Section 1
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Date created
Mar 1, 2020
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Section 1
(50 cards)
Specialty tier
highest copay
What does Medicare Advantage Part C cover?
health insurance including preventative care PLUS prescription drug coverage in a single plan; must be within network (doctor, hospital stays, pharmacists, and pharmacies, HMO&PPO)
What act regulates Medicare Part D?
The Medicare Modernization Act of 2003
When does Medicare Part D open enrollment begin?
October 15 - December 7, 2019
Define drug information
- pertains to medication - synonymous with medication information - fundamental responsibility of ALL pharmacists - pt specific OR developed for given pt populations
What does Medicare Part A cover?
inpatient hospital care, skilled nursing facilities (under certain conditions)
Vaccines covered under Medicare Part B
pneumococcal (both), influenza, Hep B for high risk
Medicare Part C
Medicare Advantage Plans
Describe Medicare Part A payment plans
usually no monthly premium, out-of-pocket deductible for hospital stays: Days 1-60 = $1340 Days 61-90 = $335 coinsurance/day Days 91-150 = $670 coinsurance/day Beyond 151 = pt pays all costs
Pros of online drug information
accessible, searchable, abundance of health info, updated easily, educated consumer/HCP
Which drugs are not covered under most Part D formularies?
non-FDA approved, weight loss/gain, erectile dysfunction, cosmetic purpose, non-rx, cough and cold relief, fertility drugs, rx vitamins and minerals (except prenatal and fluoride preps)
What does Medicare Part B cover?
physician services, durable medical equipment, PT, glucose monitors, test strips, lancets, vaccines
Who should apply for Medicare Part D?
people enrolled in Med D plan or switching to different one, people who didn't sign up when eligible, people enrolled in Medicare Advtg. Plan or Medigap Supplemental Insurance plan who want to add/change coverage
Medicare Part D vaccines covered
shingles, Tdap
Tier 1 drugs
lowest copay; most generic Rx drugs
Who doesn't need to apply for Part D?
those with creditable coverage, plans that provide rx coverage (from employer or union) equal to or better than part D
Example of Part D coverage
avg. premium = $32.50 1% of 32.50 = $0.325 12 mth penalty = $3.90 --> +$3.90/month forever
How does Medicare D work with other plans?
each coverage type = payer - primary payer pays up to limits of coverage - secondary payer (Medicare) pays other costs, may not be 100%
Medicare D Standard Plan payment progression
1. Deductible (you pay 100%) $0-435 2. Coinsurance $435-4020; copays based on formulary tiers 3. Donut hole $4020-6350; 25% brand/generic 4. Catastrophic coverage; Medicare pays 95% and unlimited drugs for remainder of year **ALWAYS PAY MONTHLY PREMIUM
When is the Medicare D penalty NOT enforced?
1. the pt wasn't previously eligible 2. creditable coverage 3. qualify for extra help program
Why is drug information important?
answer questions about medication to pt/provider, provide education for all, support clinical services, coordinate P+T committee activity, formulary management initiatives, develop criteria/guidelines for medication use and policies, analyze impact of drug policy decisions, coordinate ADR reporting/analysis programs, manage medication use evaluations, publish/edit information on appropriate medication use in newsletters/websites, manage investigational medication use (IRB activities, info for practitioners)
How many Medicare Advantage plans are available in RI?
16 plans available in RI with drug coverage and 2 without
Medicare Part B
medical insurance
Who does Medicare provide health insurance for?
age >65, age <65 w/ certain disabilities, all w/ end stage renal disease (ESRD), all with Lou Gehrig's Disease (ALS)
Medicare D: what does the explanation of benefits entail?
statement sent by insurance company telling the enrollee which medical services were paid - service: date/place - doctor fee and what was paid - remainder that pt is responsible for - sent monthly
Medicare Part D
Prescription drug coverage
Describe catastrophic coverage
in Part D, kicks in after enrollee has reached total out-of-pocket threshold by Medicare
When does Medicare Part D coverage begin?
January 1
Describe the Medicare Modernization Act of 2003
- adds outpt rx drug benefits to Medicare - rx dispensed by pharmacies (community, mail order specialty) - Part C includes Part D benefits - Part D can be sold alone w/out medical benefits as Rx drug plans by insurance companies - required to provide MTM services to enrollees
Tier 2 drugs
medium copay; most brand rx drugs, preferred
Tier 3 drugs
higher copay; non-preferred, brand rx drugs
Internet Health: Consumers
80% of internet users research health-related information, 86% online women vs. 73% men, 88% online caregivers, college grads>high school
What are criteria for free MTM services?
annual Part D drug costs (members meet criteria), #rx drugs (2-8), prevalence of chronic health conditions (2-3)
Describe Medication Therapy Review (MTR) and Comprehensive Medication Review (CMR)
collect pt specific info, review meds (indications, effectiveness, safety, adherence), ID of medication related problems
Describe (Personal Medication Record) PMR
complete medication reconciliation, ID of drug allergies
How to lower drug costs during the coverage gap
1. ask the dr. about generic and less expensive brand drugs 2. Ask the doctor for samples 3. Pharmaceutical Assistance Programs (RIPAE) 4. Apply for Medicare Extra Health
Purpose of rx drug tiers?
list of covered drugs, aka formulary
Examples of benefit programs through Medicare
Federal Employee Health Benefit Program, Vet Benefits, TRICARE, Indian Health Services
Describe Medicare Part B payment plans
monthly premium (standard $134/month), autodeducted from SS checks deductible = $183, once paid, pay 20% copay
What do Medicare Part D plans cover?
rx drug coverage, standard level of coverage set by Medicare for each drug plan, MTM services
What is MTM?
patient-centered and comprehensive approach to improve medication use, reduce risk of adverse events and inc medication adherence, aim to ID, prevent and resolve med-related issues
MTM core elements
1. Medication Therapy Review (MTR) or Comprehensive Medication Review (CMR) 2. Personal Medication Record (PMR) 3. Medication-Related Action Plan (MAP) 4. Interventions and/or referral 5. Documentation and Follow-up
Who can Medicare D coordinate benefits with?
Employer or union health coverage, COBRA, Medigap, Medicaid, Supplemental Security Income Benefits, State Pharmaceutical Assistance Programs, Long-term care facility, HUD, Food stamps, Health insurance marketplace
initial Med D enrollment: What if their 65th birthday doesn't fall in enrollment window?
7 month penalty free period; 3 months before, bday month, 3 months after
Describe Medication-Related Action Plan (MAP)
provision of action plan to help pts achieve health goals
Who is Medicare funded by?
Centers for Medicare and Medicaid Services (CMS)
Medicare Part A
hospital insurance
Pts who want Rx coverage must obtain it through their Medicare Advtg provider if they offer it; what happens if pt doesn't adhere to the statement?
health coverage under Medicare Advtg will stop and will return to original Medicare
What days does the pt receive the greatest benefit for Medicare part A?
1-60
Describe the penalty for Medicare D
1% increase in premium every month not enrolled
Section 2
(50 cards)
Natural Medicines
detailed monographs, interaction check, effectiveness check, useful charts, only available online
Which HON code principle refer to providing citations/evidence for information provided?
attribution and justifiability
Benefits of Tertiary resources
quick and easy, provides a summary
Describe HON code complementarity
information designed to support, not replace HCP
International Drugs: Martindale - the Complete Drug Reference
extensive monographs, include rx/OTC/natural products, directory of international manufacturers, text published every 2-3 years, available through MICROMEDEX
An article states that their advice is provided by HCPs unless otherwise noted. What is this an example of?
authority
Review of Natural Products
herbs and other dietary supplements (vitamins), historical information, pharmacology, less clinical data, available online through Eanswers
What was concluded from Eysenbach's trial on website quality?
55 or 70% concluded that content quality was a problem on the internet
Where would you find a monograph for a foreign drug?
Martindale or Index Nominum
What is the HON code?
Health on the Net Foundation, est. 1995 - 8 guiding principles
HON Code honesty in advertising
if advertising is source of funding, must be clearly stated; brief description of advertising policy
Sources of drug interactions
1. Hansten and Horn (ceased in 2015) 2. Top 100 Interactions- pocket booklet 3. Drug Info Facts = online thru eanswers
Medication and Mother's Milk (aka Hale)
drug characteristics and known breastfeeding information, lactation risk category, published every 2 years
AFHS Drug Information
collection of monographs, standard reference published annually, online updates, available through LexiComp
LactMed
part of NLM TOXNET, relatively new (introduced in 4/2006), updated monthly
What does orangebook entail?
drug bioavilability
Limitations of Tertiary resources
potential author bias, may be too broad, long time until publication
Describe HON code confidentiality
honor or exceed legal requirements, medical/health information privacy
Infectious Disease: Principles and Practice of ID
aka Mandell, gold standard, extensive coverage of ID and therapy recommendations, published every 5 years, available online
Questions for Quality
- Who developed/owns? - Selling something? - Info referenced? - Names/credentials of authors? - Who maintains? - opportunity for feedback? - How often is web updated? - is it THE source? - comply with the HON code?
What are the 8 guiding principles of the HON code?
authority, complementary, confidentiality, attribution, justifiability, transparency of authorship/sponsorship, honesty in advertising/editorials
HON code justifiability
claims of benefit of specific treatment supported by evidence, evidence is cited (attribution)
Pediatric Drug Information Sources
1. Harriet Lane Handbook 2. Pediatric and Neonatal Dosage Handbook
Facts and Comparisons eAnswers
concise monographs, good comparison tables, ceased print publication in 2017
Drug Topics Red Book
available online through MICROMEDEX; ordering info, NDC #s, orange book code, cost
When evaluating tertiary resources, always consider:
author qualifications, date of publications, appropriateness of citations, relevancy of information, author bias, blatant errors, frequency of publication, ease of use
Infectious Disease: Sanford Guide to Antimicrobial Therapy
organized in tables, quick reference guide, published annually, pocket reference and mobile app (useful for rotations)
International Drugs: Index Nominum - International Drug Delivery
list of drug names worldwide, limited information (structure, chemical name, therapeutic category), directory of intl manufacturers, published every 3-5 years, available through MICROMEDEX
Compatibility/Stability: King's Guide to parenteral mixtures
4 volume binder covering approx 400 drugs, compatibility of LVP solutions w/ other solutions and admixtures, published quarterly as loose-leaf, available online
A website states they are funded by Novartis. This is an example of transparency. T/F
True
Drug's in Pregnancy and Lactation (BRIGGS)
most complete source about drug use in pregnancy, published every 3-4 hours, available online through eanswers and Lexicomp
Adverse Reactions: Meyler's Side Effects of Drugs
arranged by generic name, drug index and ADR index, includes herbal ADR, EXPENSIVE
Literature Search Databases
1. PubMed 2. Embase 3. IPA 4. Cochrane Database
Government Resources
1. FDA (drug at FDA, Medwatch, Orangebook) 2. CDC 3, NIH
Compatibility/Stability: Handbook of Injectable Drugs
aka TRISSELS, IV administration, mixing dose- extensive use in hospitals, text published every 2 years, available online (URI doesn't subscribe)
Cons of online drug information
commercialized, number of hits, peer-reviewed, mis-educated consumer/HCP
General Medicine drug information sources
1. Goldman-Cech Medicine 2. Harrisons Internal Medicine 3. Merck Manual
A pt presents to the Dr. complaining of a rash. Where would you look to see if this is drug induced?
LexiComp
German Commission E
monographs contain very little information, have approved and unapproved uses, but nonsupporting data, some information on contraindications and side effects
How do we evaluate website quality?
self-directed assessment: diligent searching, ask questions, be critical
Pharmacotherapy sources
1. DuPiro (Pharmacotherapy - a patho approach) 2. Koda-Kimble = applied therapeutics
HON code attribution
information on site will be referenced, specific HTML links to data when possible
Describe HON code authority
medication/health advice given only by HCP, clear statement of non-medically qualified persons
HON code transparency of sponsorship
support for website is clearly identified, both commercial and non-commericial
What do drug monographs entail?
administration, adverse effects, classification, contraindications/warning/precautions, pregnancy/lactation, how supplied, indications (FDA approved and off label), interactions, kinetics, MOA, monitoring
Physicians Desk Reference/Prescriber Digital Reference
compilation of package inserts, manufacturers pay to list products, mobile PDR
HON code transparency of authorship
author information provided, webmaster displays email address prominently on site (for visitors to seek further info)
What is drug information used for?
coordinate P and T formulary review meetings, provide in-services for nursing staff, develop medication use guidelines
A site notes that their claims are based off of the PARAGON trial and provides citation. Which HON code principle is this?
justifiability
Examples of Biomedical Journals
- URI eJournal list - URI library catalog - Highwire press = some free - PubMed central = free - Science Direct = expensive
Section 3
(50 cards)
Embase drug search entails...
date, sources, drug fields, drug subheadings, routes of administration, quick limits, EBM/publication types, languages
How to search with PubMed
use query on main page, hit search, results of search are displayed and may be difficult to narrow
A patient visiting the US comes to your consultation window with an empty bottle of paracetamol from his home country. Which reference will help you determine what paracetamol is?
Martindale, Index Nominum, Micromedex
IPA entails...
quick search vs. advanced search, search tools (Thesaurus, command search, Hx/combine, publication type), controlled vocabulary
Are keywords bad?
yes - search less efficient with more to review
Examples of secondary resources
PubMed, Embase, IPA, CINAHL (Cumulative Index of Nursing and Allied Health Literature), PsychInfo
What is a citation?
the way you tell your readers that certain material in your work came from another source
What is an index?
list of citations
Describe Embase
60% overlap with PubMed, covers 7600 journals, expanded international coverage, expensive, controlled vocab, synonyms map to Emtree, understands more natural language
How can automatic term mapping be turned off?
put terms in quotation marks
MeSH
Medical Subject Heading
A nurse asks you if she can mix 2 parenteral products in one bag for IV admin, which reference do you use?
Trissels
MeSH subheading examples
adult, alleles, anticoagulants/PK, AUC, double-blind, human, omeprazole/PK, phenotype, PPI/PK, warfarin/PK
What does the MeSH database consist of?
definitions, pharmacologic action, supplementary concept, subheadings
What type of search term do you use when using PubMed?
Boolean operators - PubMed does not search natural language
MICROMEDEX: if you use drug interactions, reference...
IBM Micromedex Drug Interaction Checking
Other searches with Embase
disease-specific search form, device-specific search form, PICO, PV-Wizard (pharmacovigilence), article search form (no limits, enter knowns)
PubMed is mostly composed of BLANK, dating back from 1966 to present
medline
MICROMEDEX: if you use quick or in-depth answers, reference...
IBM Micromedex DRUGDEX
MICROMEDEX: if you use drug-specific monographs...
reference individual document, not entire database
Who is PubMed maintained by?
NLM (national library of medicine)
What are disadvantages of secondary resources?
have to know how to use them
What is PubMed?
search database to find articles published in biomedical journals, includes citations from 1948-present, international coverage
MeSH: using filters/limits
removes unwanted hits from search results; language, species, publication date, review articles, study design, age
Why do we use secondary resources?
to find reputable journal articles
What can IPA be specifically used for?
compounding, pharmacy management, pharmacy technology, pharmacy law
Medical Subject Headings (MeSH)
terms assigned to articles; consistent way to retrieve information, tree structure is hierarchical
A colleague find an unknown tablet on the floor and asks you what it is. Which reference will you consult to determine what the tablet is?
Clinical Pharmacology
Do PubMed keywords map to MeSH terms? If so, how?
Yes- by automatic term mapping
What is a secondary resource?
direct to primary literature
PubMed term translation
uses automatic term mapping to match search terms w/: 1. MeSH table 2. Journal names 3. author names
What is a field?
portion of each citation (author, journal, volume)
A patients asks you to determine if her St. Johns Wort supplement will interact with her sertraline. You are not sure. Which reference will you consult?
Natural Medicines
What is Major topic?
major topics identified; title, article statement of purpose, can restrict search to a major topic to decrease number of hits
MICROMEDEX: if you use Poisondex, reference...
IBM Micromedex POISONDEX
What is explosion?
search all subterms in MeSH heading, link more general term with specific terms using OR; inc number of hits
What would be the best reference for a community pharmacist regarding natural products?
natural medicines
Old MEDLINE
indexing service from 1948-1965
How to search w/ MeSH
MeSH database or dropdown menu on main PubMed page 1. minimize use of all fields 2. allows use of subheadings 3. Decision on exploding
MeSH Subheadings
further describe the MeSH heading, used to narrow searches; AEs, Drug Therapy, pharmacology, therapeutic use, toxicity, administration/dosage
MICROMEDEX: if you use Redbook, reference...
REPROTEXT format, insert Redbook as reference name
International Pharmaceutical Abstracts (IPA)
covers 800 journals, about 500k citations, introduced to ASHP in 1964, useful for pharmacy specific information
PubMed: if there is no match...
break apart phrase and repeat ATM process until match is found, terms that don't match are searched "All Fields" and then AND'd w/ other search terms
What is Medline?
abstracting service with MeSH indexing
What is controlled vocabulary?
standardized terms for database to get the most effective search; and, not, or
Best source of information for pregnancy/lactation?
briggs
How to find journal abbreviations?
from main PubMed page, click "Journals in NCBI Databases" and type in journal name
Embase advanced search entails...
date, sources, fields, quick limits, EBM, publication types, languages, gender/age/animal
PREMEDLINE
records not yet processed by NLM or not indexed by Medline
Why are secondary resources good?
concentrate information
Section 4
(3 cards)