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Week 3 Notes
Recalls, Schedules, formulary, HIPAA, JCAHO
| Question | Answer |
|---|---|
| Class I | severe adverse health consequences or death |
| Class II | temporary or medically reversible adverse health consequences |
| Class III | not likely to cause adverse health consequences |
| JCAHO | Joint Commission on Accreditation of Healthcare organization |
| offers voluntary accreditation-if do not have accreditation you cannot bill medicare or medicaid | |
| HIPAA | Health Insurance Portability & Accountability Act |
| requires adoption of security and privacy standards in order to protect personal healthcare information | |
| Controlled Substance Act | classify drugs into schedules based on their abuse potential-lower number more abusive |
| Schedule I | -highest abuse potential-No Rx, No refills, prison-no currently approved use in U.S.-most likely a hallucinogenic |
| peyote | -Sched. I drug-trafficed and monitered by DEA & tribal council-can be used by registered Native American tribes for religious ceremonial purposes |
| marijuana | -Sched I-over 500 chemicals in -over 400 chemicals found for treatments-used only to treat glacoma-Not hallucinogen-1 joint has the carcinogens of 1 pack of cigs. |
| Schedule II | -dugs with high potential for abuse with severe psychological &/or physical dependence liability-No refills-must be filled w/in 72hrs of being written-can be taken over phone in case of emergency,written Rx must be there in 7days-Hospice fill any |
| Top 3 Schedule II | -amphetamines(Adderall)-CNS stimulant-methylphenidate(Ritalin)-oxycodone(Oxycontin) |
| Schedule III & IV | can have 5 refills in 6 month period |
| Schedule III | hydracodone-APAP -Ibu -lortab -vicaprofen or vicaden |
| Schedule IV | alprazolam (Xanax) |
| Schedule V | -No Rx needed-need valid ID-must be 18-have to sign for |
| #1 Schedule V abuse | Sudafed b/c of psuedophedrine |
| NDC (National Drug Code) | -11 digits -first 5 digits is manufacturer/distributor |
| Labels for Schedule II | -Controlled substance, dangerous unless used as directed-Caution: Federal law prohibits the transfer of this drug to any person other than the patient for whom it was prescribed. |
| formulary | pharmaceuticals available &/or approved |
| evidence granting prior approval for nonformulary drugs usually must indicate: | -patient intolerance of existing drug choices-treatment failures-diagnoses w/o any listed treatments on the formulary-new drug modalities |
| AWP (average wholesale price) | cost of drugs and Rx purchased from a drug wholesaler |
| MAC (maximum allowable cost) | based on wholesaler acquisition costs |
| wholesaler acquisition costs | include contracts negotiated btwn the provider & the Rx industry |
| prior approval | prescriber must demonstrate evidence for an individual patients need for a medication outside the approved formulary for it to be reimbursed |
Created by:
amkass
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