Omnibus Budget Reconciliation Act (OBRA-90) - PowerPoint PPT Presentation

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Omnibus Budget Reconciliation Act (OBRA-90)

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Title: Omnibus Budget Reconciliation Act (OBRA-90) Author: Wayne M Brown Last modified by: Wayne M Brown Created Date: 9/13/2004 4:26:35 PM Document presentation format – PowerPoint PPT presentation

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Title: Omnibus Budget Reconciliation Act (OBRA-90)


1
Omnibus Budget Reconciliation Act (OBRA-90)
  • Goal
  • To save money

2
OBRA-90
  • Recognizes a public expectation of pharmacists
    that goes beyond oversight of drug distribution
    to include the detection and resolution of
    problems with drug therapy.

3
Basic Framework of OBRA-90
  • Three major areas
  • Rebates
  • Demonstration Projects
  • DUR

4
Rebates
  • Manufactures required to provide
    pharmaceuticals to Medicaid at their best price

5
Demonstration Projects
  • Goal
  • To determine if patient outcomes improve and cost
    decrease if pharmacists paid to provide DUR
    services

6
Drug Use Review
  • Retrospective Review
  • Educational Programs
  • Prospective Review
  • The 3 functions are all elements of a
    continuous quality improvement cycle

7
Retrospective Review
  • Board reviews drug use and compares with criteria
    for use
  • Identifies area(s) for improvement
  • Recommend educational programs

8
Educational Programs
  • Goal
  • To improve medication use

9
Prospective Review
  • Screen of prescriptions prior to dispensing
  • Patient counseling by the pharmacist
  • Pharmacist documentation of relevant information

10
Counseling Standards
  • Name and description of medication
  • Dosage form, dosage, route of administration, and
    length of therapy
  • Directions and precautions
  • Common/severe side effects
  • Techniques for self monitoring
  • Storage
  • Refill information
  • What to do if dose missed

11
Health Insurance Portability and Accountability
Act
  • Seeks to improve portability and continuity of
    health insurance coverage
  • To prohibit discrimination in health coverage

12
HIPAA
  • Targets 4 aspects of health information
  • Transactions and code sets
  • National provider identities
  • Security
  • Privacy

13
Medicare
  • Title XVIII
  • Part A provides hospitalization insurance without
    any charge to eligible beneficiaries
  • Part B insures beneficiaries against medical
    expenses

14
Medicare Prescription Drug Improvement and
Modernization Act
  • Adds a voluntary prescription drug benefit to
    Medicare beginning 2006
  • Provides coverage for disease management
    programs, termed medication therapy management
    (MTM) programs

15
Medicare--Hospital
  • A pharmacist must supervise the compounding,
    packaging, and dispensing of drugs
  • Drugs and biologicals must be kept in a locked
    storage area
  • Outdated products must be made unavailable
  • No pharmacist, only designated personnel may
    remove drugs from pharmacy
  • Stop order policy
  • Drug administration errors, adverse drug
    reactions, and incompatibilities must be reported
  • Abuses and losses of controlled substances must
    be reported
  • Information relating to drug therapy must be
    available to professional staff
  • Formulary system must be established by the
    medical staff to ensure the availability of
    quality pharmaceuticals at reasonable costs.

16
Medicaid
  • Title XIX
  • Provides for the health care costs of certain
    categories of indigents, including
  • Blind
  • Disabled
  • Aged
  • Members of families with dependent children

17
Long-Term Care
  • Self-administration of medications allowed
  • No unnecessary drugs
  • in excessive dose (including duplicative therapy)
  • for excessive duration
  • without adequate monitoring
  • without adequate indications for its use
  • in the presence of adverse consequences that
    indicate the dose should be reduced or
    discontinued
  • any combination of these reasons

18
Long-Term Care
  • No antipsychotic drugs given unless necessary to
    treat specific condition diagnosed and documented
    in the clinical record
  • Residents on antipsychotic must receive gradual
    dose reductions and behavioral interventions,
    unless clinically contraindicated
  • Facility must ensure that it is free on
    medication error rates of 5 or greater
  • Residents must be free of any significant
    medication errors

19
Long-Term Care--Pharmacy
  • Pharmacy services
  • Pharmacist consultant
  • Drug regimen review
  • Labeling of drugs and biologicals
  • Storage of drugs and biologicals

20
Federal Antitrust Laws
  • Sherman Antitrust Act
  • Makes unlawful every contract, combination, or
    conspiracy in restraint of trade
  • Prohibits monopolies, attempts to monopolize, or
    conspiracies to monopolize
  • Purpose to protect competition

21
Types of Per Se Violations
  • Price fixing
  • Boycotting
  • Tying Arrangements
  • Exclusive Contracts Joint
  • Joint Ventures

22
Robinson-Patman Act
  • Makes it unlawful for sellers to discriminate
    in price between purchasers of like products when
    the effect of the discrimination may
    substantially injure competition, unless the
    discrimination is cost justified
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