APP Exam 2

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What are some ways of meeting each standard that patients use to evaluate services?

(Basically—- what can we do to meet the standard of good care)

(Ex: the standard is “fairness”, to meet that standard or be FAIR we can treat customers in the order they arrive to the pharmacy)

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1

What are some ways of meeting each standard that patients use to evaluate services?

(Basically—- what can we do to meet the standard of good care)

(Ex: the standard is “fairness”, to meet that standard or be FAIR we can treat customers in the order they arrive to the pharmacy)

  • responsiveness (give prompt service)

  • assurance (be knowledgeable)

  • empathy (be caring)

  • friendliness (be polite)

  • RELIABILITY- receive the promised service dependably and accurately. also accurate prescription filling and patient counseling

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2

A service failure is when you fail to meet the expectations of a patient. In order to recover from a service failure, you choose a service ____________ effort and they are classified as low, mid, or high criticality. FYI

recovery

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3

What are the specific service recovery efforts for low-mid, and high criticality?

  • low- and mid-criticality— Apology, Empathy, Follow-Up, Discount/Refund, Sincerity

  • HIGH-CRITICALITY— Attempt to compensate for costs related to time, money, and inconvenience through financial settlements

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4

Identify ways to develop pharmacy staff members to provide good customer service?

  • hire employees with a caring, attitude, empower, support, encourage, and model

  • ensure employees quality of work life and job satisfaction, make customer service EVERYBODY’s job

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5

List in order the recommended steps for dealing with “difficult patients”

  1. Let the customer VENT

  2. avoid getting trapped in a negative filter

  3. express empathy to pt.

  4. begin active problem solving

  5. mutually agree on a solution

  6. follow-UP

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6

What is sensemaking?

a cognitive process that occurs before using an EDM to help make sense of a difficult situation

(basically: identify/evaluate a problem prior to EDM)

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7

3 steps of sensemaking:

  1. Learn

  2. Plan

  3. Act

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8

List the 5 different types of Ethical Decision-Making Models.

  1. Markula Center Framework

  2. PLUS model

  3. Rationalist Model

  4. Non-Rationalist Model

  5. Integrated Model

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9

Describe the following EDM model:

Markula Center Framework

  • provides specific examples of what ethics is not (feelings, religion, abiding by laws, following norms/scientific data)

  • aimed towards making decisions as an INDIVIDUAL

  • Utilizes classic philosophical perspectives to evaluate potential solutions

    • Utilitarianism, Rights-based, Justice-based, common good, virtue-based

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10

Describe the following EDM model:

PLUS Model

  • provides context for making decisions within ORGANIZATIONS

  • Utilizes ethical “filters” rather than classic philosophical perspectives

    • policies, legal, universal, self

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11

Describe the following EDM model:

Rationalist Model

  • ability to reason ethically is dependent on COGNITIVE DEVELOPEMENT STAGE

  • REASONING THAN JUDGEMENT

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12

Describe the following EDM model:

Non-Rationalist Model

  • JUDGEMENT THAN REASONING

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PRACTICE:

Does the rationalist or non-rationalist use reasoning before judgement?

rationalist

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14

Describe the following EDM model:

Integrated Model

  • integrates rationalist and non-rationalist approaches

2 key components:

  1. EDM process follows similar stepwise approach to Markula and PLUS model

  2. Recognizes MODERATING FACTORS can influence process —> issue, organization, personal factors

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15

What are the benefits of feedback?

  • reinforce good performance

  • poor performance corrected

  • provides steps for improvement

  • encourage self-reflection

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16

What are some components of effective feedback? (pretty much common sense)

  • provide in a private area

  • timely, regular, specific, descriptive

  • focus on BEHAVIORS not TRAITS

  • limit info provided

  • receive input for others

  • provide steps for improvement

  • limit info to 2-3 behaviors at a time

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17

What is the difference between feedback and evaluation?

feedback- more frequent and informal. asseses a specific task/skill

evaluation- more reflective of overall performance, judgement of achievement of goals

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18

What are 3 approaches to giving feedback? (just the names)

  1. sandwich approach

  2. Pendleton 4-step method

  3. ARCH Model

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19

What is the “sandwich method” for providing feedback?

  • it’s like a “sandwich”

    • positive feedback, then negative, then positive

  • softens blow of corrective feedback (possible downside)

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20

What is the “Pendleton 4-step method” for providing feedback?

  • 2-sided discussion that DOES NOT INCLUDE steps for improvement

  • FYI ———How it works:

    • What learner feels they’re doing well

    • What manager thinks they’re doing well

    • What learner feels they need to improve

    • What manager thinks they need to improve

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21

What is the “ARCH Model” for providing feedback?

  • 2-sided discussion that DOES INCLUDE steps for improvement/ improvement plan

  • may take extra time

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22

Asking questions to a person being evaluated to assist them in self-reflection is the definition of…

facilitative questioning

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23

What are the 2 types of negotiating?

  1. principal- goal of solving problem in a way that is mutually beneficial/agreeable to both sides—- (looking for a win-win scenario)—— 4 aspects: people, interests, options, and criterea

  2. positional- GOAL OF WINNING! GOAL OF CONVINCING THEM TO CONVERT TO YOUR POINT OF VIEW

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24

For principled negotiations what is key?

communication and listening skills

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25

What does BATNA stand for? What does it mean?

BATNA- Best alternative to negotiated agreement

  • basically the “bottom line”

  • if you have having a negotiation and can’t agree, the BATNA is the best option

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26

How do you approach a tense situation?

  • reassure

  • mirror

  • empathize

  • employ labeling

  • slow down

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27

What are the 3 types of negotiators? Briefly describe each.

  1. Analytical- methodical will want to analyze info deeply before agreeement

  2. Accommodator- values relationship> everything, may agree to less reasonable solutions if it keeps people happy

  3. Assertive- values time, wants quick resolution, self-focused

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28

Deception, extreme offers, arbitrary deadlines (fake deadline to rush you), personal attacks, ambiguous authority, good cop/bad cop are all examples of….

dirty tricks

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29

Motivational Interviewing is useful to help strengthen what?

another party’s commitment to a new idea/option

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30

What mnemonic is used for Motivational interviewing?

DARN-CAT

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31

What does DARN-CAT stand for?

DARN- prep talk to assess readiness

  • Desire, Ability, Reasoning, Need

CAT- action

  • Commitment, Activation, Taking steps

<p>DARN- prep talk to assess readiness</p><ul><li><p>Desire, Ability, Reasoning, Need</p></li></ul><p>CAT- action</p><ul><li><p>Commitment, Activation, Taking steps</p></li></ul><p></p>
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32

What some example of leadership theories? FYI

  • trait theories

  • behavioral theories

  • situational theories

(Dr. Z has a test question on each of these)

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33

The trait theory says that what personality characteristics could distinguish leaders from non-leaders?

  • extroversion

  • agreeableness

  • emotional stability

  • high energy/self confidence

  • others: conscientiousness, openness

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34

DESCRIBE the LAISSEZ-FAIRE behavioral theory:

  • THINK: EMPLOYEEEEEEE

  • laissez-faire leaders allow employees to have complete autonomy, set their own goals, and work toward them without interrupting

  • EX: A LAISSEZ-FAIRE LEADER WOULD NOT MENTION A NEW IDEA UNLESS THE EMPLOYEES CAME TO HIM WITH IT AND THE LEADER WOULD THEN ALLOW THE EMPLOYEES TO DEVELOP THE ENTIRE PROGRAM AND IMPLEMENT THE PLAN

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35
<p><span style="color: blue">From this chart, what does the blue highlighted box mean in terms of the behavior of the leader?</span></p>

From this chart, what does the blue highlighted box mean in terms of the behavior of the leader?

  • leader turns over ALL DECISIONS AND RESPONSIBILITIES for completing tasks, reaching goals, and follower implementation.

    • “delegating”

  • leader MAY BE AVAILABLE FOR CONSULATION, but usually maintains low profile

  • THINK: HANDS OFF, IMMA JUST WATCH and if you need me I’m here

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36
<p><span style="color: blue"><strong>For this chart, “delegation” or S4 has what type of followers?</strong></span></p>

For this chart, “delegation” or S4 has what type of followers?

R4 or HIGH

they are ABLE, WILLING, and CONFIDENT

<p><span style="color: blue">R4 or HIGH</span></p><p><span style="color: blue"><strong>they are ABLE, WILLING, and CONFIDENT</strong></span></p>
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37

What are the 4 components of the situational leadership model?

  • TASK ORIENTATION BEHAVIOR

  • RELATIONSHIP ORIENTATION BEHAVIOR

  • FOLLOWER READINESS OR MATURITY

  • LEADER EFFECTIVENESS

(task and relationship oriented, mature followers, effective leader)

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38

What is the definition of:

  • asset

  • financing

  • liabilities

  • owner’s equity

  • capital

  • liquidity

  • fiscal year

Definitions:

o Asset – things that are owned that can be used to generate income

o Financing – money needed to acquire assets

o Liabilities – money owed to others

o Owner’s equity – owner’s funds

o Capital – money used to acquire land, buildings, and equipment

o Liquidity – how much cash is currently on hand to pay bills, etc.

o Fiscal Year – unit of time (1 year) that businesses use to record financial interactions

  • Not always the same as the calendar year

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39

What is accrual vs. cash accounting?

  • accrual—> revenue/expenses tallied when they are incurred

    • ex: If you provide a service in December but receive payment in January, you record the revenue in December. (AKA WHEN IT OCCURED)

  • cash—> revenue/expenses tallied when they are paid

    • ex: If you receive a payment in January for a service provided in December, you record the revenue in January. (AKA WHEN YOU WERE PAID)

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40

What’s the difference between capitation and per diem?

capitation- fixed amount received per patient per month/year

per diem- payment received at a daily rate

(think: per diem= per day aka you receive money at a daily rate)

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41

What’s the difference between “value-based payments” and “fee for service”?

“value-based payments”- reimbursement rate based on QUALITY OF CARE received

  • most patient/positive outcome focused

“fee for service”- payment based on NUMBER OF visits/tests/services received

  • more focused on numbers> care

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42

What is a vertical healthcare system?

organization with group of related, but not identical providers

  • ex: a healthcare system that includes PCPs, specialists, hospitals, rehab centers, and nursing homes. like LECOM with all it’s dif buildings

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43

What is a horizontal healthcare system?

organization with group of similar providers

  • ex: several hospital/clinics joining together

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44

What are the 4 C’s of finance?

(said not to worry about in review)

  • COST measurement/minimization

  • CASH management/sufficiency

  • CAPITAL access/acquistion

  • CONTROL of resources

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45

Sole proprietorship vs. Partnership vs. Corporation

  • sole-proprietorship: individual owning business

  • partnership: multiple individuals owning a business

  • corporation: legal entity separate from owners/shareholders

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46

What type of business organization protects owners/shareholders from liability?

corporation

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47

What are a couple types of hybrid business organizations?

  • limited partnership (LP)- like partnership but limited partners only liable for initial investment

  • limited liability partnership (LLP)- partners only liable for their own malpractice

  • limited liability company (LLC)- similar liability to stockholders, taxed like partners

  • professional cooperation/association (PC/PA)- includes benefits of incorporation but still liable for malpractice

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48

What is a snapshot of an organization’s assets, liabilities, and shareholder equity at a point in time?

balance sheet

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49

What provides info about income/expenses over a given time period?

income statement

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50

What records inflow/outflow of cash?

statement of cash flows

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51

How do you calculate gross profit margin?

gross profit margin= (total sales- cost of goods sold) / total sales

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52

How do you calculate net profit margin?

net profit margin= net income after tax/ total sales

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53

How do you calculate current ratio?

current ratio= current assets / current liabilities

(current assets= cash, accounts, inventories)

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54

For a current ratio what is considered low and high?

<2 = low assets/ too risky

>5 = high assets/ too conservative

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55

How do you calculate quick ratio?

quick ratio= quick assets/ current liabilities

(quick assets= cash, accounts, NOT INVENTORY)

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56

A quick ratio goal is >_____.

>1

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57

How is ITOR calculated?

ITOR= cost of goods sold/ average inventory

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58

A formal budget system is used in order to…

in order to create a plan so that actual results can be compared to that plan

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59

What is the role of budgeting?

  • planning

  • improves communication

  • allocates resources

  • controls profit/operations

  • evaluate performance—> provide incentives

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60

What are some types of budgeting?

  • master budget

  • budgeted financial statements

  • others: capital budget, financial budget, rolling budget, operational budget, cash receipts budget

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61

What is a master budget?

  • “profit plan”

  • comprehensive set of budgets covering all phases of an organizations operations for a specified time period

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62

What are budgeted financial statements?

  • “pro forma financial statements”

  • shows how the organization’s financial statements will appear at a specified time

  • includes budgeted balance sheet, income statement, cash flow statement

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63

What are some factors looked at when “sales forecasting”?

  • historical report (past sales, trends etc.)

  • economic trends

  • legal events

  • promotions

  • market research

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64

What are operational budgets?

  • how operations will be carried out to meet demand for goods/services

  • includes: material, labor, overhead

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65

What are 3 types of financial budgets?

  1. Cash Receipts Budget- info about cash flows into pharmacy based on sales

  2. Cash Disbursements Budget- info about cash flow out of pharmacy

  3. Cash Budget- summary of inflow/outflow of cash from operations

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66

What does the following describe:

Manufacturers—> Distributors—> Provider—> Patient

pharmaceutical supply chain

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67

Padding the budget or budgetary slack is a possible ________________ behavioral implication of budgets.

a. positive

b. negative

b

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68

What is the goal of demand planning? What does the demand forecast reflect?

Goal: produce a reliable projection of future customer demand—a forecast for the items that a pharmacy expects to dispense to pts./sell to customer

(basically: how much demand for each product is expected)

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69

Inventory management deals with controlling inventory/stock and the goal is what?

to keep minimum stock necessary to fulfill need/demand without selling out

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70

What are 3 methods of inventory management?

  1. visual method- look at the # of units in inventory and compare them with a listing of how many should be carried

  2. periodic method- requires counting stock on hand at predetermined interval and comparing w/ minimum desired levels

  3. perpetual method- inventory monitored at all times—> computerized—> may need to be checked by counting stock at predetermined intervals to ensure accuracy

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71

Procurement refers to sourcing and purchasing and that means you have to identify/manage ___________ and place ______________.

suppliers, orders

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72

What are some costs associated with inventory?

  • Acquistion

  • procurement

  • carrying

  • stock-out costs

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73

What is ITOR stand for? How is it calculated? Is a high or low ITOR preferred?

  • Stands for Inventory Turn Over Ratio

  • ITOR= cost of goods sold/ average inventory value

  • HIGH ITOR preferred

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74

List and describe the 5-steps in Pharmacist Patient Care Process (PPCP):

Overview: Collect, Assess, Plan, Implement, Follow-Up: Monitor and Evaluate

  1. Collect- get pts medical history (medications, lab data, physical, social history, habits, etc.)

  2. Assess- use the info from the collect stage to make decisions regarding the patient’s current therapy

  3. Plan- individualized plan for the pt. that addresses their problems and sets goals

  4. Implement- put the plan in action w/ the PCP, nurses, and other providers

  5. Follow-Up: Monitor and Evaluate- watch the pts progress toward therapeutic goals and follow up with providers

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75

Appropriate collaboration, communication, and documentation should occur at what step of the PPCP?

EACH STEP!

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76

Explain the role of the Clinical Laboratory Improvement Amendments of 1988 (CLIA) Waiver:

  • pharmacies implementing monitoring/screening services utilizing devices that measure specimens need to apply for a CLIA Waiver

  • CLIA waived tests are considered by the CDC and FDA to be simple to administer and have little risk of error

  • Pharmacists providing tests —> agree to follow good lab practices

  • Makes pharmacists be knowledgeable about OSHA (Occupational Safety and Health Act)

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77

Explain the role of the Collaborative Practice Agreements (CPAs) in pharmacy based services:

  • should be developed to help guide the pharmacists therapeutic decisions

  • must be evidence-based and supported by national guidelines and the primary literature

  • physicians and pharmacists must all sign the CPA, and a copy should be kept at the pharmacy and physician’s practice

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78

Describe the ECHO Model of Outcomes and its 3 outcome measurements of focus:

  • ECONOMIC (health care spending)

  • CLINICAL (therapeutic targets and goals)

  • HUMANISTIC (patient satisfaction)

(Think: ECHO, the first 3 letters stand for each outcome )

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79

Identify 3 strategies used to provide ongoing monitoring to ensure program quality and success:

  1. Scheduled staff meetings-

  2. Monitor Service Outcomes

  3. Request Feedback

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80

The 3 strategies used to provide ongoing service monitoring are _________________ QUALITY IMPROVEMENT STRATEGIES.

CONTINUOUS

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81

What services do PBMs offer?

  • establish networks as part of their claims management services

  • rebate negotiations with manufacturers

  • drug benefit (formulary) design

  • formulary management

  • drug utilization management

  • disease state/ case management

  • most offer mail order services

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82

What are networks/preferred networks and how do pharmacies participate?

  • What is a network? a group of pharmacies that a PBM contacts with to provide meds and care at lower copays

  • To join? MUST accept the third party’s reimbursement rate

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83

What percentage of claims go through PBMs? What impact has that shift had on pharmacies?

86% of all claims. This has had a significant impact on pharmacy management by decreasing the FLEXIBILITY that pharmacies had on PRICING THEIR MEDICATIONS.

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84

How do PBMs reimburse pharmacies?

2 parts: product cost and dispensing fee

total reimbursement rate= product cost + DF

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85

What do each of the following 3rd party reimbursement terms mean?

  • AWP

  • AAC

  • WAC

  • MAC

  • AWP- average wholesaler price- a list price for what drug wholesalers charge pharmacies. This is an overestimate of what the wholesaler actually charges.

  • AAC- actual Acquistion cost- the price the pharmacy pays the drug wholesaler or manufacturer to obtain the drug product

  • WAC- wholesaler Acquistion cost- a list price for what pharm manufacturers charge drug wholesalers. this is an overestimate of what manufacturers actually charge.

  • MAC- maximum allowable cost- the max cost a third party will pay for a multisource drug. this typically is an average of the generic drug price from several manufacturers.

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86

What are DIR fees? How and when are they assessed? What impact do they have on pharmacies?

  • DIR Fees= Direct and Indirect Remuneration Fees

  • DIR fees are charges that pharmacies pay after the point of sale.

  • Can be a percent or flat fee

  • Impact pharmacies by decreasing reimbursement rates

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87

How does a pharmacy combat declining reimbursements?

  • increase prescription volume

  • diversify revenue streams

    • professional services (MTM, Vaccines)

    • diversify OTC offerings

    • DME

  • decrease expenses

    • like labor

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