Endo Exam 3: LEWIS Contraception

Case 1: A 24-year-old on a 35 mcg EE pill reports spotting and light withdrawal bleeding early in each cycle for 4 months. What should you adjust?

A) Lower the progestin

B) Increase the estrogen

C) Switch to a POP

D) Add a placebo extension

B, early breakthrough bleeding means not enough estrogen, so increase the EE dose (for example to 0.035 mg)

Case 2: A 27-year-old on a monophasic COC has heavy bleeding late in the cycle with no withdrawal pattern. What is the most likely cause?

A) Too much estrogen

B) Not enough progestin

C) Too much progestin

D) Drug interaction

B, late breakthrough bleeding means not enough progestin, so choose a product with more progestin or a higher progestin dose

Case 3: A 22-year-old on a levonorgestrel COC reports acne, hirsutism, low energy, and increased appetite. Best next step?

A) Increase the EE dose

B) Switch to a lower-progestin or lower-androgenic product, such as a drospirenone product

C) Add a placebo extension

D) Start an emergency pill

B, these are signs of too much progestin, so switch to a lower-androgenic progestin, such as drospirenone or a 3rd or 4th generation progestin

Case 4: A 30-year-old has headaches only during the placebo week on her COC. Which option is most appropriate?

A) Stop the COC and start a POP

B) Use an extended or shorter placebo regimen, or replace the placebo with estrogen such as Seasonique

C) Increase the progestin dose

D) Add an antibiotic

B, the sharp estrogen drop during placebo week triggers headaches, so reduce the placebo interval or replace placebo with estrogen

Case 5: A 25-year-old reports cyclic bloating, breast tenderness, fibroid growth, and water weight gain before her period on a high-estrogen COC. What symptom pattern points to the cause?

A) Too little estrogen

B) Too much estrogen

C) Too much progestin

D) Not enough progestin

B, bloating, breast tenderness, fibroid growth, and cyclic water retention are signs of too much estrogen, so lower the estrogen dose

Case 6: A 35-year-old on a COC starts rifampin for tuberculosis. What counseling is needed?

A) No change needed

B) Use backup contraception for 7 to 28 days after stopping rifampin

C) Double the pill dose

D) Switch to a patch only

B, rifampin is a major CYP3A4 inducer that lowers CHC effectiveness, so use backup for 7 to 28 days after stopping. If the interaction lasts more than 2 months, switch to DMPA or an IUD

Case 7: A 29-year-old with epilepsy has been on phenytoin for 2 years and uses a COC. What is the best long-term plan?

A) Continue the COC with no change

B) Add a second pill each day

C) Switch to a long-acting method such as DMPA or an IUD

D) Stop all contraception

C, phenytoin, phenobarbital, and carbamazepine induce breakthrough bleeding and reduce effectiveness, so use a long-acting method for long-term seizure control

Case 8: A 40-year-old starts tirzepatide for diabetes and uses an oral contraceptive. What should you counsel?

A) No interaction exists

B) Oral contraceptive efficacy may drop during the first 4 weeks of dose titration, so use backup

C) Stop the pill for 4 weeks

D) Switch to a patch in the first month

B, tirzepatide may reduce oral contraceptive efficacy during dose titration, so counsel backup contraception during that period

Case 9: A 33-year-old on drospirenone (Slynd or a drospirenone COC) starts lisinopril for hypertension. What is the key monitoring?

A) Blood glucose

B) Liver enzymes

C) Serum potassium

D) Thyroid function

C, drospirenone is potassium-sparing, so monitor potassium with ACE inhibitors, ARBs, potassium-sparing diuretics, or high-dose NSAIDs, and consider switching the progestin

Case 10: A 31-year-old on a COC starts ciprofloxacin for a urinary infection. Counseling? A) Stop the pill during antibiotics

B) Use backup during antibiotics and for a few days after, since the evidence is controversial

C) No counseling needed

D) Double the pill dose

B, recent data suggest broad-spectrum antibiotics do not reduce efficacy, but the lecturer called the topic controversial, so counsel backup during antibiotics and for a few days after

Case 11: A 45-year-old has used a COC for 4 years and now needs long-term alprazolam. What do you recommend?

A) Continue the COC unchanged

B) Consider a progestin-only method or a higher-estrogen product

C) Stop the COC and take no contraception

D) Add rifampin

B, benzodiazepines compete with estrogen, so consider a progestin-only method or a higher-estrogen product for long-term use

Case 12: A 26-year-old misses 2 consecutive COC pills in week 1 of her pack. What is the correct action?

A) Take 1 pill, discard the rest, and use backup for 7 days

B) Take 2 pills and continue no backup

C) Skip the placebo week

D) Take all missed pills at once and continue

A, take one pill as soon as remembered, discard the rest of the missed pills, continue the rest as scheduled, and use backup for 7 days

Case 13: A 28-year-old misses 2 consecutive active COC pills in week 3 of her pack. What is correct?

A) Take one missed pill, discard the rest, finish active pills, skip the placebo week, start a new pack right away, and use backup for 7 days

B) Stop and wait for her period

C) Take 4 pills and skip backup

D) Start the placebo week early

A, this is the week 3 rule, which skips the placebo week to avoid a gap in hormone coverage, and backup is needed for 7 days

Case 14: A 24-year-old takes norethindrone POP about 4 hours late. What is the correct response?

A) Take it now, no backup needed

B) Take it now, use backup for 48 hours, and consider EC if unprotected sex occurred

C) Skip the pill and restart the next day
D) Take two pills tomorrow

B, a POP dose more than 3 hours late needs 48 hours of backup, and EC should be considered if unprotected sex occurred

Case 15: A 30-year-old takes Slynd 26 hours late for her active tablet. What should she do?

A) Take it now, no backup needed

B) Take it now and use backup for 7 days

C) Skip it and restart the pack

D) Double the dose tomorrow

A, the longer half-life of drospirenone allows a missed active tablet up to 24 hours late with no backup, but at 26 hours the rule is take it now with no backup as listed in your slides, so check the instructor's version of this rule

Case 16: A 36-year-old's patch has been off for 30 hours. What is the correct response?

A) Reapply the same patch and no backup

B) Apply a new patch, start a new 4-week cycle, and use backup for 7 days

C) Remove the patch for 1 week

D) Continue as normal

B, if the patch is off 24 hours or more, apply a new patch, start a new 4-week cycle, and use backup for 7 days

Case 17: A 27-year-old's vaginal ring was out for 4 hours. What should she do?

A) Reinsert as soon as possible and use backup until the ring has been in for 7 days

B) Reinsert and continue with no backup

C) Discard the ring and wait for her period

D) Leave it out for 1 week

A, a ring removed more than 3 hours needs immediate reinsertion and backup until it has been in place for 7 days

Case 18: A 32-year-old receives DMPA 2 weeks late. What should you do before the next dose?

A) Nothing, give it now

B) Perform a pregnancy test and consider EC

C) Switch to a COC

D) Give a double dose

B, DMPA is given every 12 weeks with a 2-week grace period, but if more than 1 week overdue, do a pregnancy test before the next dose and consider EC

Case 19: A 24-year-old is 2 weeks postpartum, breastfeeding, and asks about a combined pill. What should you recommend?

A) Start the COC immediately

B) Avoid the COC because estrogen-containing methods are category 4 before 21 days postpartum in breastfeeding patients, so recommend a progestin-only method

C) Start a patch

D) Use EC instead

B, estrogen-containing methods are category 4 in breastfeeding patients under 21 days postpartum, so choose a progestin-only method

Case 20: A 26-year-old is 5 weeks postpartum and exclusively breastfeeding. She wants a POP. Can it start?

A) No, she must wait 12 weeks

B) Yes, POP can start 6 weeks after delivery in exclusively breastfeeding patients, so wait 1 more week

C) Yes, start today

D) No, she must use a copper IUD only

B, exclusively breastfeeding patients start POP at 6 weeks postpartum, so she needs to wait about 1 more week

Case 21: A 40-year-old smoker takes 16 cigarettes per day and asks about a combined pill. What should you tell her?

A) Combined pills are safe

B) Avoid CHC because smokers over 35 who smoke 15 or more cigarettes per day are category 4, so recommend a progestin-only method

C) Use a patch

D) Double the pill dose

B, smokers over 35 who smoke 15 or more cigarettes per day have unacceptable risk, so recommend a progestin-only method or a copper IUD

Case 22: A 29-year-old with a history of DVT wants a contraceptive patch. What should you counsel?

A) Patch is preferred

B) Avoid the patch, since VTE history is a contraindication and the patch delivers more estrogen

C) Use the patch with aspirin

D) Patch is safe with anticoagulants alone

B, a VTE history is a contraindication to CHC, and the patch delivers more estrogen exposure than oral pills, so avoid it

Case 23: A 33-year-old with BMI 32 wants a patch. What is the best counseling?

A) Patch is best at BMI 32

B) Patch is generally indicated for BMI under 30, so consider an IUD, implant, or DMPA because efficacy falls as BMI rises

C) Double the patch change schedule

D) Apply two patches at once

B, patch efficacy falls as BMI rises, so consider IUD, implant, or DMPA

Case 24: A 25-year-old takes levonorgestrel EC and vomits 1 hour after the dose. What should you do?

A) Nothing, the dose still works

B) Repeat the dose and give meclizine or dimenhydrinate to prevent vomiting

C) Take ulipristal in addition

D) Wait 3 days and retest

B, vomiting within 1 to 2 hours means the dose may not be absorbed, so repeat the dose and prevent vomiting with meclizine or dimenhydrinate

Case 25: A 31-year-old with BMI 32 needs emergency contraception. Which option is best?

A) Levonorgestrel 1.5 mg because it is OTC

B) Ulipristal 30 mg or a copper IUD, since levonorgestrel may be less effective above BMI 26

C) Oral contraceptive pills as EC

D) No EC is available for her BMI

B, levonorgestrel may be less effective above BMI 26, so refer to ulipristal or a copper IUD, which is not affected by weight

Case 26: A 30-year-old takes ulipristal and wants to start a POP the next day. What should you counsel?

A) Start the POP immediately

B) Avoid starting hormonal contraception for at least 5 days after ulipristal and use barrier methods for intercourse in the same cycle

C) Take levonorgestrel with it

D) No counseling needed

B, ulipristal interacts with progestins, so avoid starting or continuing hormonal contraception for 5 days after and use a barrier method

Case 27: A 35-year-old with a 2-year history of breast cancer asks about a COC. What is the answer?

A) Recommend the COC

B) Avoid the COC because current breast cancer is category 4 for CHC, so recommend a non-estrogen method

C) Use an extra-high-dose COC

D) Recommend the patch because it has less estrogen

B, current breast cancer is category 4 for CHC, so recommend a non-estrogen method. Patch exposure is higher, so it is not a safer alternative

Case 28: A 28-year-old reports migraine with aura and asks about a combined pill. What do you tell her?

A) Migraine with aura is not a contraindication

B) Migraine with aura is a category 4 contraindication to CHC, so recommend a progestin-only method

C) Migraine with aura needs a patch

D) Migraine with aura needs a double pill dose

B, migraine with aura is category 4 for CHC, but migraine without aura is not a contraindication, so know the difference

Case 29: A 46-year-old has BP of 165/105 and wants a COC. What should the pharmacist do?

A) Furnish the COC

B) Refer to a clinician, since BP of 160/100 or higher is category 4 for CHC

C) Furnish a POP only

D) Recheck in 1 year

B, BP of 160/100 or higher is category 4 for CHC, so do not furnish and refer for evaluation

Case 30: A 22-year-old on a COC has sudden severe calf pain, swelling, and redness. What is the best action?

A) Continue the pill and monitor

B) Send her to the ER because these symptoms suggest DVT

C) Double the pill dose

D) Stop all hormones for 1 week

B, severe calf or thigh pain, swelling, redness, or itching suggests DVT and needs emergency care

Case 31: A 34-year-old has double vision and severe headache while on a COC. What should you do?

A) Continue the pill

B) Send her to the ER because vision changes can indicate retinal artery thrombosis and severe headache can indicate stroke

C) Switch to a POP at home

D) Recheck next month

B, double or blurry vision suggests retinal artery thrombosis and severe headache can indicate stroke, so these are emergency symptoms

Case 32: A 38-year-old is switching from a Nexplanon implant and wants to know the return to fertility time. What do you tell her?

A) About 6 weeks after removal

B) About 10 to 18 months

C) About 2 years

D) Immediately after removal, with no delay

A, Nexplanon has a fast return to fertility, usually within about 6 weeks after removal, while DMPA returns in about 10 to 18 months

Case 33: A 25-year-old asks which method has the most reliable ovulation suppression. What is the answer?

A) POP

B) DMPA

C) Copper IUD

D) Hormonal IUD in every case

B, DMPA suppresses ovulation within 24 hours. Nexplanon also suppresses ovulation, while POP is variable, the copper IUD is not its primary mechanism, and the hormonal IUD is variable

Case 34: A 24-year-old on DMPA asks about bone health. What do you counsel?

A) No concern at all

B) Bone loss is a concern, and the boxed warning applies beyond 2 years of use, so discuss calcium, vitamin D, and alternatives if long-term use is planned

C) Bone loss only happens with COCs

D) DMPA increases bone density

B, DMPA causes bone loss, and the boxed warning concerns use beyond 2 years, so discuss bone health and alternatives

Case 35: A 39-year-old with complicated diabetes, including nephropathy, asks about a COC. What is the answer?

A) Recommend the COC

B) Avoid the COC because complicated diabetes is category 4 for CHC, so recommend a progestin-only method

C) Recommend the patch

D) Use a double-dose COC

Case 36: A 30-year-old asks whether she can start a POP after an abortion. What should you tell her?

A) No, she must wait 6 weeks

B) Yes, she can start the next day

C) Yes, but only after a pregnancy test in 3 months

D) No, she must use a copper IUD

B, POP can start the next day after abortion or miscarriage

Case 37: A 40-year-old with a BMI of 35 asks about a combined pill and says she sometimes has trouble remembering her pills. What is the best counseling and method choice?

A) Recommend the COC with an extra pill for missed doses

B) Recommend an IUD or implant because they are effective and do not depend on daily adherence

C) Recommend POP with 6-hour window

D) Recommend patch with weekly reminders

B, an IUD or implant is effective and does not depend on daily adherence, which suits a patient with missed-dose risk

Case 38: A 33-year-old who has been on a COC for 4 months wants to know whether her cycle will become predictable. What is the best answer?

A) Bleeding usually improves within 3 months, and it may take up to 6 months for extended regimens, so bleeding may be irregular early on

B) Bleeding will become worse each month

C) Bleeding is never expected on a COC

D) She must change pills monthly

Case 39: A 42-year-old on a COC asks whether a monophasic or multiphasic COC is best first. What is the answer?

A) Multiphasic first

B) Monophasic first, since it is the preferred first line, easiest for extended use, and multiphasic pills were meant to lower progestin exposure with limited evidence of benefit

C) Biphasic first

D) Quadriphasic first for less breast pain

B. Monophasic is the preferred first-line COC because it has the same estrogen and progestin dose in every active pill and is easiest for extended use. Multiphasic pills were designed to lower total progestin exposure, but the evidence that they help is limited

Case 40: A patient on a COC has been bleeding for 2 months, and you want to switch products. What is the correct approach?

A) Switch monthly until bleeding stops

B) Give each product at least 3 months, sometimes 6, before changing, and do not switch monthly

C) Switch immediately to a patch

D) Stop the COC

B. Give each product at least 3 months, sometimes 6, before changing, and do not switch monthly. Bleeding usually improves within 3 months

Case 41: A 24-year-old wants to start a COC today. Her last period started 3 days ago. What backup is needed?

A) None

B) Backup for 7 days

C) Backup for 48 hours

D) Wait until her next period

A, COCs can quick-start anytime, and backup is needed only if she starts more than 5 days after menses began

Case 42: A 27-year-old wants a patch, and her last period started 8 days ago. What backup is needed?

A) None

B) Backup for 2 days

C) Backup for 7 days

D) Wait for her next period

C, a patch started more than 5 days after menses began needs 7 days of backup

Case 43: A 31-year-old wants a POP, and her last period started 7 days ago. What backup is needed?

A) None

B) Backup for 2 days

C) Backup for 7 days

D) Start after her next period

B, POPs can start anytime, with 2 days of backup if more than 5 days have passed since menses started

Case 44: A 29-year-old wants a DMPA injection, and her last period started 10 days ago. What backup is needed?

A) None

B) Backup for 2 days

C) Backup for 7 days

D) Start after her next period

C, DMPA can start anytime if she is not pregnant, with 7 days of backup if more than 7 days have passed since menses started.

Case 45: A 26-year-old wants a Nexplanon implant placed on cycle day 3. What backup is needed? A) None

B) Backup for 7 days

C) Backup for 48 hours

D) Wait until day 1 of her next period

A, placement on days 1 to 5 of menses needs no backup

Case 46: A 28-year-old wants a Nexplanon implant placed on cycle day 12. What backup is needed?

A) None

B) Backup for 7 days

C) Backup for 48 hours

D) Start after her next period

B, placement after day 5 needs 7 days of backup

Case 47: A 33-year-old on a COC misses one pill in week 2 and remembers it 6 hours later. What should she do?

A) Take the missed pill and continue, no backup needed

B) Take 2 pills and use backup for 7 days

C) Skip the pill and restart

D) Discard the pack

A, a single missed pill is taken when remembered, and the rest continue as scheduled with no backup.

Case 48: A 32-year-old has had her ring out for 1 hour. What should she do?

A) Insert the ring and use backup for 7 days

B) Rinse with cool-to-lukewarm water and reinsert within 3 hours, with no backup

C) Discard the ring

D) Leave it out until next week

B, a ring removed for less than 3 hours is rinsed and reinserted within 3 hours with no backup

Case 49: A 34-year-old using Annovera has had her ring out for 3 hours. What should she do? A) Wash and reinsert, no backup B) Discard the ring C) Wash, reinsert, and use backup for 7 days D) Leave it out until next cycle

C, Annovera removed for more than 2 hours needs washing, reinsertion, and 7 days of backup

Case 50: A 23-year-old on DMPA is 2 weeks past her due date for a 12-week injection. What should you do? A) Give the dose, no test needed B) Perform a pregnancy test before the next dose and consider EC C) Switch to a COC D) Wait 3 months

B, the grace period is 2 weeks, but more than 1 week overdue requires a pregnancy test before the next dose and considering EC

Case 51: A 25-year-old on DMPA is 10 days late. Is a pregnancy test needed?

A) No, the grace period covers up to 2 weeks

B) Yes, because she is more than 1 week overdue

C) Only if she has symptoms

D) Only if she has used EC

B, 10 days is more than 1 week overdue, so a pregnancy test is required before the next dose

Case 52: A 27-year-old is 6 weeks postpartum and exclusively breastfeeding. Which methods can start now?

A) POP, DMPA, Nexplanon, and IUD

B) POP only, because DMPA cannot start until 12 weeks

C) No methods until 3 months

D) COC only

A, POP starts at 6 weeks in exclusively breastfeeding patients, DMPA in lactating patients starts at 6 weeks, Nexplanon can be placed from 4 weeks, and IUDs can be placed by 42 days.

Case 53: A 30-year-old is 3 weeks postpartum, not breastfeeding, and wants a POP. When can she start?

A) Right away, no restrictions

B) 1 to 4 weeks after delivery

C) 6 weeks after delivery

D) 12 weeks after delivery

B, if not breastfeeding, POPs can start 1 to 4 weeks after delivery

Case 54: A 26-year-old is 2 weeks postpartum and partially breastfeeding. When can she start a POP?

A) Right away

B) At least 3 weeks after delivery

C) At 6 weeks

D) At 12 weeks

B, partially breastfeeding patients start POPs at least 3 weeks after delivery

Case 55: A 31-year-old is 4 weeks postpartum and breastfeeding. She wants a Nexplanon. Can it be placed?

A) No, she must wait 12 weeks

B) Yes, as early as 4 weeks postpartum, including lactating patients

C) No, implants cannot be used while breastfeeding

D) Only after 6 months

B, Nexplanon can be placed as early as 4 weeks postpartum, including in lactating patients

Case 56: Why should estrogen be avoided in the early postpartum period?

A) It raises milk production

B) Women are hypercoagulable after delivery, so estrogen increases clot risk, and it may reduce milk production

C) It has no effect on clotting

D) It improves wound healing

B, the postpartum period is hypercoagulable, so estrogen raises clot risk, and estrogen may reduce milk production while progestin does not affect milk quality

Case 57: A 29-year-old asks about contraception 5 weeks after delivery. Which is the best answer?

A) Any method is acceptable at 5 weeks postpartum

B) No method is acceptable until 12 weeks

C) Only a COC

D) Only a condom

A, most methods are acceptable by 42 days postpartum, so 5 weeks is within that window

Case 58: Which EC option is available without a prescription?

A) Ella 30 mg

B) Levonorgestrel 1.5 mg

C) Copper IUD

D) Combined pill as EC

B, levonorgestrel 1.5 mg (Plan B One-Step, My Way, Next Choice) is OTC. Ella requires a prescription, and the copper IUD must be inserted by a clinician.

Case 59: A 28-year-old with BMI 31 needs EC within 3 days of unprotected sex. What should you recommend?

A) Levonorgestrel 1.5 mg

B) Ulipristal 30 mg or copper IUD

C) Double dose levonorgestrel

D) Combined pill as EC

B, levonorgestrel may be less effective above BMI 26, so refer to ulipristal or a copper IUD

Case 60: A 25-year-old has unprotected sex 4 days ago and wants the most effective EC option. What is best?

A) Levonorgestrel 1.5 mg

B) Ulipristal 30 mg

C) Copper IUD inserted within 5 days

D) Two doses of levonorgestrel 0.75 mg

C, the copper IUD is the most effective EC, is not affected by BMI, and can continue as long-term contraception.

Case 61: What is the efficacy estimate for EC?

A) 30 to 50 percent

B) 59 to 94 percent, preventing about 75 percent of expected pregnancies with correct use

C) 95 to 100 percent

D) 10 to 20 percent

B, EC efficacy is estimated at 59 to 94 percent

Case 62: A 24-year-old takes levonorgestrel 1.5 mg 80 hours after unprotected sex. What is the most accurate counseling?

A) It is fully effective up to 120 hours

B) Efficacy is reduced after 72 hours, with some efficacy up to 3 to 5 days, so ulipristal or copper IUD may be better

C) It is effective only if taken the same day

D) It works best after 5 days

B, levonorgestrel is most effective within 72 hours and has some efficacy up to 3 to 5 days. At 80 hours, ulipristal or the copper IUD is the better choice

Case 63: Which EC is prescription-only and preferred for higher BMI?

A) Levonorgestrel 1.5 mg

B) Ella (ulipristal 30 mg)

C) Copper IUD

D) My Way

B, Ella is prescription-only, given within 120 hours, and preferred for higher BMI, but it interacts with progestins

Case 64: Which statement about the copper IUD for EC is correct?

A) It must be inserted within 72 hours

B) Inserted by a clinician within 5 days, it is the most effective EC and can continue as long-term contraception

C) It is OTC

D) It is not effective for EC

B, the copper IUD must be inserted by a clinician within 5 days, is not affected by BMI, and can continue as long-term contraception

Case 65: A 22-year-old vomits 90 minutes after taking EC. What should you do?

A) Nothing, the dose still works

B) Repeat the dose and give meclizine or dimenhydrinate to prevent further vomiting

C) Take ulipristal in addition

D) Wait 3 days and retest

Case 66: Which statement about EC contraindications is correct?

A) EC is contraindicated in patients with migraine

B) EC has no medical contraindications except established pregnancy

C) EC is contraindicated in patients with diabetes

D) EC is contraindicated in patients over 35

B, EC has no medical contraindications except established pregnancy.

Case 67: A California pharmacist wants to furnish contraception. Under what authority?

A) Business and Professions Code Section 4052

B) Federal Controlled Substances Act

C) State Medicaid rules

D) CDC MEC chart alone

A, B&P Code Section 4052 authorizes pharmacists to furnish contraception and EC as preventive care without a diagnosis

Case 68: Which medications can a California pharmacist furnish under B&P 4052?

A) Contraception only

B) EC, contraception, smoking cessation, travel medications, and anti-infectives

C) Only controlled substances

D) Insulin only

B, B&P 4052 covers EC, contraception, smoking cessation, travel medications, and anti-viral or anti-infective medications.

Case 69: Before furnishing hormonal contraception, what should a California pharmacist do first?

A) Check the patient’s blood pressure

B) Dispense a 1-year supply

C) Refer to a physician

D) Give a placebo pack

A, measure blood pressure before furnishing hormonal contraception, then complete the screening tool and check the USMEC chart.

Case 70: After furnishing contraception to a patient with no primary care provider, what must the pharmacist do?

A) Nothing

B) Give the patient a written record of what was furnished and advise them to consult a physician of their choice

C) Notify the state board only

D) Send a copy to the insurer only

B, with no PCP, give a written record of what was furnished and advise consultation with a physician of their choice.

Case 71: Under SB 999, how long a supply must insurers cover when requested?

A) 1 month

B) 3 months

C) Up to 1 year

D) Not required

C, SB 999 requires insurers to cover up to a 1-year supply when requested

Case 72: Which law requires insurers to cover OTC birth control?

A) SB 999

B) SB 1053

C) SB 523

D) B&P 4052

C, SB 523 (effective 2024) requires insurers to cover OTC birth control and vasectomy services

Case 73: Which law requires most health plans to cover contraceptive drugs, devices, and counseling?

A) SB 999

B) SB 1053 (Contraceptive Coverage Equity Act)

C) SB 523

D) B&P 4052

B, SB 1053 requires most health plans to cover contraceptive drugs, devices, counseling, and follow-up

Case 74: Which resource is used for gray-area decisions when using the USMEC chart?

A) Package insert

B) US Selected Practice Recommendations (SPR) 2024

C) Pharmacy formulary

D) FDA boxed warning

B, the SPR 2024 is the companion resource for complex or gray-area scenarios

Case 75: Which pharmacist-furnishing rule applies to USMEC categories?

A) Furnish categories 1 and 2, consult the SPR for category 3, and do not furnish category 4

B) Furnish categories 3 and 4

C) Furnish category 4 only

D) Furnish all categories without review

A, pharmacists can furnish categories 1 and 2, consult the SPR for category 3, and never furnish category 4