Unit 6: Pharmacy Operations and Inventory

• Topic 01

  Prescription Processing — Intake, Data Entry, and Verification Workflow

  29 questions
• Topic 02

  Drug Utilisation Review (DUR) — Prospective, Retrospective, and Concurrent

  27 questions
• Topic 03

  Formulary Management — Preferred Drug Lists and Therapeutic Substitution

  24 questions
• Topic 04

  Inventory Management — PAR Levels, Reorder Points, and ABC Analysis

  25 questions
• Topic 05

  Drug Recalls — Class I, II, and III and Reverse Distributors

  30 questions
• Topic 06

  Billing and Third-Party Adjudication — Claim Submission, Rejections, and DAW Codes

  42 questions
• Topic 07

  Prior Authorisation — Process, PA Forms, and Step Therapy

  30 questions
• Topic 08

  Automated Dispensing Cabinets (ADCs) — Pyxis, Omnicell, and Override Policies

  28 questions

A few questions from this unit, with the answer and a full explanation. The complete bank is available when you start practising.

1. A pharmacy data entry computer is left unattended with a patient's complete prescription history visible on the screen. A waiting customer walks by and reads the patient's medication list. What HIPAA principles have been violated?

   • A
     Only the prescriber's privacy rights were violated; patient medication histories are not protected health information
   • B
     The minimum necessary standard (information was exposed beyond what was needed for any immediate task) and the pharmacy's physical safeguard obligations to protect PHI from incidental disclosure
     Correct answer
   • C
     No HIPAA violation occurred because the patient information was not intentionally disclosed by staff
   • D
     Only the Privacy Rule was violated, not the Security Rule, because no electronic transmission of data occurred
   Explanation

   This scenario involves two HIPAA issues: (1) the minimum necessary standard violation — no staff task required that the full patient history be visible on an unattended screen; and (2) a physical safeguard failure — the HIPAA Security Rule and Privacy Rule require pharmacies to implement physical safeguards (e.g., screen privacy filters, locking workstations when unattended) to prevent incidental PHI disclosure. An inadvertent disclosure is still a HIPAA issue even without intent. Key takeaway: Unattended screens displaying PHI violate HIPAA minimum necessary and physical safeguard requirements, even without intentional disclosure.

2. A pharmacy technician enters a prescription and notices a DUR alert for a major drug-drug interaction involving warfarin and a newly prescribed NSAID. The pharmacist is on a lunch break. What is the correct action?

   • A
     Dismiss the alert and proceed with filling the prescription, noting it in the patient's profile for the pharmacist to review later
   • B
     Override the alert and dispense the NSAID because the patient may be waiting and a major alert does not automatically mean the drug is harmful
   • C
     Do not override or dismiss the alert; notify the pharmacist immediately and hold the prescription until the pharmacist returns to evaluate the alert
     Correct answer
   • D
     Dispense the drug and leave a note for the pharmacist to counsel the patient about the interaction at pickup
   Explanation

   A major DDI alert for warfarin and an NSAID (increased bleeding risk) is a clinically significant finding requiring pharmacist evaluation before dispensing. The technician's correct action is to hold the prescription and promptly notify the pharmacist — not override the alert, not dismiss it, and not call the prescriber without the pharmacist's direction. A lunch break does not eliminate the pharmacist's responsibility; the technician should locate them or contact them by phone. Key takeaway: Major DUR alerts must never be overridden by technicians; the prescription should be held and the pharmacist notified immediately.

3. A community pharmacy technician enters a new prescription for amoxicillin. The system alerts that the patient has a documented penicillin allergy. Who is responsible for evaluating and deciding how to handle this alert?

   • A
     The technician can cancel the alert and proceed if the patient's allergy was entered more than one year ago
   • B
     The patient should decide whether to proceed based on their own history with penicillin products
   • C
     The pharmacist, because evaluating and acting on DUR clinical alerts requires clinical judgment that is beyond the scope of a pharmacy technician
     Correct answer
   • D
     The technician can independently override the alert if the patient says they take penicillin drugs regularly
   Explanation

   DUR alerts — including drug-allergy interaction alerts — require clinical evaluation by the pharmacist. The technician's role is to flag the alert and notify the pharmacist, but evaluating whether the drug is safe given the allergy history requires clinical training and judgment. Technicians must not override DUR alerts independently. Key takeaway: Only pharmacists may evaluate and override DUR alerts; technicians flag alerts and refer them to the pharmacist.