Pharmacy Practice Chapter 6 Quiz

Specific timeframes for Medicare beneficiaries to enroll in Part D prescription drug coverage.

Guidelines in place for beneficiaries to have access to participating pharmacies for prescription filling and coverage.

Criteria that determines if a person or group is eligible to receive benefits under the Medicaid program.

Legal regulations intended to prevent and address fraud activities related to receiving benefits under Medicare and Medicaid.

Federal law that addresses and prosecutes fraudulent claims made to obtain Medicare and Medicaid funds.

Federal law that prohibits offering, paying, soliciting, or receiving remuneration to influence referrals for Medicare or Medicaid services.

Services provided by qualified professionals to improve the effectiveness and safety of prescriptions, especially regarding prescription drug costs.

Specific groupings of people (e.g., the elderly) who often qualify.

Beneficiaries receive the same drugs at any community or mail-order pharmacy.

Many insurance plans use preferred pharmacy networks, and some exclude pharmacies.

Pharmacies paid ingredient cost plus dispensing fee, with claims paid within 14 days.

Pharmacies must give patients a printed notice if a prescription isn't covered.

Plans must offer Medication Therapy Management (MTM) programs, and pharmacists can get paid for these services.

Beneficiaries only require 3 chronic diseases to qualify for MTM; the plan must offer MTM for at least 5 of 9 chronic conditions.

Part D plans and pharmacies must address fraud, waste, and abuse; policies and training are required.

Pharmacies supplying Durable Medical Equipment, Prosthetics, Orthotics, and Supplies (DMEPOS) must be accredited, but there are exceptions.

The Anti-Kickback Statute; prohibits knowingly soliciting, receiving, offering, or paying remuneration for referrals or goods/services paid for by Medicare/Medicaid.

Prohibits certain healthcare providers from referring Medicare/Medicaid patients to entities where the provider or family member has financial ties.

Long-Term Care Facilities. Federal rules impact drug storage, administration, and dispensing in LTCFs.

Programs that give incentives to providers for using their products may violate AKS. (e.g. educational grants, research funding, gifts, drug switching fees).

Residents in LTCFs may self-administer medications if the interdisciplinary team approves it.

Excessive doses, duration, or lack of monitoring, and/or adverse consequences, are considered unnecessary medications, hence these should be avoided

Use of psychotropic medications in LTCFs is limited to documented diagnoses and gradually reduced/discontinued when not medically needed. PRN orders are limited to 14 days.

Pharmacies servicing LTCFs are limited to dispensing medications for a maximum of 14 days at a time.

Medicare part covering hospitalizations.

Medicare part covering certain outpatient services.

Medicare part offering managed care options.

Medicare part providing prescription drug benefits.

Specific timeframes for Medicare beneficiaries to enroll.

Prohibits submitting false claims to government programs.

Prohibits inducements for referrals for covered services.

Criteria for receiving Medicaid benefits based on income.

Medicare covers individuals aged 65+, those under 65 with disabilities, those with End-Stage Renal Disease (ESRD), and Amyotrophic Lateral Sclerosis (ALS).

Annual open enrollment from October 15 to December 7 for Medicare Part D plans.

Medicaid covers low-income individuals, families, children, pregnant women, and individuals with disabilities; eligibility is set by states based on federal guidelines.

Federal law prohibiting knowingly submitting false claims for federal programs; penalties for violation include fines and treble damages.

Prohibits offering or accepting remuneration (payment) for referrals in federal programs like Medicare/Medicaid; safe harbors exist for discounts and personal service agreements.

Prevents price discrimination among buyers in competitive markets; exempts nonprofits using the "own use" doctrine.

Prohibits agreements that restrain trade (e.g., price fixing) and monopolization or attempts to monopolize markets under Sections 1 and 2, respectively.

Medicare Part D plans must offer medication therapy management (MTM) for enrollees with multiple chronic conditions.