|
ANSWER
6
(b) General member satisfaction can be measured
by qualitative and quantitative assessment of
telephone inquiries on help lines. Help lines
assist the plan member to resolve inquiries related
to pharmacy benefits. Automatic call distributor
(ACD) measures the help line performance for PBM.
The following industry standards are verified
or measured:
1.
Calls received.
2. Calls answered.
3. Calls abandoned.
4. Abandoned rate.
5. Percent of calls answered within 30 seconds.
6. Average speed of answer.
7. Average talk time.
ANSWER
7
(d) Atomoxetine (Strattera) is the first and only
non-stimulant medication approved by the US Food
and Drug Administration (FDA) for the treatment
of attention-deficit/hyperactivity disorder (ADHD)
in children, adolescents, and adults. It is a
norepinephrine reuptake inhibitor, a class of
ADHD treatment that works differently from the
other ADHD medications available. All other choices
are controlled substances that can be diverted
or abused.
ANSWER
8
(a) Reactively. States use different approaches
to analyzing the prescription information they
receive. A few states routinely analyze prescription
data collected by the PDMPs to identify individuals,
physicians, or pharmacies that have unusual use,
prescribing, or dispensing patterns that may suggest
potential drug diversion, abuse, or doctor shopping.
States refer to this as a proactive approach to
identifying drug diversion. Trend analyses are
shared with appropriate entities, such as law
enforcement, practitioners, and regulatory and
licensing boards.
In contrast, most state PDMPs generally use the
prescription data to respond to requests for information.
These requests may come from physicians or from
law enforcement or state officials based on leads
about potential instances of diversion. According
to state program officials, most PDMPs operate
in the latter fashion, which is called reactively,
because of the increased amount of resources required
to operate a proactive system.
ANSWER 9
(b) Medigap usually covers the Part A coinsurance
and for the cost of 365 extra days of hospital
care during a patient’s lifetime after Medicare
coverage ends. It also covers the Part B coinsurance
(generally 20% of the Medicare-approved payment
amount) and foreign travel emergency. In addition
to these, some plans may cover limited prescription
drug benefits and offer preventive care.
Medigap
policy does not cover:
1.
Long-term care.
2. Vision or dental care.
3. Hearing aids.
4. Private-duty nursing.
5. Unlimited prescription drugs.
ANSWER
10
(a)
Current DUR procedures in most healthcare plans
focus on product-centered utilization trends.
For example, at the time of analyzing a DUR study
most of the attention is given to drug products
in terms of dollar costs and total unit dispensing
rate. This sometimes may result in unwarranted
physician inquiries and intervention that are
not clinically significant. For example, if a
patient is taking a proton pump inhibitor for
several months, the computer will mark the patient
profile to be reviewed for DUR under the category
of “exceeds appropriate duration of use.” The
DUR performer in this type of study does not look
in depth for the past patient history of severe
erosive esophagitis or gastric surgery.
>>> Next
|
ORDER
NOW
