Free Multistate Pharmacy Jurisprudence Examination (MPJE) Patient Counseling and Confidentiality Questions and Answers — Questions and Answers
Question 1: A caregiver picks up a new prescription for an elderly patient. The pharmacy technician at the counter completes the sale and asks, "Do you have any questions for the pharmacist today?" The caregiver replies, "No, we're all set," and leaves. Which statement best describes the pharmacy's fulfillment of its patient counseling obligations under the Omnibus Budget Reconciliation Act of 1990 (OBRA '90)?
- The pharmacy's obligation was not met because the pharmacist must personally make the offer to counsel.
- The pharmacy's obligation was met because an offer to counsel was made and subsequently refused by the patient's agent. (Correct answer)
- The pharmacy's obligation was not met because counseling is mandatory for all new prescriptions and cannot be refused.
- The pharmacy's obligation was met because the technician is a designated agent of the pharmacist for all non-clinical tasks.
Correct answer: The pharmacy's obligation was met because an offer to counsel was made and subsequently refused by the patient's agent.
Under OBRA '90, a pharmacist must make an 'offer to counsel' a patient or their agent on new prescriptions. While the counseling itself must be performed by a pharmacist, the offer can often be made by ancillary personnel like a technician. Since the caregiver, acting as the patient's agent, refused the offer, the pharmacy has met its legal obligation. Counseling is not mandatory if a patient or their agent refuses the offer.
Question 2: Under the Health Insurance Portability and Accountability Act (HIPAA), which of the following disclosures of Protected Health Information (PHI) by a pharmacy requires prior written authorization from the patient?
- Providing a patient's prescription history to their primary care physician for continuity of care.
- Submitting a claim to a patient's insurance company for reimbursement of a filled prescription.
- Disclosing a patient's name and address to a pharmaceutical company for the purpose of marketing a new medication. (Correct answer)
- Reporting a suspected case of child abuse discovered during a patient interaction to a public health authority as required by state law.
Correct answer: Disclosing a patient's name and address to a pharmaceutical company for the purpose of marketing a new medication.
HIPAA permits the disclosure of PHI without patient authorization for treatment, payment, and healthcare operations (TPO). Disclosing information to a physician for treatment or to an insurer for payment falls under TPO. Disclosures required by law, such as to public health authorities, are also permitted without authorization. However, using PHI for marketing purposes that are not related to the patient's direct care requires explicit written authorization from the patient.
Question 3: A pharmacist is discussing a patient's sensitive diagnosis and complex medication history with a pharmacy technician in the breakroom. The technician was not involved in preparing this specific patient's prescription. Which HIPAA principle is most directly violated in this scenario?
- The Patient's Right to Access.
- The Notice of Privacy Practices.
- The Breach Notification Rule.
- The Minimum Necessary Standard. (Correct answer)
Correct answer: The Minimum Necessary Standard.
The HIPAA Minimum Necessary Standard requires that workforce members only access, use, or disclose the minimum amount of PHI needed to perform their job duties. Since the technician was not involved with the patient's prescription, there was no job-related need for them to know the details of the patient's PHI. Discussing this information, even in a private breakroom, constitutes an unnecessary disclosure and violates this core principle.
Question 4: A 16-year-old patient, who is not emancipated, obtains a prescription for a contraceptive, which is a service minors can consent to under state law. Later that day, the patient's parent calls the pharmacy and requests to know what medication their child received. According to HIPAA and prevailing state law principles, what is the most appropriate action for the pharmacist?
- Immediately provide the medication name to the parent, as they are the minor's legal guardian.
- Refuse to confirm that the minor is a patient at the pharmacy.
- Inform the parent that due to state and federal privacy laws, this information cannot be disclosed without the minor's consent. (Correct answer)
- Tell the parent they must obtain a court order to access the minor's records.
Correct answer: Inform the parent that due to state and federal privacy laws, this information cannot be disclosed without the minor's consent.
HIPAA defers to state laws when a minor is permitted to consent to their own healthcare. In situations involving sensitive services like contraception, where state law allows a minor to consent, the minor generally controls the associated PHI. Therefore, the parent is not considered the minor's 'personal representative' for this specific information, and the pharmacist must protect the minor's confidentiality by not disclosing the information without the minor's permission.
Question 5: According to the Omnibus Budget Reconciliation Act of 1990 (OBRA '90), which of the following is a required component of a pharmacist's prospective drug utilization review (DUR)?
- Verifying the patient's insurance co-payment amount.
- Screening for therapeutic duplication. (Correct answer)
- Confirming the patient's preferred method of contact.
- Ensuring the dispensed drug is the most cost-effective generic available.
Correct answer: Screening for therapeutic duplication.
OBRA '90 mandates that pharmacists conduct a prospective DUR before dispensing. This review must include screening for several potential therapy problems, including therapeutic duplication, drug-disease contraindications, drug-drug interactions, incorrect dosage or duration, drug-allergy interactions, and clinical abuse/misuse. Verifying co-pays or contact preferences are administrative tasks, not clinical components of the mandated DUR.
Question 6: A patient is visiting a pharmacy for the first time. Regarding the pharmacy's HIPAA Notice of Privacy Practices (NPP), what is the pharmacy's primary legal obligation to this new patient?
- The pharmacy must mail a copy of the NPP to the patient's home within 7 business days.
- The pharmacy must post the NPP in a prominent location and provide a copy to the patient upon request.
- The pharmacy must read the entire NPP aloud to the patient before dispensing the prescription.
- The pharmacy must provide a copy of the NPP and make a good faith effort to obtain the patient's written acknowledgment of receipt. (Correct answer)
Correct answer: The pharmacy must provide a copy of the NPP and make a good faith effort to obtain the patient's written acknowledgment of receipt.
For healthcare providers with direct treatment relationships, such as a pharmacy, HIPAA requires that they provide the NPP to the patient no later than the date of the first service delivery. The pharmacy must also make a good faith effort to obtain a written acknowledgment from the patient that they have received the notice. While posting the notice is also required, the key obligation upon first service is providing the copy and attempting to get acknowledgment.
Free Multistate Pharmacy Jurisprudence Examination (MPJE) Patient Counseling and Confidentiality Questions and Answers
A caregiver picks up a new prescription for an elderly patient.
The pharmacy technician at the counter completes the sale and asks, "Do you have any questions for the pharmacist today?" The caregiver replies, "No, we're all set," and leaves.
Which statement best describes the pharmacy's fulfillment of its patient counseling obligations under the Omnibus Budget Reconciliation Act of 1990 (OBRA '90)?