Storebrand glucometer and test strips will often result in 50% savings
  • expiration dates should always be checked before sale of strips
• lancets are needed to pierce the skin to produce a drop of blood
• alcohol swabs are needed to clean the skin before piercing to lessen the chance of introducing a foreign body past the skin barrier
  *

Question 22

Insurance Coverage for Diabetic Supplies

Answer 22

• syringes and other diabetic supplies are sometimes covered by drug insurance or medicare Part B if there is a script presented by a physician
• If patient uses insurance for diabetic supply coverage it is important that they present a prescription with the ICD-9 or ICD-10 diagnosis code and frequency of dialy insulin injections and blood glucose testing

Question 23

certificate of medical necissity

Answer 23

may need to be completed for each patient for diabetic supplies and signed by the prescriber

Question 24

Test Kits

Answer 24

• pregnancy
• ovulation cycle
• bladder infection
• high cholesterol
• illegal drug use
• HIV infection
  
  • HIV test kit is a relatively recent product
• some kits may need special ordering by pharmacy
• pharm tech can help patients select a kit and understand the instruction on the kit

Question 25

OraQuick

Answer 25

• OTC test kit for HIV detection
• FDA approved
• used at home for the presence of the virus in the saliva
• results known from a mouth swab in 20 minutes
• it will rarely miss someone who is not carrying the virus
• may miss 1 in 12 who are infected with HIV
• if positive testing by OTC kit, patient must see physician for comfirmation testing
• 1-800 number on package also provides someone for patient to speak to about results and/or to receive referral to a local center

Question 26

General Medical Supplies

Answer 26

• pharmacy tech can assist with these transactions
• examples:
  
  • thermometers
  • BP cuffs
  • spacers for inhalers
  • splints
  • braces
  • bathroom accessories
  • nebulizer tubing
  • masks
  • bandages,
  • gauze pads
  • adhesive tape
  • hydrogen peroxide
  • isopropyl alcohol
    *

Question 27

Pharmacy Automation

Answer 27

• Computers
• Cash Registers
• Bar code scanners
• scales
• robotics

Question 28

Pharmacy Computers

Answer 28

• critical tool needed for the safe and efficient dispensing of prescriptions and online billing

Question 29

smart terminal

Answer 29

• computer that contains its own storage and processing capabilities
• seen in most small pharmacies

Question 30

dumb terminal

Answer 30

• computer device that contains a keyboard and monitor but does not contain its own storage and processing capabilities
• terminal is connected to a remote computer
• seen as most chain pharmacies

Question 31

remote terminal

Answer 31

• often a minicomputer or a mainframe at the company headquarters or home office
• stores and processes data such as patient information, prescription history, and insurance coverage

Question 32

Pharmacy computer software

Answer 32

• software is designed to help process prescriptions with both speed and accuracy
• software systems vary widely among pharmacies, but most use a software program application that allows one to enter, retrieve, and query patient records
• referred to as database management system

Question 33

DBMS

Answer 33

• database management system
• typically contains patient profile, physician database, pharmacy drug inventory, and directory of prescribers and insurance plans
• patient identification by name and DOB
  
  • always use 2 identifiers
• use links to conduct real time online billing with insurance companies
• links with online insurance plans also help to notify of potential errors with scripts previously dispensed at another pharmacy
• copies or backups of database should be made at regular intervals
• some systems automatically store prescription database
• most systems print medication container labels, patient information sheets, track expenses, perform dosing calculations, retrieve medical and pharmacy literature

Question 34

receipt

Answer 34

proof of purchase printout

Question 35

ANDA

Answer 35

• abreviated new drug approval
• must be obtained before another manufacturer can produce a drug (generic) from a new brand name

Question 36

Orange Book

Answer 36

• Approved Drug Products with Therapeutic Equivalence Evaluation
• in other words = generic
• available online and designates:
  
  • A - indicates the generic is therapeutically equivalent to the brand name drug
  • B - designates the generic is not equivalent to the brand name
• Most states require that a generic be on the A list for it to be substituted as a replacement for the brand name