What does managed care mean in pharmacy?
What does managed care mean in pharmacy?
Managed Care Pharmacy is the practice of developing and applying evidence-based medication use strategies that enhance member and population health outcomes while optimizing health care resources.
What did OBRA 90 do?
The federal Omnibus Budget Reconciliation Act of 1990 (OBRA-90) established a new condition of participation for federally funded and state-managed Medicaid programs. OBRA-90 establishes standards for state Medicaid programs and not for pharmacists.
Which of the following issues is the most likely target of OBRA mandated Dur for Medicaid patients?
Which of the following issues is the most likely target of OBRA-mandated DUR for Medicaid patients? DURs screen for therapeutic duplication, drug-disease contraindications, drug-drug interactions, incorrect drug dosage, incorrect duration of treatment, drug-allergy interactions, and clinical abuse/misuse of medication.
What is the approved list of prescription drugs that managed care plans provide for their enrollees called?
Each Medicare drug plan has its own list of covered drugs. This is called a formulary (drug list). Our formulary lists the drugs covered by our Medicare plans. You can search the list by the name of your medication.
What is a managed healthcare organization?
What is a managed care organization? A managed care organization or MCO is a health care company or a health plan that is focused on managed care as a model to limit costs, while keeping quality of care high.
What does Amcp stand for?
Academy of Managed Care Pharmacy
AMCP (Academy of Managed Care Pharmacy) is a professional organization representing the interests of pharmacists who practice in managed care settings. It publishes the Journal of Managed Care & Specialty Pharmacy.
What is the main goal of OBRA?
The primary goal of OBRA is to establish uniform standards for nursing homes and ensure the protection and safety of patients. For example, under OBRA, nursing homes must be inspected annually.
Why is OBRA important?
The Omnibus Budget Reconciliation Act (OBRA), also known as the Nursing Home Reform Act of 1987, has dramatically improved the quality of care in the nursing home over the last twenty years by setting forth federal standards of how care should be provided to residents.
Which of the following medication purchases may be tracked using MethCheck?
Which of the following medication purchases may be tracked using MethCheck? Correct because pseudoephedrine is a methamphetamine precursor, and MethCheck allows pharmacies to log and track pseudoephedrine transactions in compliance with the Combat Methamphetamine Epidemic Act of 2005.
Who is responsible for completing a drug utilization review?
Pharmacists routinely perform prospective reviews in their daily practice by assessing a prescription medications dosage and directions while reviewing patient information for possible drug interactions or duplicate therapy.
What is the best prescription drug plan for seniors?
The 5 Best Medicare Part D Providers for 2021
- Best in Ease of Use: Humana.
- Best in Broad Information: Blue Cross Blue Shield.
- Best for Simplicity: Aetna.
- Best in Number of Medications Covered: Cigna.
- Best in Education: AARP.
Which type of managed care program usually has the most restrictions?
HMOs tend to be the most restrictive type of managed care. They frequently require members to select a primary care physician, from whom a referral is typically required before receiving care from a specialist or other physician. HMOs usually only pay for care within the provider network.
What does managed care mean for a pharmacy?
Managed care pharmacy has developed a variety of managed care pharmacy strategies utilized by commercial health plans and government-managed programs like Medicaid and Medicare that are used to moderate costs while providing a safe, clinically effective, and valuable prescription drug benefit.
What’s the difference between Dur and Obra 90?
The Pharmaceutical Care Management Association (PCMA) says DUR is a “structured, ongoing program that interprets patterns of drug use in relation to predetermined criteria and attempts to prevent or minimize inappropriate prescribing. DUR may be conducted retrospectively or prospectively, and OBRA ’90 mandated both types.”
What does EPA stand for in managed care?
Prior authorization (PA) is a process designed to ensure that the medications patients receive are safe, effective, and provide the greatest value. ePA is an automated PA process which provides real-time responses. Managed care pharmacists take care to ensure that medication is used appropriately in their patient population.
How are medications assigned to tiers in managed care?
Medications are assigned to tiers based on medication usage, cost, and, most importantly, effectiveness. Tier 1 drugs are the most accessible to patients in terms of usage and lower out- of-pocket costs. The higher tiers will have different copay responsibilities due to the higher cost of the medications.
