Health Care system-Answer According to WHO, health care system is defined as a
system that consists of organizations, institutions and resources of people whose
primary purpose is to improve public health
Medicare-Answer Provides service for the elderly and disabled individuals must meet
certain criteria
Medicaid-Answer Provides service for lower income individuals. Federally and state
funded
Tricare - Answer AKA military insurance; provides service to veterans and soldiers
NIH - Answer National Institute of Health
Employer Insurance - Answer Most employers provide health insurance to full time
employees
Private Insurance - Answer Individuals can apply and pay for health insurance. Smaller
businesses offer group rates to their employees.
Copay - Answer The amount a person pays for their prescription drug after insurance.
This type of payment is made at point of sale, ie the pharmacy
Medicare A - Answer Covers inpatient hospital stays
,Medicare B - Answer Covers outpatient hospital stays as well as diabetic supplies, DME,
patients on long term disabilities, X-rays, dialysis, vaccines, and respiratory nebulizers
Medicare C - Answer Additional coverage not covered under A or B. Often called the
advantage plan or choice plan.
Medicare Part D - Answer Covers prescription medications; usually processed by private
insurance but funding is provided by CMS (government)
Medicare Part E - Answer Supplemental coverage; covers A, B, and D (Different than just
Medicare C)
Medicare C only covers A and B
HMO - Answer Health Maintenance organization
Health Maintenance Organization (HMO) - Answer With an HMO plan, you have to choose
a PCP from a network of local health providers who refers you to in-network specialists
or hospitals when treatments are needed. Your all care is routed via your PCP Lost cost
to the insurance and the patient PPO - Answer preferred provider organization
PPO - Preferred Provider Organization Preferred list of in-network providers and hospitals
-If you go out of network, you will pay a higher copay
-More flexibility= pay more money per month
EPO - Exclusive Provider Organization
Exclusive Provider Organization - EPO Answer Combination of sorts between HMO's and
PPO's
-There is a preferred list of providers and specialists but cannot choose a provider
outside of network
,-You can choose any primary care physician but they must be in-network
Workers Compensation - Response When a patient has been injured at work and his/her
company has agreed to pay for the cost of his/her medication
out of pocket - Response People without health care coverage and must pay out of
pocket expenses
Pharmacy Benefit Managers - Answer PBM
-Primarily responsible for development and maintenance of the formulary, contracting
with pharmacies, negotiating discounts and rebates with drug manufacturers, and
processing and paying prescription drug claims.
-Working with self-insured companies and government programs; trying to reduce
pharmacy expenditures of the plan and trying to improve health outcomes
Drug Development - Answer Complex and time consuming; on average it takes 8-15 years
for a drug to be developed and approved by the Food and Drug Administration
3 Basic Steps of Drug Development - Answer 1. Research
2. Testing
3. Approval
Research - Answer Can be done be pharmacologists, toxicologists, clinical
pharmacologists, pharmacists, and physicians
Research to find a new active ingredient, or change the structure of current drugs
FDA Regulation - Response The food and drug administration began in 1906
-Charged with the regulation of medications ensuring their safety and effectiveness
before medications are brought to market
, Where does testing begin? - Response In the laboratory
-Stability
-Structure
-Dosage forms of the drug
Tests are preformed in animals to evaluate _______ - Answer Toxicity
- New drug must be proved safe before being used in humans
How many steps is the approval process for testing in humans regulated by the FDA? -
Answer 4
Human Test Phase 1 - Answer Objective: To evaluate the first dose and to identify if
humans can tolerate the drug (toxicology)
A. New drug is tested on a few healthy individuals at the lowest dose and is slowly
increased
Pharmacokinetics - Answer absorption, distribution, metabolism, biotransformation, and
excretion
Most drugs do not make it past phase _______ - Answer 2
Human Test Phase 2 - Answer When the drug passes the first phase
-The drug is tested on a few hundred volunteers who have the disease the drug is
intended for
-Extensive data on pharmacokinetic and toxicology profile of the drug are collected in
this phase
-The optimal dose of the drug is determined in this phase
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