Pharmacy Career Paths -- foundations

Independent chain, mass merchandise, supermarket, specialty pharmacy, and mail order are all considered to be under…

community practice

hospital, inpatient/outpatient, ambulatory care, home health/infusion, nursing home/long term care are all considered to be under…

hospital/health- system practice

when you have the opportunity to speak to the patient you have the chance to counsel, improve his or her health literacy, and remove barriers to healthcare

this type of care is considered…

clinical

the number of comunity pharmacies is moderately decreasing as _____________ and _________ pharmacies assume a larger market share

online

mail order

_____% of community pharmacies are located within hospitals or medical clinics as _________ pharmacies

5 outpatient

Explain the Meds to Beds discharge counseling provided in outpatient pharmacies in the hospital setting

Pharmacist will talk their patients through their medications so they are prepared when they leave

What are PBMs responsible for?

• determine which drugs go on the formulary

• develop and maintain the network of pharmacies that patients can use— competitive to get in

• utilization management

• Negotiate prices

Manufacturers pay discounts or __________ to get their brand and generic drugs on the formulary

Pharmacies negotiate reimbursement for both Brand and generic drugs to be included in the network covered by the ___________ ___________ _____________

Health Insurance Plan reimburses __________ for drug at retail price, but _______ only passes a portion of the MANUFACTURER rebate back to the Health Insurance Plan

rebates

Health Insurance Plan

PBM

difference between reimbursement from health plan and prescription reimbursement to pharmacy

network spread

PBMs can take back money from the Pharmacy months after the prescription was dispensed due to failure to meet performance on quality measures on Medicare Part D prescriptions that are not made public

Direct and Indirect Renumeration (DIR)

copay based on __________ price

retail

79% of all prescriptions are handled by the top 3 __________ all of which are vertically integrated with a Healthcare Insurance Plan and a Mail Order Pharmacy

pharmacy benefit manager

List community pharmacies in order of how prevalent they are?

• traditional chain pharmacies

• independent and franchise pharmacies

• big box pharmacies (Walmart and Target)

• super-market based pharmacies

One result of the ______________________ has been cost reduction through a focused shift to providing more healthcare services in the outpatient setting and preventing hospital readmissions

affordable care act

Transitions of Care: coordination of care and responsibilities as the patient transitions from _________________ to __________ services

inpatient

outpatient

_____________ occur more frequently as patients transition between inpatient and outpatient settings with approximately 20% of patient s being readmitted ______ days of discharge

medication errors

• poor communication between healthcare providers

• lack of patient follow-up

• poor patient education

• poor medication reconciliation

these are indications of poor ____________________

transitions of care

there are currently 3000 retail clinics in the US; more than 800 of these are _______________

CVS MinuteClinics

small private spaces inside the chain or big box pharmacies staffed by a prescriber (generally a nurse practitioner or physicians assistant)

retail clinics

these institutions are designed to

• target patients with chronic diseases to increase healthcare access, patient education and empowerment, and medication adherence

• ultimately designed to decrease hospital readmissions and reduce healthcare costs

Retail Clinicals

Do pharmacists need to be certified in order to give vaccinations?

yes

In New Jersey, pharmacists may not administer vaccines to children less than ____ years of age

7

what permitted health care practitioners in training (medical or nursing students) to administer a covid-19 vaccine to patients upon direction from a supervising health care practitioners

NJ division of consumer affairs

which pharmacies specialize in high cost complex medication therapies (biologics, injectables) for patients with complicated or rare chronic diseases such as cancer, rheumatoid arthritis, multiple sclerosis and genetic disorders

specialty

what is the average adult cost for a vaccination?

$54.98

which pharmacies manage RISK EVALUATION and MITIGATION STRATEGIES programs (REMS)

specialty

Approximately how many high-risk drugs are there in the US that have an FDA-imposed REMS requirement based on Phase 4 post-marketing studies?

60

Who must apply their patients into REMS? Can REMS drugs be found in retail pharmacies?

physicians

REMS are typically found in specialty pharmacies

the following are the duties of which type of pharmacist?

• drug preparation (IV medications) and dispensing

• purchasing

• monitoring of drug therapy, including the interpretation of lab results

• overseeing drug administration

• responding to problems (missing or wasted doses, adverse drug events)

• responding to codes (respiratory or cardiac arrest)

hospital pharmacist

do staff pharmacists rarely interact with patients in centralized hospital settings or decentralized?

centralized bc/ its just ONE area

which positions generally do not include drug dispensing responsibilities, instead based in one or more patient care areas as members of the multidisciplinary healthcare rounding team?

dedicated clinical pharmacist

Drug Distribution Systems:

• Unit Dose Systems —- 24- hour supply to each patient in unit-of-use packaging; medication cabinets can be filled by _____________ or _______________

• Automated Dispensing Cabinets are located directly in ________________; only accessible to authorized personal; cabinet inventory generally checked and refilled by ____________

unit dose systems: technicians or robots

automated dispensing cabinets: technicians

which program is designed to manage and reduce the risk of antibiotic resistance?

antibiotic stewardship program

Antibiotic Stewardship Programs:

• identify ___________- use, excessive cost

• designate certain microbial for __________use

• monitor and report antimicrobial __________ patterns

• who are the programs typically chaired by?

• works closely with the _______ company which must vote to impose drug restrictions, _________ microbials, ect.

• inappropriate

• restricted

• resistance

• infectious disease physician + infectious disease trained PGY2 resident

• Pharmacy and Therapeutics (P&T)

• add
  

which hospital service involves drugs with a narrow therapeutic index? what does that mean?

Pharmacokinetics Services (PK)

The highest - lowest dose you can take is very small

which drugs fall have a narrow therapeutic index?

warfarin

phenytoin

gentamicin

vancomycin

What are the 4 major pharmaceutical industry jobs?

• Research and development

• Pre-clinical testing

• Clinical Trials

• Marketing (manufacture— distribute approved drugs)

what would a industrial pharmacist apart of Research and Discovery do?

• discover new molecular entities

• early testing for proof of concept

• establish “lead candidates”

• secure drug patents

what is recoup investment?

distribution of approved drugs

how are the starting salaries and job security like working in industry?

low starting salary

unstable job security

• pharmaceutical formulation development

• clinical manufacture and supply

• quality assurance

• regulatory affairs

• medical information

• PK and drug metabolism

• project management

• commercial business development

• marketing and sales

these are all jobs that you can get as a ____________ pharmacist

industrial

do all pharmacy jobs REQUIRE residency/fellowship?

NO but it is highly competitive

how many years of residency are hospitals typically looking for?

at least PGY1

PGYY2 for specialized (ex. pediatric)

Do retail pharmacies have residencies?

SPECIALTY PHARMACY @ walgreens has PGY1

emsop has _______industrial pharmaceutical fellows at __________ pharma company partners

300

22