CPhT Week 2 Kickoff

The speaker welcomes students to the second full week of the CPhT program, highlighting two live classes this week (today and Friday). Exam one will cover all information from last week and this week, with a review session on Friday focusing on practice questions. A slack prompt on inventory management will be introduced today.

This week's optional but recommended slack competition focuses on inventory management using household items. Students are asked to select 5-10 items from their pantry or medicine cabinet, check expiration dates, group them, explain the grouping logic (e.g., by color, type), reorganize them using the 'first in first out' (FIFO) method, and identify items that would need reordering based on a reorder point of two (after removing expired items).

The discussion shifts to institutional pharmacies, also known as health system pharmacies, which serve admitted patients. Examples include hospital pharmacies, long-term care facilities, skilled nursing units, hospice centers, nursing homes, and correctional facilities. Key services include inventory management, medication preparation (unit dose), order fulfillment, and record maintenance.

Technician-specific duties in institutional pharmacies involve medication preparation and dispensing, sterile compounding (with additional training), accurate labeling, data handling and reporting for quality assurance, and managing recalls or expired medications. Education and safety protocols are also crucial for ensuring proper medication administration by other staff.

The preferred dispensing system in institutional settings is the unit dose system, where each individual dose is packaged separately. This allows for better tracking, reduced waste, and the ability to return unused, untampered medications. Less efficient systems like floor stock and patient prescription stock systems are also discussed, emphasizing their higher potential for waste.

Inventory management involves checking for expired items, generating orders, receiving and stocking medications, and processing returns. Pharmacies can purchase directly from manufacturers, through wholesalers, or via primary vendors. Automated computer systems typically manage reorder points and quantities, while technicians can make manual adjustments and special orders for atypical or unique products. The process of receiving orders, checking packing lists, and handling discrepancies is also covered.

Special orders are placed for atypical products not frequently dispensed, such as investigational drugs, some HIV or immunotherapy medications, or non-formulary drugs. Backordered items (marked 'Bo' on packing slips) require communication with patients and manufacturers. If a medication is backordered, the pharmacy may contact the manufacturer directly, check other pharmacies, or consult the prescribing physician for alternatives.

Any changes in product availability, such as changes in appearance due to a new manufacturer, must be communicated to the patient to prevent confusion. Returns are necessary for expired, recalled, damaged, or incorrectly sent products. Conditions for returns usually require products to be unopened and unmarked. Recalls can be initiated by manufacturers or the FDA and are classified by danger level (Class I: most serious, potential for adverse effects or death; Class III: least harmful, often labeling issues).

Expired drugs cannot be dispensed. Pharmacies regularly check for expiration dates, marking those expiring within six months. Medications expiring within three months are typically pulled and returned for credit. Proper disposal protocols are followed to destroy and document expired, tainted, or deteriorated medications, with clear labeling to prevent accidental dispensing.

Insurance billing is a complex but manageable aspect of pharmacy work. Formularies are drug lists, with the FDA maintaining a national formulary, and insurance companies and hospitals having their own. PBMs (Pharmacy Benefits Managers) process prescription claims for some insurance companies. Formularies can be open (cover non-listed drugs at higher cost), closed (only cover listed drugs), or restricted (limit to generics or specific drugs, often with tiered co-pays).

HMOs (Health Maintenance Organizations) require a primary care physician referral for specialists and only cover services from contracted providers. PPOs (Preferred Provider Organizations) offer greater choice, do not require PCP referrals, and allow patients to use out-of-network providers (though usually at a higher out-of-pocket cost).

Medicaid and Medicare are government-issued insurance programs. Medicaid serves low-income and disabled individuals, administered by states. Medicare (for those 65+, disabled, or with ESRD) has parts A (hospital), B (medical/diagnostic supplies), C (Medicare Advantage), and D (prescription coverage). Patients can have both Medicaid and Medicare, requiring coordination of benefits. Drug discount cards and coupons (like GoodRx) are also discussed as ways to reduce patient costs.

Adjudication refers to electronically submitting a claim, with the carrier being the insurance provider. The co-pay is the patient's out-of-pocket cost. Deductibles are amounts paid upfront before insurance coverage begins. DAW (Dispense As Written) codes indicate substitution preferences: DAW 0 (generic allowed), DAW 1 (brand medically necessary), DAW 2 (patient requested brand). Accurate day supply calculation is crucial to prevent refill too soon errors or fraud. Key information for processing a claim includes BIN, PCN, member ID, and RX group numbers. Troubleshooting insurance rejections involves checking data entry and potentially contacting the insurance company.

Fraud is a serious issue in pharmacy, with significant penalties including fines and jail time. Laws like the Anti-Kickback Statute and Stark Law prevent conflicts of interest. Regulatory agencies like the Centers for Medicaid and Medicare Services (CMS) and State Departments of Health conduct compliance visits and inspections to ensure adherence to guidelines.

Digital technology and drug references are vital tools in modern pharmacies. Computer systems store patient profiles and identify drugs by NDC numbers. Automation and robotics (e.g., counting machines, prescription-filling robots) improve efficiency. Important drug references include Micromedex/Identidex (identifies medication by physical characteristics), Merck's Manual (guide to conditions), FDA Red Book (pricing), and FDA Orange Book (therapeutic equivalents/generics). Electronic formats are preferred for their ease of updates.

Students are assigned a unit dose simulation. This involves individually packaging each dose with a label, mimicking hospital settings. Students can use household items like ice trays or egg cartons, or even draw sections on paper, to demonstrate their understanding of unit dosing, including proper labeling and quantity.