Lecture 6 - Prescribing, OBRA' 90 and DSHEA

Question 1

What are the four prescribers recognized as having the authority to prescribe in every jurisdiction?

Answer 1

-Physicians (MD/DO)
-Dentists (DDS/DMD)
-Podiatrists (DPM)
-Veterinarians (DVM)

Question 2

What is a full prescriber?

Answer 2

Full prescribers’ prescriptions are honored in any part of the United States so long as they are licensed in at least one jurisdiction of the United States

Question 3

What prescribing authority do mid-level prescribers have?

Answer 3

They can not prescribe in all states and may not be honored in every jurisdiction

Question 4

What is the physician scope of practice?

Answer 4

Whole body authority for humans

Question 5

What is the dentist scope of practice?

Answer 5

Mouth and maxillofacial (jaw and face) area for humans

Question 6

What is the podiatrist scope of practice?

Answer 6

Feet, ankles, and in some places hands for humans

Question 7

What is the veterinarian scope of practice?

Answer 7

Whole body authority for animals

Question 8

What is the mid-level practitioner scope of practice?

Answer 8

Depends on their scope of training, the specialty of their supervising practitioner, and/or the formulary of drugs they are allowed to prescribe

Question 9

What is the difference between a scope of practice and specialty practice?

Answer 9

Some physicians get specialized, but this does not take away their training as a physician, so they can still prescribe for the entire body despite being specialized for a specific part of the body

Question 10

What is an agent?

Answer 10

A healthcare worker who is authorized by a prescriber to act as their voice and relay a prescription on behalf of a prescriber. They can NOT make decisions on behalf of the prescriber

Question 11

Federal prescription requirements

Answer 11

-From a federal standpoint, there are no uniform standards for non-controlled prescriptions in the United States
-Additionally, federal law does not address prescription expiration or refills (this is done by the states)

Question 12

What are the requirements for a prescription label?

Answer 12

-The name and address of the dispenser
-The serial number of the prescription (prescription number)
-The date of the prescription or its filling
-The name of the prescriber
-If stated on the prescription, the name of the patient
-If contained on the prescription, any directions for use
-If contained on the prescription, any cautionary statements

Question 13

What is not technically required to be on a prescription label because it is not required to be on the prescription itself?

Answer 13

-Date of the prescription
-Name of the patient
-Directions for use
-Any cautionary statements

Question 14

How long can an OTC prescription be refilled for?

Answer 14

One year

Question 15

How many full refills are allowed of an OTC prescription?

Answer 15

No rule

Question 16

When does the prescription expiration clock start ticking?

Answer 16

The date it is issued

Question 17

How long can a prescription only drug be refilled for?

Answer 17

One year

Question 18

How many full refills are allowed of a prescription only drug?

Answer 18

No rule

Question 19

How long can a C3-5 drug be refilled for?

Answer 19

Six months

Question 20

How many full refills are allowed of a C3-5 drug?

Answer 20

Five

Question 21

How long can a C2 drug be refilled for?

Answer 21

One year

Question 22

How many full refills are allowed of a C2 drug?

Answer 22

Not refillable

Question 23

What did the OBRA ‘90 Act do?

Answer 23

Targeted spending on medications by Medicaid beneficiaries

Question 24

What are the four primary requirements of OBRA ‘90 related to pharmacy practice?

Answer 24

-Prospective drug utilization review (DUR)
-Retrospective drug utilization review
-Offer to conduct patient counseling
-Maintaining patient records

Question 25

What is the prospective drug utilization review?

Answer 25

Pharmacist must review drug therapy before each prescription is filled for accuracy and appropriateness

Question 26

What is the retrospective drug utilization review?

Answer 26

States must review medication use of drugs and compare how they are being used against accepted standards

Question 27

What is patient counseling?

Answer 27

-Law requires an offer to have a pharmacist counsel the patient be made -Pharmacist should counsel on matter which, in the pharmacist's professional judgement, are significant -Nothing in this clause requires consultation when an individual refuses such consultation

Question 28

How does OBRA 90 define maintaining patient records?

Answer 28

-A reasonable effort must be made by the pharmacist to obtain, record and maintain patient records -Like patient counseling, this only applies to Medicaid patients, though many state legislatures have extended this to all patients

Question 29

How did the Dietary Supplement Health and Education Act define dietary supplements?

Answer 29

A product (other than tobacco) intended to supplement the diet that contains one or more of the following: -A vitamin -A mineral -An herb or other botanical -An amino acid

Question 30

What must all dietary supplement labels contain?

Answer 30

-The name of the product and the phrase "dietary supplement" -The quantity of the contents -The manufacturers, packers or distributors name and address -Directions for use -A supplement facts panel containing serving size, list of dietary ingredients, amount per serving size, and percent daily value if established