MPJE General 5 — Questions and Answers
Question 1: A pharmacist receives an oral order for a Schedule II controlled substance. Under which circumstance is this permitted by federal law?
- Never; all CII prescriptions must be written
- In a genuine emergency when the prescriber cannot provide a written prescription (Correct answer)
- When the prescriber is a DEA-registered physician and the patient is a minor
- When the pharmacy's computer system is down
Correct answer: In a genuine emergency when the prescriber cannot provide a written prescription
Federal law permits oral orders for Schedule II substances only in genuine emergencies, with a written prescription to follow within 7 days.
Question 2: Under the Omnibus Budget Reconciliation Act of 1990 (OBRA '90), pharmacists providing Medicaid services are required to:
- Dispense only generic drugs unless brand is medically necessary
- Offer prospective drug utilization review and patient counseling (Correct answer)
- Submit all prescription claims to CMS within 24 hours
- Maintain a pharmacist-to-patient ratio of no more than 1:50
Correct answer: Offer prospective drug utilization review and patient counseling
OBRA '90 mandates that pharmacists offer prospective DUR and patient counseling for Medicaid beneficiaries.
Question 3: Which of the following is the primary purpose of a Drug Utilization Review (DUR) program?
- To track opioid prescribing patterns for DEA reporting
- To identify and resolve potential drug therapy problems before dispensing (Correct answer)
- To calculate pharmacy reimbursement rates for insurance plans
- To verify that prescribers have active DEA registrations
Correct answer: To identify and resolve potential drug therapy problems before dispensing
DUR programs are designed to identify drug therapy problems such as interactions, duplications, and contraindications to improve patient safety.
Question 4: A pharmacy discovers that a Schedule II drug was stolen. Under DEA regulations, the pharmacy must notify the DEA field office within:
- 24 hours of discovery (Correct answer)
- 1 business day of discovery
- 72 hours of discovery
- 30 days of discovery
Correct answer: 24 hours of discovery
Pharmacies must notify the nearest DEA field office by telephone within 24 hours upon discovery of a significant theft or loss of controlled substances.
Question 5: Under federal law, a valid prescription must include all of the following EXCEPT:
- Date issued
- Patient address
- Drug name, strength, and quantity
- Prescriber's National Provider Identifier (NPI) number (Correct answer)
Correct answer: Prescriber's National Provider Identifier (NPI) number
Federal law does not require a prescriber's NPI number on a prescription; required elements include patient name/address, date, drug information, and prescriber signature/DEA number for controlled substances.
Question 6: The Drug Enforcement Administration (DEA) Form 222 is used for:
- Reporting theft or significant loss of controlled substances
- Ordering Schedule I and II controlled substances (Correct answer)
- Registering a new pharmacy with the DEA
- Requesting a waiver to dispense buprenorphine for OUD
Correct answer: Ordering Schedule I and II controlled substances
DEA Form 222 (or its electronic equivalent CSOS) is the official order form used to purchase or transfer Schedule I and II controlled substances.
Question 7: Under the Affordable Care Act, which provision most directly expanded pharmacist authority to provide immunizations and preventive services?
- The individual mandate provision
- Coverage of preventive services without cost-sharing and state scope-of-practice recognition (Correct answer)
- Establishment of Accountable Care Organizations
- Mandatory formulary transparency requirements
Correct answer: Coverage of preventive services without cost-sharing and state scope-of-practice recognition
The ACA's preventive services provisions and recognition of expanded state scope-of-practice laws have broadened pharmacists' roles in immunization and preventive care delivery.
MPJE General 5
A pharmacist receives an oral order for a Schedule II controlled substance.
Under which circumstance is this permitted by federal law?