PTCB Exam: Order Entry and Processing

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198 Terms

1
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Pharmacy Technicians are permitted to perform the following 6 tasks

1. Accepting new prescriptions from patients

2. Receiving refills from the patient

3. Requesting refill authorization from the patient's prescriber

4. Collecting patient information

5. Maintaining patient profiles

6. Entering patient, prescriber, and medication information into database system

2
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Pharmacy Technicians are permitted to perform the following 5 tasks

1. Interpreting the patients direction (sig code)

2. Billing prescription to third party prescription providers

3. Counting. pouring medications and labeling prescription labels

4. Repacking medications

5. Preparing unit dose medications

3
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What are the methods of receiving a prescription order?

1. Hard copy

2. Call in for non C-II

3. E prescribing

4. Fax for non C-II

4
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What information is needed from the prescriber for a prescription to be considered valid?

1. Name and adress

2. DEA number for controlled substances

3. NPI number

4. Medicare/medicaid number

5
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What patient information is needed for a prescription to be considered valid?

1. Patient name

2. Adress

3. Date of Birth

6
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What are the things that make up a prescription?

1. Instructions to the pharmacist

2. Name of the medication, strength and dose form

3. Directions to pharmacist

4. Quantity to be dispensed

5. Refill information: number of refills authorized

6. Physicians signature must be in ink

7
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What information is required for a medication order in an institute

1. Prescribers information and hospital assigned ID

2. Date of prescription order

3. Patient information

4. Name, strength, and dosage form of medications

5. Frequency to be administered

6. Duration of therapy

7. Prescribers signature

8
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What is included in a patients profile?

1. Patient identifying information such as date of birth, name, sex, address and contact phone number

2. Billing information, third party information includes subscriber ID, plan name, group number, PCN number and relationship to cardholder

3. Medications the patient is taking

4. Medical history

5. drug allergies

6. Adverse drug effects previously experienced

7. Patients health history

9
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Are CII prescriptions allowed to be refilled?

No

10
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How do patients get refills for CII prescriptions?

A patient must obtain a new prescription from prescriber

11
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Are CIII-CIV prescriptions allowed to be refilled?

If allowed by prescriber

12
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How many times may CIII-CIV prescriptions be refilled?

Up to 5 times within 6 months after the date of issue

13
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How may C five prescriptions be refilled?

As authorized by the practitioner

14
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How long are non controlled prescriptions valid for?

1 year from the date of issue

15
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How does a PRN refill work?

It may be refilled as many times up to 1 year of issuance

16
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What information must be obtained from a patient who calls in a prescription refill?

1. Patients name

2. Contact information

3. Patients DOB

4. Prescription number

5. Name, dosage and quantity of medications

17
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What happens if the patient does not have the proper information in their profile?

Once the patient information is verified the patients profile can be accessed

18
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How does a pharmacy tech interpret a prescription, what are the 5 things they should look for?

1. Identify the name, strength, dosage form and quantity of the prescription to be dispensed

2. Determine if the generic drug may be dispensed

3. Identify the route of administration

4. Identify the frequency of administration

5. Identify the number of refills prescribed

19
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What is DAW code 0

No product selection indicated

20
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What is DAW code 1

Substitutions not allowed by prescriber

21
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What is DAW code 2

Substitutions allowed; patient requested brand name

22
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What is DAW code 3

Substitutions allowed; pharmacist selected brand name

23
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What is DAW code 4

Substitution allowed; generic drug not in stock

24
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What is DAW code 5

Substitution allowed; brand drug dispensed as generic

25
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What is DAW code 6

Override

26
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What is DAW code 7

Substitution now allowed; brand drug mandated by law

27
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What is DAW code 8

Substitution allowed; generic drug not available in marketplace

28
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What is DAW code 9

Other

29
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What does a PA require a physician to do?

Obtain approval from a managed care organization for specific medication

30
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Without Prior Authorization the patient may?

Be responsible for the entire cost of the medication

31
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What are the 7 situations that may require a doctor to do a PA?

1. Filling brand name medication where generic is available

2. Expensive medications

3. Medications with age limits

4. Drugs used for cosmetic purposes

5. Medications prescribed for non life threatening conditions (Viagra)

6. Drugs not usually covered by plan but prescriber deems medically necessary by physician

7. Medications that are usually covered but prescribed at a higher than normal dose

32
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The use of third party programs pay for?

Some or all of the cost of medications

33
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Most third party programs are?

Public or private health insurances such as Medicaid and medicare and HMO's and basic health insurance

34
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Not all Third party programs Include?

Prescription drug coverage

35
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Drug programs may require?

Generic substitutions and may limit the quantity dispensed

36
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What or who is a pharmacy benefit manager? (PBM)

Companies that manage prescription drug benefits on behalf of health insurance, medicare part D drug plans, large employers, and other payers

37
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In order for a pharmacy to bill a patients prescription through their insurance the pharmacy must?

Be contracted with the health plan/ PBM

38
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Third Party adjudication

Involves submitting a prescription for payment to the patients health plan

39
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What happens if the health plan denies payment?

The patient is responsible for the full payment or the claim can be submitted for a PA

40
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What are the 4 Pieces of information that are transmitted during adjudication?

1. Patient information (name, DOB, gender, address, phone number, relationship to cardholder)

2. Prescriber information (name, phone, NPI, DEA number)

3. Pharmacy information (Pharmacy name, NPI number, pharmacist name and NPI number, pharmacy address and phone)

4. Prescription information (Prescription number, NDC number, quantity dispensed and day supply)

41
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Information contained on a prescription drug card

1. Plan number

2. Member number, patient name

3. Member ID

4. BIN number

5. PCN number

6. Group number

7. PCP number

8. Co pays

9. Help desk telephone number

42
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What does BIN number stand for

Bank identification number

43
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What does PCN number stand for

Processor control number

44
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Why use coordination of benefits?

Ensuring the maximum benefits are paid to a patient covered under more than one plan

45
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What is the primary insurance during a coordination of benefits?

The first plan that the patient will use to bill prescription claims

46
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What is the secondary insurance during a coordination of benefits?

The plan used after the primary insurance is billed for any remaining dollar amount not covered by the primary insurance

47
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What do co pay savings cards do?

Help bring co pays down on expensive medications

48
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What is a copay?

A predetermined amount you pay for health care services at the time you receive care, for example when you visit the doctor, purchase medication, or visit the hospital

49
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The patient is responsible for?

all prescription deductibles and copays

50
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Can copays fluctuate?

YES

51
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Rejected prescription claims will have

at least one rejection code

52
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Rejection codes must be corrected before

resubmitting to the managed care provider

53
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What is rejection code 1

Missing or invalid BIN

54
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What is rejection code 2

Missing or invalid version number

55
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What is rejection code 3

Missing or invalid transaction code

56
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What is rejection code 4

Missing or invalid pharmacy number

57
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What is rejection code 5

Missing or invalid pharmacy number

58
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What is rejection code 6

Missing or invalid group number

59
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What is rejection code 7

Missing or invalid cardholder ID

60
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What is rejection code 8

Missing or invalid person code

61
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What is rejection code 9

Missing or invalid birth day

62
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What is rejection code 10

Missing or invalid gender

63
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What is rejection code 11

Missing or invalid relationship to cardholder

64
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What is rejection code 15

Missing or invalid date of service

65
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What is rejection code 19

Missing or invalid days supply

66
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What is rejection code 20

Missing or invalid compound code

67
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What is rejection code 22

Missing or invalid DAW

68
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What is rejection code 25

Missing or invalid prescriber ID

69
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What is rejection code 26

Missing or invalid unit of measure

70
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What is rejection code 28

Missing or invalid prescription written

71
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What is rejection code 29

Missing or invalid number of authorized refills

72
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An adjustment may occur when the amount charged on a claim

is not equal to the amount paid

73
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What are the three codes used in payment adjustment

1. claim adjustment group code (describes the type of needed claim adjustment)

2. Claim adjustment reason code (a mandatory code used to specify reason for adjustment)

3. Remittance advice remark code (a non mandatory code used to provide further explanation)

74
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What does a DUR or drug utilization review do?

Verifying that the prescription does not interact with other medications on patient profile

75
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What happens if a DUR shows up on a patients profile

If warning is observed the pharmacist determines proper course of action. making a decision based on the information at hand

76
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What is the NDC or national drug code?

A quick way to verify that you are pulling the intended product

77
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What do you do special if you are filling a hazardous medication

Count in a designated area, wipe the tray/ spatula with isopropyl alcohol and be sure to follow hazardous drug handling guidlines

78
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How do you pick the appropriate packaging

Select appropriate sized container that is child resistant (unless otherwise specified)

79
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What are the 9 USP classifications of containers

1. Tamper evident packaging

2. Light resistant container

3. Tight closed container

4. Single unit container

5. Single dose container

6. Multiple unit container

7. Multiple dose container

8.Unit dose container

9. Hermetic container

80
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The consumer product safety commission requires?

drug manufactures to place prescription drugs in child resistant containers if the package goes directly from the pharmacist to the patient

81
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All legend drugs intended for oral use must be dispensed by

the pharmacist to the patient with a safety closure unless the prescribing physician or patient requests a non child proof container

82
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What are examples of medications that are exempt from child resistant containers

1. Sublingual nitroglycerin/isosorbide dinitrate

2. Powdered unflavored aspirin

3. Effervescent aspirin

4. Oral contraceptives

5. Hormone replacement therapy

6. Powdered iron preparations

7. Effervescent acetaminophen

83
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Drugs that are dispensed in hospitals, nursing homes, and inpatient institutions are not required

To be in child resistant containers

84
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What are the federal prescription label requirements

1. Name of the prescription

2. In the case of a liquid preparation, the percentage content of drug or amount of drug in a specified volume

3. In the case of a dry prescription the amount of active ingredient

4. The route of administration

5. A statement of storage conditions and an expiration date

6. The name and place of business of the manufacture package or distributor

7. An identifying lot number

85
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In addition to the federal prescription label requirements, your individual state law may require the following information

1. Serial number of prescription

2. Name and address of pharmacy

3. name of patient

4. Name of prescriber

5. directions for use

6. generic and brand name and strength of medication

7. Name of manufacturer

8. Quantity dispensed

9. Expiration date of medication

10. Initials of verifying pharmacist

11. Number of refills allowed

12. Auxiliary labels

86
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Medication order label requirements

1. Name and location of patient

2. Drug name

3. Expiration date of prescription

4. lot number

87
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Sterile product label requirements

1. pharmacy name

2. patient name

3. date of filling

4. strength and quantity of each ingredient

5. directions for use

6. total volume

7, infusion rate

8. beyond use date

88
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Repackaged drug label requirements

1. Name of the medication

2. Drug manufacture

3. Dosage form

4. Strength of drug

5. Beyond use date

6. lot number

89
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Unit dose label requirements

1. brand or generic name of drug

2. drug manufacturer

3. strength of drug

4. beyond use date

5. lot number

90
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What is the NDC or national drug code

A 10 or 11 digit number composed of three segments

91
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What do the first 5 digits of the ndc represent

The drug manufacture

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What do the second 4 digits of the NDC represent?

Drug product/ strength

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What do the last 2 digits of the NDC represent?

package size

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Lot numbers

assigned by the manufacture to identify specific batches of medication

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Expiration dates

Assigned by the drug manufactures who guarantee that the medication if fully potent and safe unit shelf life expiration date

96
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Patient package insert PPI

A PPI is an informational leaflet describing the benefits and risks of medications

97
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Pharmacies are required to provide Patient package insert PPI to all patients receiving

1. Metered dose inhalers

2. oral contraceptives

3. Estrogen

4. Progesterone

5. Isotrention

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Medication Guides

FDA requires medication guides with certain drugs

99
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The FDA requires medication guides for certain drugs when

1. Certain information is necessary to prevent serious adverse side effects

2. Decision making- patients should be informed about known serious side effects

3. Patient adherence to directions for use are essential for its effectiveness

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Automated dispensing systems

medication counting systems use to accurately count individual patient prescriptions