MPJE Patient Counseling and Confidentiality 2 — Questions and Answers
Question 1: Under OBRA '90, which patients are specifically entitled to pharmacist counseling offers for new prescriptions?
- Only patients with chronic diseases
- Medicaid outpatients receiving new prescriptions (Correct answer)
- All patients regardless of payer source
- Only patients purchasing brand-name medications
Correct answer: Medicaid outpatients receiving new prescriptions
OBRA '90 mandated that pharmacists offer counseling to Medicaid outpatients for new prescriptions as a condition of Medicaid participation.
Question 2: A pharmacist discovers during counseling that a patient is taking an OTC drug that causes a significant interaction with their new prescription. The pharmacist's BEST action is to:
- Dispense the medication and document the interaction in the patient's profile
- Refuse to dispense until the prescriber is contacted and the issue resolved
- Counsel the patient on the interaction and advise them to consult their physician (Correct answer)
- Dispense only half the prescription quantity until the interaction is clarified
Correct answer: Counsel the patient on the interaction and advise them to consult their physician
Counseling the patient on the drug interaction and advising physician consultation fulfills the pharmacist's duty while respecting patient autonomy.
Question 3: Which HIPAA provision specifically allows a pharmacist to discuss a patient's prescription information with the patient's adult child who is present at the counter?
- The minimum necessary standard
- The patient's implied authorization based on the circumstances (Correct answer)
- The treatment, payment, and operations exception
- The incidental disclosure allowance
Correct answer: The patient's implied authorization based on the circumstances
HIPAA allows disclosure when a patient's conduct implies authorization, such as bringing a family member to the pharmacy counter.
Question 4: A pharmacy receives a subpoena for a patient's prescription records. The appropriate response is to:
- Immediately comply and provide all requested records
- Contact the pharmacy's legal counsel before releasing records (Correct answer)
- Refuse to release any records without a court order signed by a judge
- Notify the patient and allow them 30 days to object before releasing records
Correct answer: Contact the pharmacy's legal counsel before releasing records
A subpoena is not a court order, and pharmacies should consult legal counsel to determine the appropriate response and protect patient rights.
Question 5: When counseling a patient on a new antihypertensive medication, which component is MOST critical to include per standard counseling guidelines?
- The cost of the medication compared to alternatives
- Signs and symptoms of adverse effects requiring medical attention (Correct answer)
- The prescriber's rationale for choosing this specific drug
- How the drug compares to other drugs in its class
Correct answer: Signs and symptoms of adverse effects requiring medical attention
Informing patients about adverse effects requiring medical attention is essential for patient safety and is a core counseling element.
Question 6: A pharmacist receives a prescription for a controlled substance for a patient known to have recently completed a drug rehabilitation program. The pharmacist should:
- Refuse to fill the prescription due to the patient's history
- Contact the rehabilitation facility before dispensing
- Evaluate the prescription's legitimacy and counsel the patient appropriately (Correct answer)
- Require a urine drug screen before dispensing
Correct answer: Evaluate the prescription's legitimacy and counsel the patient appropriately
A pharmacist must evaluate each prescription on its merits and provide appropriate counseling without discriminating based on a patient's medical history.
Question 7: Under the HIPAA Privacy Rule, a covered entity may disclose PHI for public health activities to:
- Any government agency upon request
- Public health authorities authorized by law to collect or receive such information (Correct answer)
- News media reporting on public health emergencies
- Insurance companies for actuarial purposes
Correct answer: Public health authorities authorized by law to collect or receive such information
HIPAA permits disclosure of PHI to public health authorities legally authorized to collect or receive information for public health purposes.
MPJE Patient Counseling and Confidentiality 2
Under OBRA '90, which patients are specifically entitled to pharmacist counseling offers for new prescriptions?