Lecture 6

Question 1

over the next 2 years, there are plans to close ~____ retail pharmacies, which is around _____ pharmacist jobs (assuming 2.5 per store)

Answer 1

~1500 retail pharmacies, ~4500 jobs

Question 2

as mentioned, over the next 2 years there are plans to close ~1500 retail pharmacies.
where are these pharmacies primarily located?

Answer 2

in MUAs (medically underserved areas) – low income

Question 3

true or false

when a pt switches pharmacies, it is possible that they may not receive the same benefits as their previous pharmacy, even though their insurance remained the same

Answer 3

TRUE

Question 4

true or false

there is a positive correlation between retail pharmacy closures and patient nonadherence

Answer 4

true

Question 5

what is the yearly prescription drug spending in the US

Answer 5

$400 billion

Question 6

is inflation affecting prescription drugs? what about OTC?

Answer 6

inflation is affecting OTC drugs more than prescription (due to health insurance)

Question 7

CVS + caremark + Aetna
veritical or horizontal integration?
why is this done?

Answer 7

VERTICAL integration. PBM + pharmacy + insurance

done to achieve the CONTINUATION of care

Question 8

if an inpatient facility merges with an outpatient facility, is it considered a vertical or horizontal integration?

Answer 8

vertical

Question 9

what are AMMO laws

Answer 9

Anti Mandatory Mail Order laws

prevents insurance companies from requiring their clients to use mail order to obtain their Rx

Question 10

AMMO laws are an attempt to combat ___

Answer 10

steering

Question 11

true or false

steering in healthcare is illegal in some states

Answer 11

true

Question 12

Aetna clients can go to any pharmacy to get their meds, but there are better deals at CVS.

is this illegal

Answer 12

no, but unethical

Question 13

what is an example of a distribution shift in pharmacy

Answer 13

pharmacists are leaving low incomes areas and going to higher class areas

Question 14

distribution shift in pharmacy is an example of a ___ ___

Answer 14

health disparity (that pharmacists are contributing to)

Question 15

true or false

racial minorities have a similar risk of high blood pressure and diabetes as the majority

Answer 15

FALSE – racial minorities have a higher risk
example of a health disparity

Question 16

explain the difference between TRADITIONAL MAIL ORDER and CENTRAL FILL

Answer 16

traditional mail order: rx is processed DIRECTLY by mail order

central fill: mail order (technically), but Rx is processed by the local pharmacy

Question 17

PAPS are patient assistance programs. When run by drug manufacturers, they are called…..

Answer 17

pharmaceutical assistance programs

Question 18

it is the job of a ______ pharmacist to assist a patient with paps

Answer 18

med rec

Question 19

needymeds.com is a comprehensive list of ____ and _____

Answer 19

of PAPS and discount cards

Question 20

name some components of needymeds.com

Answer 20

not only has prescription savings.
diagnosis specific savings

sliding scale clinics – those that have a lower cost for those with lower incomes

Question 21

what is Pharmacists at Baycare

Answer 21

a non-profit healthcare system.
targets medicare parts A and B benificiaries.
goal is to decrease 30 day hospital readmissions

Question 22

what is HRRP?
who sponsors it?

Answer 22

hospital readmission reduction program
sponsored by CMS (centers for medicare and medicaid services)

Question 23

healthcare is making a shift to ____ based care

Answer 23

value (tied to quality)

Question 24

what is capitation?
is it considered a part of FFS?

Answer 24

capitation — per member per month
NOT considered part of FFS
it’s a cost cutting method – DRs paid for amt of patients they see REGARDLESS of if they receive care or not

Question 25

is FFS a problem in healthcare?

Answer 25

yes – drs can essentially charge whatever they want.
“usual and customary charges”

PCP and specialist can charge diff things when they do the same exact thing.
specialist is more $

Question 26

as mentioned, FFS is a problem in healthcare.
is it as big of a problem now?

Answer 26

no. FFS is still around, but not nearly as popular

we are moving towards prospective payments – whether you go to specialist or PCP, both get paid the same by the insurance through a predetermined contract with the DR

Question 27

BayCare health systems introduced a program whose goal was targeted at medicare parts A and B beneficiaries, with the goal of decreasing 30 day hospital readmission rates.

what is this program called?

Answer 27

PTOC
Pharmacy Transitions of Care Progra,

Question 28

explain how the pharmacist does its role in PTOC

Answer 28

a pharmacist collaborates with inpatient and outpatient care teams (social workers, home care experts, and physicians).
pharmacist conducts 2 PATIENT VISITS after discharge from the hospital and teleophone calls within 7 and at 21 days after discharge.
here, they provide CMR, MTM, and counseling. help to identify side effects, dosing issues, etc

Question 29

to be a pharmacist in the PTOC program, what are the requirements?

Answer 29

board certified and/or residency trained
trained in ambulatory/transition of care

Question 30

are CMR, MTM, and counseling (duties of pharmacists in PTOC) independent of each other? explain

Answer 30

NO
CMR is part of MTM and MR
therefore, med rec (TOC) pharmacists is also a CMR, MTM, and CDTM pharmacist

Question 31

CMR is part of __ And ___

Answer 31

MR and MTM

Question 32

CMR could become….

Answer 32

CMM – comprehensive medication management

Question 33

explain the difference between CMR and CMM

Answer 33

CMR is a med list – more specific scope

CMM is a BROADER scope. disease focused. has the same elements as CMR but more comprehensive and complex problems. pharmacist is incorporated directly into the care team