MCQ Quiz: Medicaid and the Expansion of Pharmacy Services

The Omnibus Budget Reconciliation Act of 1990 (OBRA ’90) is a landmark piece of federal legislation that fundamentally reshaped the practice of pharmacy. By mandating drug utilization reviews and an offer to counsel for Medicaid patients, it established a new standard of care that has since been adopted by most states for all patients. This topic is a cornerstone of the Principles of Pharmacy Law and Ethics course “ and its application is central to the practice of pharmacy. This quiz will test your knowledge on the key components of OBRA ’90 and its lasting impact.

1. The Omnibus Budget Reconciliation Act of 1990 (OBRA ’90) established federal mandates for pharmacy practice for which patient population?

• a. All patients in the United States
• b. Medicare patients
• c. Medicaid patients
• d. Only pediatric patients

Answer: c. Medicaid patients

2. What was the primary goal of the federal government in passing the OBRA ’90 pharmacy provisions?

• a. To increase the number of pharmacists.
• b. To save money in the Medicaid program by improving therapeutic outcomes and reducing adverse drug events.
• c. To make all prescriptions free for patients.
• d. To increase the speed of dispensing.

Answer: b. To save money in the Medicaid program by improving therapeutic outcomes and reducing adverse drug events.

3. Which of the following is NOT one of the three major components required by OBRA ’90?

• a. Prospective Drug Utilization Review (Pro-DUR)
• b. Mandatory price controls on all medications
• c. Maintenance of patient records
• d. An offer to counsel

Answer: b. Mandatory price controls on all medications

4. A Prospective Drug Utilization Review (Pro-DUR) is a review of a patient’s therapy that must be done:

• a. After the prescription is dispensed.
• b. Before the prescription is dispensed.
• c. Once a month for all patients.
• d. By a pharmacy technician only.

Answer: b. Before the prescription is dispensed.

5. The federal OBRA ’90 statute requires a pharmacist to ____ every Medicaid patient for new prescriptions.

• a. personally counsel
• b. make an offer to counsel
• c. give a pamphlet to
• d. call on the phone

Answer: b. make an offer to counsel

6. The “Principles of Pharmacy Law and Ethics” is a core course in the curriculum.

• a. True
• b. False

Answer: a. True

7. A Pro-DUR is intended to identify potential drug therapy problems such as:

• a. Therapeutic duplication
• b. Incorrect dose
• c. Drug-drug interactions
• d. All of the above

Answer: d. All of the above.

8. Most state laws have expanded the principles of OBRA ’90 to apply to:

• a. Only cash-paying patients.
• b. Only patients with private insurance.
• c. All patients, regardless of their payer.
• d. Only Medicaid patients, as per the federal law.

Answer: c. All patients, regardless of their payer.

9. The patient record-keeping component of OBRA ’90 is essential for a pharmacist to be able to:

• a. Perform an effective Pro-DUR.
• b. Bill the patient’s insurance.
• c. Order medications.
• d. Manage pharmacy inventory.

Answer: a. Perform an effective Pro-DUR.

10. Who is legally permitted to provide patient counseling according to most state pharmacy practice acts?

• a. Any pharmacy employee.
• b. Only the pharmacy manager.
• c. A pharmacist or a pharmacy intern under the direct supervision of a pharmacist.
• d. A certified pharmacy technician.

Answer: c. A pharmacist or a pharmacy intern under the direct supervision of a pharmacist.

11. Counseling patients on the appropriate use of medications is a key objective in the IPPE curriculum.

• a. True
• b. False

Answer: a. True

12. If a Medicaid patient refuses the offer to counsel, the pharmacist must:

• a. Refuse to dispense the medication.
• b. Counsel the patient anyway.
• c. Document the refusal according to state law and professional judgment.
• d. Report the patient to Medicaid.

Answer: c. Document the refusal according to state law and professional judgment.

13. Which of the following topics is NOT typically required to be covered in an OBRA ’90-style counseling session?

• a. The name and description of the medication.
• b. The manufacturer’s profit margin for the medication.
• c. Common severe side effects or adverse effects.
• d. Proper storage of the medication.

Answer: b. The manufacturer’s profit margin for the medication.

14. A pharmacist identifies a potential drug-allergy interaction during a Pro-DUR. What is the most appropriate next step?

• a. Dispense the medication and let the patient decide if they want to take it.
• b. Override the alert and document it was a false alarm.
• c. Contact the prescriber to discuss the potential issue and recommend an alternative.
• d. Ask the technician what to do.

Answer: c. Contact the prescriber to discuss the potential issue and recommend an alternative.

15. Displaying appropriate counseling techniques is a key objective for student pharmacists.

• a. True
• b. False

Answer: a. True

16. OBRA ’90 is considered a landmark law because it shifted the legal standard of pharmacy practice toward a more:

• a. Product-focused model.
• b. Business-oriented model.
• c. Patient-centered, clinical model.
• d. Technically-focused model.

Answer: c. Patient-centered, clinical model.

17. The “offer to counsel” requirement applies to which prescriptions for Medicaid patients?

• a. Only new prescriptions.
• b. Only refill prescriptions.
• c. All new and refill prescriptions.
• d. Only controlled substances.

Answer: a. Only new prescriptions.

18. A key element of a patient profile as required by OBRA ’90 includes:

• a. A list of the patient’s medications.
• b. The pharmacist’s comments relevant to the patient’s therapy.
• c. Basic demographic information.
• d. All of the above.

Answer: d. All of the above.

19. A pharmacist providing counseling via a mail-order pharmacy can fulfill the counseling requirement by:

• a. Doing nothing, as it is waived.
• b. Providing written information and access to a pharmacist via a toll-free number.
• c. Sending an email a week later.
• d. Assuming the patient will look it up online.

Answer: b. Providing written information and access to a pharmacist via a toll-free number.

20. A pharmacist’s “corresponding responsibility” for controlled substances is conceptually similar to what OBRA ’90 component?

• a. The need to maintain patient records.
• b. The prospective drug utilization review (Pro-DUR).
• c. The offer to counsel.
• d. There is no similarity.

Answer: b. The prospective drug utilization review (Pro-DUR).

21. A patient says “no” when the technician asks if they have any questions for the pharmacist. This legally constitutes a valid refusal of the offer to counsel.

• a. True
• b. False

Answer: a. True

22. Which of the following would NOT be considered a drug therapy problem to be identified in a Pro-DUR?

• a. A patient being prescribed two drugs from the same therapeutic class.
• b. A dose that is below the standard therapeutic range.
• c. A drug that is contraindicated with the patient’s kidney disease.
• d. The patient’s preference for a brand name drug over a generic.

Answer: d. The patient’s preference for a brand name drug over a generic.

23. The Professional Practice Skills Lab courses provide training in patient counseling.

• a. True
• b. False

Answer: a. True

24. A pharmacist’s professional judgment is required to determine the content and extent of patient counseling.

• a. True
• b. False

Answer: a. True

25. A pharmacist who fails to perform a Pro-DUR for a Medicaid patient, resulting in a harmful drug interaction, has violated which law?

• a. HIPAA
• b. The Controlled Substances Act
• c. OBRA ’90
• d. The Food, Drug, and Cosmetic Act

Answer: c. OBRA ’90

26. The law course PHA5703 is foundational to understanding these requirements.

• a. True
• b. False

Answer: a. True

27. A key goal of patient counseling is to improve:

• a. Medication adherence.
• b. The patient’s understanding of their therapy.
• c. The detection of adverse effects.
• d. All of the above.

Answer: d. All of the above.

28. An active learning session on pharmacy law is a key part of which course?

• a. PHA5703 Principles of Pharmacy Law and Ethics
• b. PHA5163L Professional Skills Lab 3
• c. PHA5781 Patient Care I
• d. PHA5782C Patient Care 2

Answer: a. PHA5703 Principles of Pharmacy Law and Ethics

29. The offer to counsel must be made by the pharmacist personally in all states.

• a. True
• b. False

Answer: b. False

30. The legal requirements established by OBRA ’90 helped to lay the foundation for which pharmacist-led clinical service?

• a. Sterile compounding
• b. Medication Therapy Management (MTM)
• c. Dispensing
• d. Inventory management

Answer: b. Medication Therapy Management (MTM)

31. A patient’s refusal of counseling relieves the pharmacist of all professional liability for the prescription.

• a. True
• b. False

Answer: b. False

32. A pharmacist uses the pharmacy computer system to check for interactions before dispensing. This is part of the ____ process.

• a. patient counseling
• b. record keeping
• c. prospective DUR
• d. billing

Answer: c. prospective DUR

33. The patient counseling requirements of OBRA ’90 apply to which setting?

• a. Hospital inpatient pharmacies
• b. Community and outpatient pharmacies
• c. Nuclear pharmacies
• d. All pharmacy settings

Answer: b. Community and outpatient pharmacies

34. The “offer to counsel” must be a meaningful offer.

• a. True
• b. False

Answer: a. True

35. A pharmacist can be disciplined by a State Board of Pharmacy for failing to counsel according to state regulations.

• a. True
• b. False

Answer: a. True

36. A key part of the pharmacist’s role in counseling is using language the patient can understand. This is a principle of:

• a. Health literacy
• b. Clinical pharmacology
• c. Medicinal chemistry
• d. Pharmacoeconomics

Answer: a. Health literacy

37. When counseling, open-ended questions are preferred over questions that can be answered with a simple “yes” or “no”.

• a. True
• b. False

Answer: a. True

38. The HIPPE curriculum requires students to display appropriate counseling techniques.

• a. True
• b. False

Answer: a. True

39. A pharmacist asks a patient, “What did your doctor tell you this medication is for?” This is a good way to begin a counseling session to assess:

• a. The patient’s understanding.
• b. The patient’s adherence.
• c. The patient’s insurance status.
• d. The patient’s relationship with their doctor.

Answer: a. The patient’s understanding.

40. An active learning session covering pharmacy law is part of which course?

• a. PHA5703 Principles of Pharmacy Law and Ethics
• b. PHA5163L Professional Skills Lab 3
• c. PHA5781 Patient Care I
• d. PHA5782C Patient Care 2

Answer: a. PHA5703 Principles of Pharmacy Law and Ethics

41. The legal requirement to counsel has elevated the standard of care for pharmacy practice.

• a. True
• b. False

Answer: a. True

42. A pharmacist is not required to counsel on a refill if they do not believe there have been any changes or issues.

• a. True, in most states, the mandate is primarily for new prescriptions.
• b. False, counseling is required for every single refill.
• c. True, counseling is never required for refills.
• d. False, the law prohibits counseling on refills.

Answer: a. True, in most states, the mandate is primarily for new prescriptions.

43. A pharmacist’s professional and ethical responsibility to ensure patient safety may lead them to counsel a patient even when it is not legally required.

• a. True
• b. False

Answer: a. True

44. Which of the following is NOT a main goal of OBRA ’90?

• a. Improve quality of patient care.
• b. Reduce healthcare costs.
• c. Increase the number of prescriptions dispensed.
• d. Expand the clinical role of the pharmacist.

Answer: c. Increase the number of prescriptions dispensed.

45. The “three prime questions” model is a technique used for:

• a. Prospective DUR
• b. Patient counseling
• c. Inventory management
• d. Compounding

Answer: b. Patient counseling

46. If a state has no specific law regarding patient counseling, the pharmacist must still comply with:

• a. No regulations.
• b. The federal OBRA ’90 requirements for Medicaid patients.
• c. The policies of the largest pharmacy chain.
• d. The recommendations of the drug manufacturer.

Answer: b. The federal OBRA ’90 requirements for Medicaid patients.

47. The CIPPE curriculum requires students to counsel on how to read a prescription label.

• a. True
• b. False

Answer: a. True

48. An active learning session on pharmacy law is part of which course?

• a. PHA5703 Principles of Pharmacy Law and Ethics
• b. PHA5163L Professional Skills Lab 3
• c. PHA5781 Patient Care I
• d. PHA5782C Patient Care 2

Answer: a. PHA5703 Principles of Pharmacy Law and Ethics

49. The overall impact of OBRA ’90 and subsequent state laws has been to:

• a. Make the pharmacist’s job easier.
• b. Formally recognize the pharmacist’s role as a medication expert responsible for patient outcomes.
• c. Decrease the importance of pharmacy technicians.
• d. Increase the cost of prescription drugs.

Answer: b. Formally recognize the pharmacist’s role as a medication expert responsible for patient outcomes.

50. The ultimate reason a pharmacist must understand the laws regarding counseling is to:

• a. Practice legally and ethically to ensure the safety and well-being of their patients.
• b. Avoid being sued.
• c. Pass the MPJE.
• d. Both a and c are correct.

Answer: d. Both a and c are correct.