IPPEXUP2.pdf

Ethics Vocabulary It is essential to understand the meaning of the words in order to grasp the meaning of the statements.  Autonomy Independent choice The patient must: – Understand the options – Understand the consequences of acting on various options – Unders...

Ethics Vocabulary It is essential to understand the meaning of the words in order to grasp the meaning of the statements.  Autonomy Independent choice The patient must: – Understand the options – Understand the consequences of acting on various options – Understand the costs and benefits to them of these consequences in terms of their own values and priorities  “First, do no harm” Not doing harm Nonmaleficence If I do this, will I harm someone? What steps can I take to limit the potential for someone to be harmed?  Obligation to do good Active interventions to prevent harm, Beneficence remove harm, or promote good What are the benefits of my actions?  Pharmacists have a moral obligation in response to the gift of trust received from society Pharmacists promise to help Covenantal individuals relationship – achieve optimum benefit from their medications – be committed to their welfare – to maintain their trust  Fidelity To keep promises, commitments, contracts  To tell the truth – absolute honesty Patient has a right to Veracity know the truth Personal integrity  The patient’s medical information will not be revealed to another person or institution without the patient’s permission. Confidentiality Health Insurance Portability and Accountability Act of 1996 (HIPAA)  Fair distribution of goods and harms Justice (fairness) Fairness in allocation of resources and in your obligations to patients  Purpose- goal, objective Point of View- frame of reference Question- problem to solve Elements of Information- data, observations Thought Concepts- laws, principles, theories Assumptions- taking for granted Conclusions- assessments, decisions Implications- potential outcomes  Oath of a Pharmacist I promise to devote myself to a lifetime of service to others through the profession of pharmacy. In fulfilling this vow: I will consider the welfare of humanity and relief of suffering my primary concerns. I will promote inclusion, embrace diversity, and advocate for justice to advance health equity. I will apply my knowledge, experience, and skills to the best of my ability to assure optimal outcomes for all patients. I will respect and protect all personal and health information entrusted to me. I will accept the responsibility to improve my professional knowledge, expertise, and self-awareness. I will hold myself and my colleagues to the highest principles of our profession’s moral, ethical and legal conduct. I will embrace and advocate changes that improve patient care. I will utilize my knowledge, skills, experiences, and values to prepare the next generation of pharmacists. I take these vows voluntarily with the full realization of the responsibility with which I am entrusted by the public. Pharmacists Help People Live Healthier, Better Lives.  Code of Ethics for Pharmacists PREAMBLE Pharmacists are health professionals who assist individuals in making the best use of medications. This Code, prepared and supported by pharmacists, is intended to state publicly the principles that form the fundamental basis of the roles and responsibilities of pharmacists. These principles, based on moral obligations and virtues, are established to guide pharmacists in relationships with patients, health professionals, and society. I. A pharmacist respects the covenantal relationship between the patient and pharmacist. Considering the patient-pharmacist relationship as a covenant means that a pharmacist has moral obligations in response to the gift of trust received from society. In return for this gift, a pharmacist promises to help individuals achieve optimum benefit from their medications, to be committed to their welfare, and to maintain their trust. II. A pharmacist promotes the good of every patient in a caring, compassionate, and confidential manner. A pharmacist places concern for the well-being of the patient at the center of professional practice. In doing so, a pharmacist considers needs stated by the patient as well as those defined by health science. A pharmacist is dedicated to protecting the dignity of the patient. With a caring attitude and a compassionate spirit, a pharmacist focuses on serving the patient in a private and confidential manner. III. A pharmacist respects the autonomy and dignity of each patient. A pharmacist promotes the right of self-determination and recognizes individual self- worth by encouraging patients to participate in decisions about their health. A pharmacist communicates with patients in terms that are understandable. In all cases, a pharmacist respects personal and cultural differences among patients. IV. A pharmacist acts with honesty and integrity in professional relationships. A pharmacist has a duty to tell the truth and to act with conviction of conscience. A pharmacist avoids discriminatory practices, behavior or work conditions that impair professional judgment, and actions that compromise dedication to the best interests of patients. V. A pharmacist maintains professional competence. A pharmacist has a duty to maintain knowledge and abilities as new medications, devices, and technologies become available and as health information advances. VI. A pharmacist respects the values and abilities of colleagues and other health professionals. When appropriate, a pharmacist asks for the consultation of colleagues or other health professionals or refers the patient. A pharmacist acknowledges that colleagues and other health professionals may differ in the beliefs and values they apply to the care of the patient. VII. A pharmacist serves individual, community, and societal needs. The primary obligation of a pharmacist is to individual patients. However, the obligations of a pharmacist may at times extend beyond the individual to the community and society. In these situations, the pharmacist recognizes the responsibilities that accompany these obligations and acts accordingly. VIII. A pharmacist seeks justice in the distribution of health resources. When health resources are allocated, a pharmacist is fair and equitable, balancing the needs of patients and society. * adopted by the membership of the American Pharmacists Association October 27, 1994. (pharmacist.com)  Center for the Advancement of Pharmacy American  Education (CAPE Outcomes) Association  www.aacp.org/resource/cape-educational- outcomes of Colleges  American Association of Colleges of Pharmacy (AACP) of Pharmacy  Results of the Doctor of Pharmacy Education (AACP)  Included in the syllabi of the LECOM School of Pharmacy  Accredits schools of pharmacy Accreditation Council for Requires reporting and Pharmacy on-site visits Education (ACPE) Monitors performance of graduates  Complete the Doctor of Pharmacy degree Transcripts BOP Forms for degree verification Eligibility Apply for licensure with a state board of pharmacy Pick a state for Research the requirements of that state/jurisdiction Licensure Apply to NABP for eligibility to take their exams https://nabp.pharmacy/programs/naplex/ Registration Bulletin New version each year All states require the NAPLEX MPJE is state-specific Process of Application 1. Apply for licensure with a state board of pharmacy 2. Apply to NABP for eligibility to take the exams 3. The state BOP will notify NAPB after they determine that you are eligible to take the exams 4. NABP will email when you are allowed to purchase your exams 5. Purchase your exam and then you will receive Authorization to Test (ATT) from Pearson VUE 6. Schedule your exam at a Pearson VUE Testing Center (locate testing centers online)   Find the website and the most current information  Find the application for new graduates  Read the application process State Board  What documents do you need to gather and of Pharmacy  submit? LECOM registrar processes paperwork for individual states  [email protected]  [email protected] Exam Administration   Pearson VUE  http://www.pearsonvue.com/nabp/  Testing software tutorial (Pearson VUE Demo)  Rules are specific to the NAPLEX and MPJE Test  Remember other people in the testing center are not under the same rules you are under administration  It is your responsibility to know your rules  Video of security procedures  https://home.pearsonvue.com/test- taker/security.aspx   The number of items on the exam is 225  200 count toward the score  25 are pre-test questions (not scored)  It is impossible to know which count NAPLEX  The time to take the exam is 6 hours with two Format 10-minute breaks that are scheduled and optional  The examination is not modified based on your choices   “Majority” of questions are asked in scenario- based format  Patient profile NAPLEX  Medical record Require scrolling, clicking tabs Format  Continued  Scoring uses difficulty weighting  All questions must be answered in order, cannot skip NAPLEX  Pass or Fail  If you fail, you will receive a Scoring report of your relative performance on the 6 major competency areas NAPLEX Blueprint  Area 3 – 35%  Clinical determination of medication without an indication, untreated conditions, duplication of therapy  Contraindications, precautions, adverse effects, drug interactions  Application of clinical guidelines  Area 4 – 14%, Calculate:  Patient factors such as BSA, CrCl, ANC  Quantities of drugs to dispense and use for compounding  Nutrition, rates of administration, dose conversions, drug concentrations  Biostatistics and pharmacokinetics NAPLEX Blueprint  Area 5 – 11%  Sterile and non-sterile compounding including hazardous  Drug product properties for stability, compatibility, pharmacokinetics  Storage, packaging, disposal  Area 6 – 7%  Medication safety with the medication-use system  Prevention, screening, vaccination, antimicrobial stewardship MPJE Content  Laws and regulations that must be followed in pharmacy practice  Federal  State  Questions ask what pharmacists need to do in order to act in compliance with all the laws or regulations that relate to the action described  Board of Pharmacy members in each state write questions  Study resources from NABP https://nabp.pharmacy/resources/publications/  Pre-MPJE is available for $65  Students are responsible to apply Licensure   Must apply for licensure with at least Process one state  Register with NABP to take the exams  Schedule exams at Pearson VUE testing center  State-specific variations in the process and the requirements  MPJE is state-specific   Required to renew the pharmacist license  States set requirements through legislation  Pharmacy Practice Act Continuing  States clarify requirements through rules  Boards of Pharmacy Education  Number of hours are specifically defined  Certain subjects may be required  Manner of learning may be specific, such as requiring some hours received in live sessions What is a pharmacy residency?  It is a post-graduate training program for pharmacists that lasts 1 year  Involves developing clinical skills in:  Direct patient care  Practice management  Pharmacy residency is optional but is highly encouraged for those interested in further refining their clinical skills after graduation Residency Research  In both a PGY-1 and PGY-2 residency, pharmacists will be required to conduct a 1-year long research project  These projects primarily focus on improving patient care, increasing opportunities for pharmacists, or implementing new services  After completing a research project, residents may be required to present posters or presentations at conferences  Some may require research to be published in a journal Academia/Teaching  Some residencies may offer opportunities for residents to teach at a college of pharmacy  Residencies may also offer a teaching certificate which increases chance of acquiring a faculty position at a college of pharmacy  Completion of a teaching certificate may be optional or required depending on the residency Other Components of a Residency  Residencies can also include:  Resident to present a continuing education presentation  A medication-use evaluation  Precepting advanced pharmacy practice experiential (APPE) students  Additional opportunities to attend conferences Accreditation of Residencies  American Society of Health System Pharmacy (ASHP) is the organization that oversees and accredits most pharmacy residencies  Some organizations, such as Indian Health Services, provides their own residencies separate from ASHP  ASHP also hosts their national conference “Mid- Year” for pharmacy students to scope out potential residency programs ASHP Midyear Conference  National conference for residency programs to meet and scope out new candidates  Conference occurs each year in December  Opportunity to network and become involved! https://www.qleanair.com/qa/resources/15/1512463300878/ASHP%20QA2_f48b.jpg What is a fellowship?  A pharmacy fellowship is a postgraduate program that prepares a pharmacist to become an independent researcher  Focuses to develop competency in scientific research process  Most fellowships focus on training individuals to prepare for drug development & design Types of Fellowship  Traditional Fellowships:  Academic fellowship that focus on research (up to 80% of time) and clinical experience (20% of time)  Industry Fellowships:  Fellows work in a pharmaceutical industry to gain experience in different departments of a company  May include drug information, health economics, and pharmacovigilance Residencies vs. Fellowships Residencies Fellowships  Always 1 year  May be >1 year  Always requires licensure  May or may not require licensure  Typical settings are hospital,  Typical settings are pharmacy outpatient, or community school or industry  Accreditation is through ASHP  No formal accreditation process  A lot of patient interaction  May not include patient interaction Both are very competitive What is board certification?  Board certification is when a pharmacist becomes certified in a specialized area of practice  The Board of Pharmacy Specialties (BPS) is the organization that offers board certifications to pharmacists  Certification usually requires certain number of years of experience and passing a certification exam  BPS certification may help increase job opportunities and may even be a requirement for certain jobs Basic Insurance Principles MATT IE FOLLEN, PHARMD, MS  Important Key Words Beneficiary – the person eligible for benefits under the insurance policy Deductible – the amount the beneficiary/member owes for covered health care services before the health insurance or plan begins to pay Copayment – an amount the beneficiary pays as their share of the cost for a medical service or item (i.e., doctor’s visit) Coinsurance – the beneficiaries' share of the cost for a covered health care service ▪ Usually calculated as a percentage of the allowed amount for the service Premium – the amount the beneficiary pays for the health insurance or plan each month Network – the doctors, hospitals, and suppliers the health insurer has contracted with to deliver health care services to their members  What is insurance anyway? Insurance: contractual agreement in which one party (insurer) agrees to reimburse another party (insured) for losses that occur under the terms of the contract You (or someone on your behalf) pays a premium to the insurance company to transfer the “risk” from you to them Types of insurance ▪ Life ▪ Home ▪ Auto ▪ Disability ▪ HEALTH  Medicare THE U.S. GOVE RN ME NT FUNDE D HEALTH CARE MOD EL  Where did Medicare come from? Social Security Act of 1935 ▪ Passed as part of “New Deal” reforms under FDR ▪ Designed to provide some material needs of Americans, particularly the elderly – NOTE: NOT HEALTH INSURANCE 1950’s – Idea of universal health care is proposed, debated, and ultimately abandoned in congress  Where did Medicare come from? 1965 – Lyndon B. Johnson re-elected ▪ Congress brings together 3 separate pieces of legislation 1. Hospital care for elderly (Part A) 2. Optional physician services (Part B) 3. Need based health insurance for the poor – state & federal funds (Medicaid) 1990s-2000s – Expansion of Medicare parts C & D 2010 – Affordable Care Act  Department of Health & Human Services Responsible for 18% of overall federal spending (2018) ▪ $3.5 trillion dollars (more than any other country in the world) Notable agencies housed under HHS ▪ Centers for Medicare & Medicaid Services (CMS) – largest of all agencies housed under HHS ▪ Health Resources & Services Administration (HRSA) ▪ Indian Health Service (IHS) ▪ Food & Drug Administration (FDA) ▪ National Institutes of Health (NIH) ▪ Agency for Healthcare Research & Quality (AHRQ) ▪ Centers for Disease Control & Prevention (CDC)  Medicare Federal health insurance program for: ▪ People who are 65 years or older ▪ Certain younger people with severe disabilities ▪ People with end-stage renal disease (ESRD) Covers 62 million Americans In 2020, the Medicare program cost $776 billion – about 12% of total federal government spending  Part A and Part B Premiums Most people do not pay a monthly premium for Part A ▪ “Premium-free Part A” If beneficiaries do not qualify for premium-free Part A, they can buy Part A Everyone pays a monthly premium for Part B  How Does Medicare Work? Beneficiaries have options in how they get coverage with Medicare Once enrolled, they will need to decide how they will get Medicare coverage There are two main ways: ▪ Original Medicare ▪ Medicare Advantage How Does Medicare Work? Original Medicare ▪ Includes Part A (hospital insurance) and Part B (medical insurance) ▪ Beneficiaries pay a deductible at the start of each year and usually pay 20% of the cost of the service (coinsurance) ▪ Up to the maximum out-of-pocket cost ▪ Beneficiaries may choose to add a separate drug plan (Part D) ▪ Pays much, but not all, of the cost for covered health care services and supplies ▪ A Medicare Supplement Insurance (Medigap) policy can help pay some of the remaining health care costs How Does Medicare Work? Medicare Advantage (Part C) ▪ Includes services covered by Part A, Part B, and usually Part D ▪ “All in one” alternative to Original Medicare ▪ Most plans offer extra benefits that Original Medicare does not cover (vision, hearing, dental, etc.) ▪ Must follow Medicare’s coverage rules ▪ Each plan can charge different out-of-pocket costs and have different rules for how members get services  Medicare Prescription Drug Coverage (Part D) Helps pay for prescription drugs Members join a Medicare-approved plan that offers drug coverage ▪ Each plan can vary in cost and specific drugs covered ▪ Medicare drug coverage includes generic and brand-name drugs ▪ Plans can vary the list of prescription drugs they cover (formulary) and how they place drugs into different "tiers" on their formularies Plans have different monthly premiums Beneficiaries will also have other costs throughout the year in a Medicare drug plan ▪ How much they pay for each drug depends on which plan they choose  Medicare Part A Hospital insurance program Costs ▪ Free to anyone receiving social security ≥ 65 years of age ▪ Free to anyone who worked in a government job ▪ Free to those < 65 who: Collect social security disability benefits Has end stage renal disease requiring dialysis or transplant  Medicare Part A Covered services: ▪ Inpatient hospitalizations ▪ Skilled nursing facilities ▪ Home health care after a hospitalization ▪ Hospice care ▪ Emergency care outside U.S.  Medicare Part B Those eligible for Part A can enroll in Part B for about $104.90 per month Eligibility ▪ Anyone who is eligible for Part A can participate in Part B ▪ OPTIONAL coverage (~93% of patients enroll) ▪ Monthly cost deducted from social security check ▪ People that would have to pay for Part A can enroll in Part B without purchasing Part A  Medicare Part B Covered services: ▪ Outpatient medical care ▪ Physician and outpatient hospital services ▪ Home health care NOT covered by Part A ▪ Vision ▪ Physical therapy ▪ Mental health ▪ Laboratory ▪ Mammography and other cancer screenings  Medicare Part C Medicare Advantage “Medicare Advantage Plans” ▪ Combines services of Part A, Part B, and usually Part D into one insurance Supplemental premiums may be charged to offer additional services In 2021, more than 26 million people were enrolled in a Medicare Advantage plan, accounting for 42% of the total Medicare population Plans are administered by PRIVATE insurance providers ▪ Cost is determined by the private plan ▪ Must be “equivalent” to coverage provided by A & B NOT EXACTLY THE SAME!  Medicare Part D Benefits offered by private insurance providers Eligibility ▪ Anyone who has Part A or Part B can enroll in Part D ▪ Anyone with Part C probably already has prescription benefits in the plan and therefore does not have Part D  Medicare Part D – Costs ▪Cost of the plan and copay structure depend on plan particulars ▪ Monthly premium: ~$30 per month ▪ Deductible: ~$445 ▪Initial coverage period Coinsurance/copays vary by plan and by drug within plan In most plans, after spending about $4,130 in total drug costs, beneficiaries reach the coverage gap ▪Coverage gap (prior to 2020) During the coverage gap, beneficiaries pay 45 – 65% of the cost of their drugs In all plans, after spending $6,550 out of pocket, beneficiaries leave the coverage gap and reach catastrophic coverage ▪Catastrophic coverage During this period, beneficiaries pay 5% of the cost for each of their drugs, or $3.70 for generics and $9.20 for brand-name drugs (whichever is greater) Key Point: The dollars for various stages are based on the CASH PRICE for the drugs NOT COPAY AMOUNT Medicare Part D Closing the Coverage Gap ▪The donut hole is closing for all drugs (2020) ▪ When beneficiaries enter the coverage gap, they will be responsible for 25% of the cost of their drugs ▪ They were previously responsible for a higher percentage of the cost of their drugs (i.e., 45% for brand drugs and 65% for generic drugs) ▪Beneficiaries may still see a difference in cost between the initial coverage period and the donut hole ▪ If a drug’s total cost is $100 and they pay the plan’s $20 copay during the initial coverage period, they will be responsible for paying $25 (25% of $100) during the coverage gap  Medicare Part D Variations in standard plan ▪ Benefit and cost sharing structure can vary by plan ▪ Most used Managed Care philosophies to create: Tiered co-pays Systems of Prior Authorization and Formulary Restrictions ▪ Prices can be negotiated with manufacturers by individual plans but NOT Medicare itself Formulary requirements ▪ Every plan MUST have at least 1 medication in every class on formulary Medicare recipients enroll or make changes in Part D plans through the government Medicare member portal: ▪ Plan Finder webpage at www.medicare.gov  Medicare Prescription Drug, Improvement and Modernization Act of 2003 Created Medicare Part D ▪ Voluntary prescription drug benefit Administered by prescription drug plans (PDPs) ▪ Formularies ▪ Patient cost sharing ▪ At least 20 to choose from A total of 45 million people with Medicare are currently enrolled in plans that provide the Medicare Part D drug benefit, representing 70% of all Medicare beneficiaries Five dominant companies ▪ UnitedHealth, Humana, CVS Caremark, Coventry Health Care, Express Scripts  Medicare Prescription Drug, Improvement and Modernization Act of 2003 Medication Therapy Management ▪ “…program that may be furnished by a pharmacist that is designed to ensure that covered medications are used appropriately to optimize therapeutic outcomes through improved medication use, and to reduce the risk of adverse events, including adverse drug interactions.” ▪ Targeted beneficiaries Multiple chronic diseases (diabetes, asthma, hypertension, hyperlipidemia, congestive heart failure) Multiple covered drugs Drug costs above $4000/year ▪ Optimize therapeutic outcomes and reduce risk of adverse effects and drug interactions  Out-of-Pocket Costs Beneficiaries’ expenses for medical care that are not reimbursed by insurance ▪ Out-of-pocket costs include deductibles, coinsurance, and copayments for covered services plus all costs for services that are not covered Medicare pays only about ½ of health expenditures ▪ Medicare households spend 14% of their budgets on health care (3 times more than non-Medicare families) ▪ Out-of-pocket average per year is $4734  Medigap Coverage Medicare Supplement insurance that helps fill “gaps” in original Medicare ▪ Sold by private companies Medicare does not cover everything! Medigap policy can help pay some of the remaining health care costs, including: ▪ Copayments ▪ Coinsurance ▪ Deductibles  Medigap Policies Things to Know ▪Beneficiaries must have Medicare Part A and Part B ▪ Only supplements Original Medicare benefits ▪Beneficiaries pay the private insurance company a monthly premium in addition to the monthly Part B premium that they pay to Medicare ▪Medigap policies only cover one person ▪Medigap policies are NOT allowed to include prescription drug coverage  Medigap Policies Things to Know Medigap policies do not cover everything Services typically not covered: ▪ Long-term care ▪ Vision or dental care ▪ Hearing aids ▪ Eyeglasses ▪ Private-duty nursing  Medicare Funding Overseen by the Department of the Treasury ▪Part A – Hospital Insurance (HI) Trust Fund ▪Part B – Supplemental Medical Insurance (SMI) Trust Fund ▪Part C – does not have a distinct funding source Draws from the HI and SMI funds ▪Part D – Prescription drug plans SMI funds pay for some Part D prescription drug coverage Medicaid STATE INSURAN CE  Remember your history… Part of the SSA amendments passed in 1965 ▪ “Grants to the States for Medical Assistance Programs Provide medical care (insurance) for low-income individuals & families  Medicaid State program to provide health care to low-income Americans No State is REQUIRED to have a Medicaid program, but all states have them During the 2020 policy year, over 75 million Americans enrolled in their states’ Medicaid and CHIP programs Total Medicaid spending (including the federal and state share) in 2020 was $359.6 billion  Medicaid Voluntary state participation (all have participated since 1982) Federal government pays at least ½ of expenses States administer the program under federal oversight State budget expenditures for Medicaid are only exceeded by their expenditures for education  Medicaid Eligibility Income based (varies between states) AND Categorically needy: ▪ Children ▪ Pregnant women ▪ Elderly ▪ Disabled ▪ Parents Medically needy are covered by many states ▪ Do not meet income requirements, but have high medical costs  Medicaid Coverage COMMONLY COVERED, BUT STATES MUST COVER: OPTIONAL: ▪ Inpatient and outpatient ▪Prescription drugs hospital services ▪Clinic services ▪ Physician, midwife, and NP services ▪Prosthetics ▪ Laboratory and X-ray ▪Hearing aids ▪ Nursing home and home health ▪ Screening, diagnosis, and ▪Dental care treatment for children