MPJE Tips for Pharmacists and Students

The Multistate Pharmacy Jurisprudence Exam, or more commonly referred to as the “MPJE”, is a law exam that pharmacists must pass to practice pharmacy in most states.  There are few states such as Idaho and Ohio, which do not require MPJE to practice, and California, which runs its own version of MPJE called CPJE that focuses more on clinical aspects of the pharmacy practice, but passing the MPJE is required to practice pharmacy in all other states.  MPJE poses challenge and frustration to many pharmacy graduates and pharmacists who are seeking licensure in another state because the topic of law and regulations is not something most pharmacists and graduates are familiar nor comfortable with.   This post is intended to provide some tips to not only increase the chance of passing the exam, but also to reduce the time and stress in preparing for the MPJE.

‘Who are you to provide tips to others?’, one may ask, and that is a fair and logical question.  After all, advice from a data analytics student on a very specialized exam that has little to do with data analyses should not carry much weight to a reasonable pharmacist or pharmacy graduate.  However, as of the date of this entry, I have passed ten MPJEs on first attempt, eight of them within two months (yes, I was taking one MPJE per week, shortest interval being four days between the exams) due to my job requiring multistate licensure.

*Note: Guam result is not reported via NABP but I passed.

Above is my current progress with MPJEs and I was able to achieve passing scores while working 48 hours per week.  Now, I am not trying to boast my time management skills or testing abilities (well, may be just a little bit on time management aspect) but what I would like to emphasize is that preparing for MPJE does not need weeks or months of studying.  I have seen some interns studying for 3 months (even preparing for the bar exam doesn’t take that long!) and I believe 20 hours of studying is more than sufficient for the first MPJE. For subsequent MPJEs, 8 hours of studying should be more than enough assuming knowledge in federal law has not completely faded away.

To be fair, MPJE is a difficult exam.  I personally found my first MPJEs (I consider both NJ MPJE on 07/09/2005 and MS MPJE on 10/18/2021 as “first” due to more than 16 years of time in between) more difficult than the NYS bar exam.  My pharmacist friends and coworkers all laugh when I share my experience but I truly felt that way.  This is because unlike the bar exam, the way some of the questions are worded in MPJEs are so convoluted and makes little sense even to a licensed attorney who has been practicing pharmacy in multiple settings for 15+ years.  Also, at least with the NYS bar exam, students can take advantage of the essay portion of the exam to show how much they know about the law, how to apply them, and the likely outcome of the cases.  With MPJEs, it is 100% multiple choice with mix of SATA (select all that apply) type questions, giving no room for test takers to demonstrate their knowledge on the topic.   By the way, do not panic if you see back to back SATA questions.  This is actually a good sign!  While I have no evidence since NABP does not release much information on how MPJE is graded other than it is an adaptive test, I believe SATA type questions are only given when the test taker is doing well.  Think about it.  If you are keep answering questions wrong, the exam software algorithm will keep giving you easy questions.  In other words, in order to “unlock” these SATA type questions, you have to be answering multiple questions correct in a row.  So, if you see back to back to back SATA type questions, it probably means you are acing the exam!  On the contrary, if you don’t see many SATA type questions or see few SATA question here and there with subsequent question being really easy (e.g., “do you need a license to practice pharmacy?”), then you should be concerned.  Again, this is my personal theory just based on the adaptive nature of the exam, but I am fairly certain that my hypothesis is correct.  While the exam is difficult, getting the passing score of 75 out of 100 should not be too difficult if you know what topics to study for.  Also, score of 75 does not mean that you need to get 75% correct since it is a scaled score.  No one knows how the exam is scaled since NABP does not provide such information, but my guess (another pure speculation based on my personal experience) is that answering 50% of the graded questions correct (remember that 20 out of 120 questions are “experimental” that do not affect your score) is more than sufficient to pass the exam.

Now, let me share what legal topics I study when I am preparing for the MPJE.  Most of the answers to these questions can be found using a simple search function in each state’s pharmacy laws, rules, and regulations page (some states even provide them in pdf files).  I also highly recommend  reading through board of pharmacy’s FAQ section since this page explains the law in more detail for legal topics that is unclear through the language of the statutes.  In other words, all the topics in board’s FAQ section covers laws, rules, and regulations that pharmacists have difficult time understanding or following during their day to day practice due to the vagueness of the law.  I have seen questions asked in the FAQ section on the actual MPJE multiple times (sometimes, even verbatim) and these were rare freebies that I knew with 100% certainty that I answered them correctly.  In addition, read through the recent board of pharmacy letters (usually available via NABP or each state’s board of pharmacy website) since these documents also provide board’s own interpretation of the pharmacy laws on subjects where pharmacists are consistently having issues following them.  Similar to FAQs, I have seen many of the topics discussed in these letters on the actual MPJE and I cannot recommend enough to go through them.  Believe it or not, these letters are pretty interesting and entertaining to read since it usually covers the most controversial or popular topics at the time.  The followings are the topics that I memorize before the exam, and just to clarify, I do not study anything that is outside of the topics discussed below.  If I get a question that isn’t covered in my choice of topics, I just make an educated guess and move on.  Remember, we are not trying to get every question correct on the MPJE.  We are only looking to get that scaled score of 75, which I believe is somewhere close to 50% (again, my own speculation without any evidence, aka “trust me bro/sis”), so do not feel discouraged if you have to guess on multiple questions.  Besides, if you studied federal law in detail, than educated guess probably has a decent chance of being correct.

 

I. KNOW THE FEDERAL LAW

Federal law is the foundation of any state’s MPJE because MPJE is pretty much federal law + individual state’s own modification of the federal law + state’s unique law that is not addressed in the federal law.  In other words, if the state law is silent on certain issue, pharmacist must follow the federal law.  It is important to note that when federal law and state law conflicts with each other, pharmacist must follow the stricter law.  In most cases, states will have stricter law but you will encounter federal law being more strict (especially with controlled substances) in few cases.  Therefore, learn the federal law and memorize them prior to looking at the state law.  You must make federal law as your base knowledge and add or modify some sections based on the state law.  I would even go far as claiming that test takers have very decent chance of passing any state’s MPJE even without studying the state law if they know the federal law by heart since we are not trying to get 75% of the questions correct to get a score of 75.  Learning the federal law is half the battle and I strongly recommend spending good amount of studying time on the federal law if you are taking the MPJE for the first time.

(1)  Study the history and background of laws related to pharmaceuticals, patient safety, pharmacy/medical practice which have led to current regulations. Key laws and legislation include the following:

    1. Drug Importation Act of 1848: requires U.S. Customs to inspect imported drugs and stop the entry of adulterated drugs.
    2. Pure Food and Drug Act of 1906: first major federal law regulating food and drugs in the US, which prohibits the manufacture, sale, or transportation of adulterated or misbranded food and drugs.  The United States Food and Drug Administration (FDA) was created to enforce this Act.
    3. Federal Food, Drug, and Cosmetic Act of 1938: enacted in response to a tragedy where a drug called “elixir sulfanilamide” containing a toxic solvent killed over 100 people, and requires evidence of safety before a drug could be marketed and expanded FDA’s regulatory authority to include cosmetics and medical devices.
    4. Durham-Humphrey Amendment of 1951: established two classes of medications – prescription (Rx) and over-the-counter (OTC).
    5. Kefauver-Harris Amendments of 1962: passed in response to the thalidomide tragedy and requires manufacturers to demonstrate the efficacy of a drug before it could be marketed in the U.S.
    6. Poison Prevention Packaging Act of 1970: requires certain household substances such as prescription drugs, over-the-counter drugs, and hazardous chemicals to use child-resistant packaging.  Note that there are some exemptions such as permitting non-child resistant packaging for certain medications if requested by the prescriber doctor or patient to accommodate the elderly and disabled.
    7. Medical Device Amendments of 1976: requires safety and effectiveness safeguards to new medical devices following a U.S. Senate finding that faulty devices had caused thousands of injuries and deaths.
    8. Drug Price Competition and Patent Term Restoration Act of 1984 (a.k.a. Hatch-Waxman Act): allows generic drugs to rely on the brand’s safety and efficacy data to gain approval while granting brand manufacturers years of exclusivity period where generics cannot be submitted to the FDA.
    9. Health Insurance Portability and Accountability Act (HIPAA) of 1996: enacted to modernize the flow of healthcare information, provide national standards for electronic healthcare transactions, and protect the privacy and security of personal health information.
    10. Health Information Technology for Economic and Clinical Health (HITECH) Act of 2009: enacted to accelerate the adoption of electronic health records (HER) and other health information technology in the U.S healthcare system through a combination of incentives, standards, and enforcement mechanisms.

The list is not comprehensive and make sure you understand what effect the laws and regulations you encounter during your studies have in current pharmacy practice

(2)  Know the labeling requirements for prescription medications, OTC medications, unit dose medications dispensed in hospital, retail, and other practice settings. Memorize every component as MPJE frequently asks what is or is not required on a label.  For example, is NDC number required on the label of the vial dispensed to the patient at a retail pharmacy?  How about on the labels of unit-dosed packages in an inpatient setting?

(3)  Understand the difference between misbranding and adulteration. Know the examples of both definitions.  Good way to differentiate between the two is that misbranding is about false or misleading labeling while adulteration is about issues with the actual composition, quality, or manufacturing of the product.  In other words, misbranding relates to how the product is presented while adulteration relates to how the product is made.  For example, if a patient receives a prescription labeled atorvastatin 20mg on the vial from a retail pharmacy but it actually had lisinopril 20mg instead, it would be mislabeling as the vial’s label misrepresents the content inside the vial but there are no inherent defects in the lisinopril itself.  If the same vial contained atorvastatin 20mg but you see discoloration of tablets, then this would be considered adulteration as it has inherent defects.  If the lisinopril had discoloration in the atorvastatin vial, it would be considered both misbranded an adulterated.  How about if atorvastatin 20mg vial with a label indicating manufacturer A but contains atorvastatin 20mg from manufacturer B?  This would constitute misbranding even if the active ingredient, strength, and formulation is the same as the label has misinformation.  What if the pharmacist who was compounding IV chemotherapy medications in the chemotherapy hood and starts compounding vancomycin bags without changing the gloves?  That would be an example of adulteration even though there is no clear evidence of contamination.  The contamination risk itself is sufficient to constitute adulteration.  It is imperative you understand the difference between the two definitions as it is frequently tested on the MPJE with many different scenarios.

(4)  Know the various classes of FDA recalls and how to respond to them.

(5)  Know the eligibility requirements for a facility to register as a 503B outsourcing facility with the FDA.

(6)  Learn both the generic and common brand names of federally scheduled class drugs (CI-CV): Note that some states will classify federally non-controlled substances as a controlled substance in their state.  Common example would be gabapentin.  Also, some states will have a different schedule within the controlled substance classes.

(7)  Understand how to determine controlled substance class based on codeine content by milligrams.

(8)  Know what rating in the Orange Book would constitute bioequivalency between two medications. Note that there are various codes (AA, AB, AN, AO, AP, AT, BC, BD, BE, BN, BP, BR, BS, BT, BX, and B*) but only relevant codes for the MPJE are AB and BC.  Know what AB and BC rating means.

(9)  Know when patient package insert must be dispensed along with the medication.

(10)  Learn the common floorplan for sterile compounding areas and be familiar with the common abbreviations used in sterile compounding settings such as ISO, PEC, LAFW, BSC, and ACPH. Know the ISO class level for areas that prepare low-risk, medium-risk, high-risk, and radiopharmaceuticals.

 

II. KNOW THE CONTROLLED SUBSTANCE LAW

Have you ever wondered why pharmacists have to take a law exam before they can start practicing?  If you think about it, no other healthcare professionals need to pass a law exam to practice (please correct me if I am wrong).  Doctors, nurses, dentists, physician assistants, and other healthcare professionals only need to demonstrate their clinical knowledge and practical skills prior to licensure.  What makes pharmacists different from others?  The major difference is that the pharmacists are involved in moving large amounts of controlled substances.  You do not need to be a pharmacist to speculate that every aspect of controlled substances is governed by complex laws, regulations, and entities (why else would it be called “controlled” substances?).   As a pharmacist, you need to know every aspect of the controlled substance system since you will be ordering, storing, distributing, and dispensing them.  In addition to the complex regulations on controlled substances, many states relying on pharmacists to identify inappropriate prescribing and dispensing of controlled substances in effort to combat opioid epidemic makes controlled substance law not only a key component, but also the most frequently asked topic in the MPJE.

While a thorough reading of the controlled substance law is strongly encouraged, we are all busy individuals with families, friends, work, school, netflix, youtube, reddit, and other high quality and productive time commitments.  Because of this reason, I focused my studying on topics that I have to know by heart to practice pharmacy without getting into trouble with the DEA and the Board of Pharmacy.   As convoluted as many of the MPJE questions are worded, we must remember that the intent of the exam is to ensure that pharmacists understand the laws and procedures of pharmacy practice to minimize the chance of harming patients or disrupting current controlled substance regulations.  In other words, it aims to test the knowledge of the law and the test taker’s ability to apply the law during the actual practice of pharmacy.  Therefore, I found it helpful to study the materials based on various scenarios that pharmacists commonly encounter during their practice.  Let’s go through some common scenarios.

Good starting point is when pharmacist receives a prescription for a controlled substance.

(1)  Is this a CII or CIII-V?

(2)  Does the prescription include everything that is required by law? (e.g., patient name, date, prescriber’s signature, etc.)  If such information is missing or incorrect, can I add or modify them with or without prescriber’s knowledge or approval?

(3)  If it is a CII, is the prescription still valid based on the written date of the prescription?  Same question applies to CIII-V.

(4)  Is there a quantity or day supply limit for CII per prescription?  Same question applies to CIII-V and should also know how many refills are allowed on CIII-V prescriptions.

(5)  If it is a CII, are post-dated prescriptions allowed?  If not, how does the prescriber issue CII prescriptions if patient needs it for long term and cannot reasonably see the prescriber for new prescriptions?

(6)  Are emergency verbal orders allowed?  If so, who can call in the order?  Are only prescribers are allowed to phone in or can their agents call them in?  Any quantity or day supply limit for emergency verbal orders?  When does the pharmacy must receive the cover prescription?  Does the cover prescription must be a physical prescription or electronic prescription?  To whom does the pharmacist report if such cover prescription is not received?

(7)  Who can prescribe controlled substances in this state?  Can NPs, PAs, or other non-MD/DO prescribe CIIs?  Any quantity or day supply limits?  Any restrictions or special circumstances for advanced practitioners in prescribing controlled substances?

(8)  Can controlled substance prescriptions be transferred between pharmacies within the state? Pharmacies outside of the state? Any limits on how many times it can be transferred?  What information must be communicated between pharmacies?  Are licensed pharmacists the only personnel that can transfer in or out controlled substances?

(9)  Any state-specific controlled substances that is different from federal schedule?

(10)  Can partial of CII prescriptions be dispensed?  If so, under what conditions?  Same question applies to CIII-V.

(11)  Can pharmacist use faxed CII prescription order as original?  If so, in which practice settings under what conditions?

(12)  What if the prescriber dies after issuing controlled substance prescription?  Can pharmacist still dispense it?  Would the answer be different if the prescription is CII or CIII-V?  How about refills on existing controlled substance prescriptions?  Is patient barred from receiving all remaining refills once the doctor dies?  Are they allowed one refill until they find a new prescriber?

 

Another common scenarios include ordering, receiving, sending, selling, and dispensing controlled substances.

(1)  What form do DEA registered entities use to order or return CII? CIII-V?

(2)  Know when to use DEA-222 form or invoice. Good rule of thumb is to memorize that any situations involving CII must use DEA-222 form while everything else uses invoice.

(3)  Is the use of electronic CSOS required? Who has access to CSOS?

(4)  Who can sign DEA from 222 and the CSOS?

(5)  Can prescribers prescribe controlled substances for themselves or family members? If so, any restrictions?

(6)  Can prescribers dispense controlled substances? If so, any reporting requirements?

(7)  Do patients must present government issued photo ID to pick up controlled substance prescriptions?

(8)  How often does pharmacy must perform inventory for controlled substances?

(9)  How do pharmacists deal with expired controlled substances? Damaged controlled substances?  Controlled substances that arrived damaged when receiving the order?

(10)  What is the state approved process for destructing controlled substances? Who can qualify as witness?

(11)  Do controlled substances must be locked in a cabinet? CII only?

(12)  Is checking PDMP prior to dispensing controlled substances required by law or merely recommended? Who can access PDMP?  Does the law require prescribers to review PDMP prior to prescribing new controlled substance prescriptions or refills?  If so, how often?

(13)  Is reporting controlled substance dispensing data to PDMP required? How soon and often does the pharmacy must upload or transmit the data?  How soon does the pharmacy rectify errors in such data and upload or transmit to PDMP?

(14)  What does the pharmacist must do when controlled substances get stolen? Contact the DEA?  Local police?  Board of Pharmacy?  Any time frame it must be reported by?  Does the report must be in writing or can it be verbal?

(15)  Know the common DEA forms and registration rules: Which form is used to report theft or loss of controlled substance (DEA-106)?  Destruction of controlled substances (DEA-41)?  Registration?  How long are DEA registration good for?  Does hospital pharmacy department with multiple satellite pharmacies require separate DEA registrations?

(16)  Know the dispensing process of buprenorphine containing products in an outpatient setting and how to recognize DATA waiver ID number.

(17)Learn how to calculate whether the DEA number is valid.

 

III.  KNOW THE NON-CONTROLLED SUBSTANCES LAW

As important as controlled substance laws are, most pharmacists will spend majority of their time dispensing non-controlled substances during their practice, unless they operate in locations near pain management specialists.  The initial approach is the same as controlled substance prescriptions.

(1)  Does the prescription include everything that is required by law? (e.g., patient name, date, prescriber’s signature, etc.)  If such information is missing or incorrect, can I add or modify them with or without prescriber’s knowledge or approval?

(2)  Is the prescription valid based on the written date?

(3)  What does prescriber must indicate on the prescription to disallow substitution?  Is indicating DAW enough?  Does “Brand Medically Necessary” must be written out?

(4)  Can patients request generic to be dispensed if the prescriber indicated DAW or brand medically necessary for a brand name drug?  Can patients request brand name when the prescription is issued for a generic drug?  Can patients request a different manufacturer of a generic product when the prescriber specified a certain manufacturer on the prescription indicating DAW?  What about for medications that have NTI?  Can any of these be done without receiving prescriber’s approval solely based on patient’s request?  Can pharmacists make substitutions based on their professional judgment prior to getting prescriber’s approval as long as prescriber is notified within reasonable amount of time?

(5)  Can pharmacists make substitutions on biosimilar drugs?  If so, does this require prescriber’s approval prior to switching?  Does the law allow pharmacists to substitute as long as the pharmacist notifies the prescriber after the switch?

(6)  Can pharmacists make dosage form substitutions? If so, does this require prescriber’s approval prior to switching?  Does the law allow pharmacists to substitute as long as the pharmacist notifies the prescriber after the switch?

(7)  Can all non-controlled substance prescriptions be transferred between pharmacies within the state?  Pharmacies outsides of the state?  Any limits on how many times it can be transferred?  What information must be communicated between pharmacies?  Are licensed pharmacist the only personnel that can transfer in or out prescriptions?

(8)  Know the FDA’s various “colored” books and what information it lists (e.g., orange book, purple book, yellow book, green book, etc.).

(9)  Understand the REMS program.  Know the medications, rules, and the dispensing process.  Understand what can and cannot be done when each required step of REMS program has not been met (e.g., prescriber not enrolled, missing authorization #, patient showing up after the authorization expires, etc.).  Also, can prescriptions requiring REMS/IPLEDGE transferred between pharmacies?

(10)  How often does inventory must be completed by law?

(11)  Know the prescriptive authority.  Who can prescribe in your state?  Are certain prescribers restricted to certain therapeutic classes of medications?  Can pharmacists prescribe?  If so, what medications?  CDTM for pharmacists?  Eligibility requirements?  What can pharmacists do under collaborative agreements (e.g., initiate/modify/end therapy, order labs, etc.)?

(12)  Can pharmacists immunize?  If so, what are the requirements to become an immunizer?  What vaccines can be given via standing order?  What vaccines need prescription?  Which vaccines can be given to minors? children?  Can pharmacy technicians give immunizations?  Do they need to be certified or licensed?  Pharmacy interns?  Externs?

(13)  Know the retention time for various documents and prescriptions (paper and electronic form) and understand which documents and prescriptions can be stored on-site or off-site.

(14)  Can syringes be sold without a prescription?  How about pen needles?  Any quantity limits?  Does the purchase must show any proof of medical necessity?  ID required to purchase?  If so, which IDs are acceptable?

(15)  Naloxone –  Can this be dispensed without prescription?  Any requirements that must be met prior to dispensing?

(16)  What if the prescriber dies after issuing the prescription?  Can pharmacist still dispense it?  How about refills on existing prescriptions?  Is patient barred from receiving all remaining refills once the doctor dies?  Are they allowed one refill until they find a new prescriber?

(17)  Can pharmacists refuse to fill a prescription?  Based on clinical judgment?  Based on moral/ethical/religious grounds?  What is pharmacist’s obligations in such cases?

 

IV.  HAVE GENERAL UNDERSTANDING OF PHARMACY OPERATIONS IN ALL SETTINGS

While the majority of the pharmacists practice in a community setting, it is important to have understanding of pharmacy operations in other practice settings.  In particular, you must know what part of operations can be only done by a licensed pharmacist.  Also, know which tasks can be delegated to pharmacy interns, externs, licensed/certified techs, non-licensed/certified techs, and clerks.  In some practice settings, doctors or nurses can be designated to carry out certain pharmacy related tasks, so make sure you know who can do what under which circumstances.

(1)  Compounding – What is USP 795, 797, and 800?  What constitutes compounding?  Can pharmacists compound medications in advance?  If so, how do pharmacists determine the quantity of compounded medications to be prepared in advance?  What is the difference between compounding and manufacturing?  Who can compound sterile products?  Who can compound non-sterile products?  Any training or certification requirements for compounding?  Also, understand the general structure of the clean room and the order of wearing and taking off PPEs.

(2)  Expiration and beyond-use dates – Know how to calculate expiration or beyond-use dates for medications that are repackaged and compounded. Understand the differences in use by dates depending on the type of compounding environment (sterile v. non-sterile), amount of medications being compounded, storage conditions (refrigeration v. room temperature), and other factors.   Know the different categories of risks per USP 797 and how it affects the beyond-use date at controlled room temperature, refrigerator, and freezer.  Know how the beyond-use dates differ depending on non-preserved aqueous compounds, preserved aqueous compounds, nonaqueous dosage forms and solid dosage forms.  How about IV medications prepared at bedside for immediate administrations in emergency settings?

(3)  Counseling – Is counseling required?  Is offer to counsel sufficient?  Does counseling law only apply to new prescriptions?  refills?  maintenance drugs?  Whenever pharmacist feels appropriate?  Who can counsel?  Do you have to document refused or accepted counsels?  If so, for how long?  Can you counsel if patients are accompanying someone with them?  Can you counsel patient’s agent instead?  If so, how do you know whether patient is okay with the agent receiving counseling for his or her behalf?  Can counseling be done via telephone, video-audio communication, or in writing?

(4)  Behind the counter medications – Know which products (e.g. pseudoephedrine) must be kept behind the counter and the process of selling such products to the patient.  For pseudoephedrine containing products, what is the maximum amount you can sell per day?  Per 30 days?  Would the answer be different if the product is sold via mail order?  What type of IDs are accepted?  For example, is social security card an acceptable form of ID?

(5)  Emergency oral contraceptives –  Who can buy them?  Is ID required?

(6)  Automated dispensing system – Who can stock them?  Who can withdraw medications from them?  Any technological requirements (e.g., barcode)?  How often does it have to be maintained?  Any auditing requirements?  Can anyone other than pharmacist have access to them when pharmacist is unavailable?  Any logging requirements?

(7)  Medication Kits / Emergency Kits – Who decides the contents of the kit?  Any restrictions on number of medications, class of medications (controlled substance okay?), and quantity of medications?  Who legally owns the kit?  Who can remove medications from the kit?  By what time does the person who removed the medication from the kit must notify the pharmacy?  By what time does the pharmacy must replenish the kit?  Any logging requirements?  Expiration date requirements?

(8)  RPh to intern/tech ratio – How many interns can pharmacist supervise?  Does this number depend on the types of intern (e.g., graduate intern, academic intern doing rotations, extern)?  How about technicians?  Does the ratio change depending on whether the techs are licensed/certified/registered?  Does intern doing technician work count towards intern ratio or technician ratio?

(9)  Returns – Know at what point the actual dispensing occurs.  Does your state law consider medication to be dispensed once it leaves the pharmacy premises or only when it is in patient’s possession (mail order, delivery service, etc.)?  When can medications be returned to the pharmacy for redispensing in retail setting?  hospital setting?  LTC setting?  What conditions must be met in order to accept returns for redispensing?  Are controlled substance returnable for redispensing?  Are injectables returnable for redispensing?  How about refrigerated medications?  Can returned medications donated to non-profit organizations?  If so, what are the requirements?

(10)  Remote filling and dispensing – If one pharmacy receives the prescription but the actual dispensing happens at another pharmacy, which pharmacy’s information should be on the label?  What if pharmacy A receives the prescription, pharmacy B fills it and mails it back to pharmacy A, then pharmacy A dispenses the prescription, which pharmacy’s information should be on the label?  Which pharmacy is responsible for counseling?  Can controlled substances filled and/or dispensed remotely?  Is there a restriction on whether the remote pharmacy must be in-state?  Do pharmacists or the pharmacy managers at remote settings must be licensed in the state where the pharmacy that receives original prescription is located?  Do pharmacists must be licensed in patient’s residing state to counsel?

(11)  Can pharmacists administer medications?  Retail setting?  Hospital setting?  Long-term care setting?

(12)  What are the requirements to become a nuclear pharmacist?

(13)  Can pharmacists work remotely?  If so, what are the requirements?  How about working remotely from a different state that the pharmacy is located?  How about from a different country?

 

V.  BOARD OF PHARMACY REQUIREMENTS & TIMELINES

(1)  Understand the organizational structure of the Board – How many members sit on the board of pharmacy?  Any quota per member’s background (e.g., hospital, retail, public member, etc.)?  What are the requirements to become a board member?  Who chairs the board?  How are board members selected?  How long do they serve?  How often does the board convene?  Who can attend these meetings?

(2)  Know the procedure and timelines for reporting when opening, closing, relocating, and temporarily closing pharmacy.

(3)  Know the procedure and timelines for reporting when there is a change in pharmacist in charge (PIC).

(4)  Know the procedure and timelines for reporting when there is a change in name or the ownership of the pharmacy.

(5)  Know the timelines for reporting changes in address, employment, and other information related to the licensee.

(6)  Know the licensure and renewal requirements including renewal period, number of CEs, types of CEs required (how many credits must be from live CEs?  Specific topic required as part of the CE?), and whether there are grace periods and fees for late renewals.

(7)  Know the procedure and timelines for new registration and renewal of registration for facilities.

(7) Common deadlines:  Immediately, as soon as possible, 1 day, 2 days, 3 days, 5 days, 7 days, 10 days, 14 days, 30 days, 60 days, and 90 days.  Good way of memorizing these time lines is by assessing the importance and urgency of the nature of business in question.

 

VI.  BOARD OF PHARACY NEWSLETTERS

Newsletters from the Board of Pharmacy is arguably the best source to learn the law as it contains interpretation of pharmacy laws and regulations by none other than the Board itself.  These newsletters include the Board explaining pharmacy laws, regulations, and rules in detail that are frequently inquired by pharmacists and pharmacy technicians for clarification.  For example, NJ BOP’s January 2024 Newsletter outlines the criteria for determining whether or not to fill a prescription for a patient, which is much more detailed than “using professional judgment”.  Same newsletter also explains how to determine when compounding semaglutide is permissible, which is more comprehensive than the statute.  It is extremely common to see topics discussed in these newsletters to be on the MPJE (many times verbatim), so it is strongly recommended to study them.

 

FINAL TIPS:

(1)  KNOW WHICH LAW TO APPLY

If state law is silent on certain issue but federal law covers the topic, then follow the federal law.

If federal law is silent on certain issue but state law covers the topic, then follow the state law.

If both the federal law and state law covers the topic, then follow the stricter law.

If both the federal law and state law is silent on the topic, make an educated guess.  However, the chances are that it was covered (most likely in BoP’s FAQ section or publications) but you probably missed it during studying, which is perfectly fine.  Remember that you do not need to get every question or even majority of the questions correct to pass.

(2)  KEEP MOVING – DO NOT STARE AT THE SCREEN

If you do not know the answer to a question, make an educated guess and move on!  It’s not like the correct answer will highlight itself if you stare at it long enough nor can you reverse engineer these answer choices as some of us would do with calculation questions on the NAPLEX.  Make an educated guess -consider the intent of the question and whether the answer choice you are about to choose is realistic or logical in real world pharmacy practice- and hope for the best.  One research from the Center for Teaching at Vanderbilt University suggests that choosing answer choice “none of the above” or “all of the above” has the highest statistical probability of being the correct answer on a 5-choice multiple choice question as these answers were found to be correct 52% of the time, which is a 90% improvement over random guessing.  This is because test creators often use these types of answer choices when they want to ensure the right answer is “indisputably right” and requires “some qualifying language.  So if you had to randomly guess and one of those answer choices are available, go for it as we can consider it as an “evidence based guessing”.  Don’t forget that you are not trying to get 100% on this exam and 50% is probably good enough to pass.

(3)  IDENTIFY THE LEGAL ISSUE & UNDERSTAND THE INTENT OF THE LAW

Oliver Wendell Holmes Jr, an associate justice of the SCOTUS, once said “This is a court of law, young man, not a court of justice”.  This is the mindset you must have in order to successfully tackle any law related questions, including the MPJE.  Identify the legal issue on hand and focus only on the legal issue.  Some of you may be thinking ‘duh, isn’t that obvious?’, but it actually is not always easy because what you believe is the “right thing to do” does not necessarily mean it is legal.  I know pharmacy law professors at pharmacy schools often tell students “do what is best for the patient and you will not get into trouble”.  This is a very dangerous advice which I wish pharmacy law professors stopped preaching to students because in order for this advice to be valid, the individual pharmacist’s professional judgment on what is “best” for the patient must not deviate from what a reasonable pharmacist in similar circumstances will consider as “best”.  If a pharmacist gets sued for actions that were taken for patient’s best interest based on his or her professional judgment, I can assure you that the plaintiff’s side will have another pharmacist who will testify otherwise.  In other words, if you see a question that provides additional information for room for your own moral judgment or personal opinion, do not get distracted and simply answer the underlying legal question.  Always try to understand the intent of the law and what the agencies are attempting to achieve with such law, rule, or regulation.  If you understand the intent of the lawmakers, it makes studying law a lot easier and will help you making an educated guess.

(4)  READ THE DEFINITIONS CAREFULLY

Make sure you understand the definition of the terms in the statutes.  For example, your state law may say valid prescription must include age of the patient.  Do not equate “age” with “date of birth” since these are two different terms.  Also, as obvious as some of the terms may sound to you, at least read through the definition once.  Definition of drug utilization review, for instance, may or may not include drug-food interaction depending on your state.  Also, you will be surprised how law defines “dispensing” in some states.   Therefore, read through definitions carefully even if you believe you know them.  Knowing the definitions will help you tremendously in SATA type of questions.

(5)  USE COMMON SENSE AND LOGIC

Apply common sense and logic if you feel lost during the MPJE.  If a question is asking about the deadline for reporting your new residential address, you can confidently rule out any answer choices with short time frames.  Do you really think the Board puts tracking new addresses of pharmacists as their top priority?  Similarly, if it is about pharmacy being robbed, you bet you can cross out any answer choices that have long time frames.  If the question features some brand name that you’ve never heard of, you can logically guess that it must be either the same drug or drug in the same class as ones mentioned in answer choices.  If your state is fighting opioid epidemic, your guesses should be leaning toward this cause.  For example, NYS pharmacy law states “Unless an earlier refilling is authorized by the prescriber, no prescription shall be refilled earlier than seven days prior to the date the previously dispensed supply would be exhausted if used in conformity with the directions for use”.  Many pharmacists, including director levels, and patients interpret this as allowing controlled substance prescription to be filled 7 days early every month.  NO!  NY is facing one of the worst opioid epidemic in the country and do you really think the law will allow patients to have 84 additional day supply of medications per year?  If you read the words carefully, the law means that at any given time, patient can have an additional 7 day supply at a time throughout the duration of therapy, which makes much more sense.  Just think logical and if your interpretation of the law does not make sense, chances of misinterpretation is pretty high.  You may also get the same question during the MPJE.  If you were debating between two answer choices earlier, then it may be a good time to hedge your bets to ensure you get at least one of them correct.

(6)  RELAX

Relax and chill.  The worst that can happen is failing the MPJE, which you can retake it in 30 days.  I know job offer or residency may depend on the outcome of this exam for some test-takers, but most employers will be understanding if you do not pass.  Now, they may not be as understanding if you keep failing it, but it is very rare for an employer or residency director to withdraw their offer just because someone fails the MPJE for the first time.  This isn’t necessarily because they are nice people, but it is just easier to wait until you pass on the next try than going through the hiring processes again and deal with the HR department.  Therefore, unless your role was something that needed to be filled immediately and failure to do so will jeopardize the operation (which is unlikely if you are a new grad), you will most likely get another chance (or even two or three depending on the timing).   Do not stress out too much over the future.  Besides, if you can answer most of the questions in this guide, your chance of not passing the MPJE is next to none.

(7)  PRE-MPJE

I have taken the Pre-MPJE for every state except for my first two licenses because my employer paid for them.  Since NABP does not release the actual MPJE scores anymore, I cannot say how close the Pre-MPJE scores mirror the actual MPJE scores.  However, I highly recommend taking the Pre-MPJE because you get to see the actual questions that are asked on the MPJE.  I’ve even had same questions from the Pre-MPJE word-to-word on the actual test!  Does this mean that question was a freebie?  Not really.  Pre-MPJE, similar to pre-NAPLEX, does not give you the model answers after the exam.  It does not even tell you what questions you answered incorrectly nor how many questions were answered incorrectly.  It simply gives you a scaled score that is supposed to be similar to the actual MPJE.  However, I think it is worth every penny just to experience the exam format and the actual questions that were tested on the MPJE.

 

Hope this guide was helpful in preparing for the MPJE.  Since this blog is hosted by one of the wealthiest academic institutions in the world at no cost to me for life, there is no need to like, subscribe, or share as I have no intention of monetizing my blog content.  I wish all of you good luck and say hi if you ever see me in person!

 

*Disclaimer:  This is a personal blog.  Any views or opinions represented in this blog are personal and belong solely to the blog owner and do not represent those of people, institutions, or organizations that the owner may or may not be associated within professional or personal capacity unless explicitly stated.  All content provided on this blog is for informational purposes only.  The owner of this blog makes no representations as to the accuracy or completeness of any information on this site or found by following any link on this site.  The owner will not be liable for any errors or omissions in information nor for the availability of information in this blog.  The owner will not be liable for any losses, injuries, or damages from the display or use of information in this blog.

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Hello World!

Hello World! (Second hello to the world since 1997 in html)

I don’t know if anyone blogs anymore in the current era of TikTok, Instagram, and Youtube, but I guess this can become my hobby since I learned from a colleague that webhosting from the school is free for life.  I am not even sure what I would blog about at this point but leaning toward pharmacy related articles since that is my primary specialty.

One thing to note today is that I successfully completed the Capstone project for the Applied Analytics program thanks to my awesome colleagues.  Better yet, I was able to meet up with many of them in person to celebrate the successful project in this COVID era!  Special thanks to all members of the team “Corona Coders” and it was a true pleasure to work with you all – Devon, Stephen, Saori, Varadharajan, Alia, Liz, Chuxuan, and Luca.  I feel very fortunate to work with such talented and diverse group of colleagues, and I guess that is one of the many perks Columbia offers.  I would like to express my gratitude again to my colleagues and wish them the very best in their future endeavors.

 

 

*Disclaimer:  This is a personal blog.  Any views or opinions represented in this blog are personal and belong solely to the blog owner and do not represent those of people, institutions, or organizations that the owner may or may not be associated within professional or personal capacity unless explicitly stated.  All content provided on this blog is for informational purposes only.  The owner of this blog makes no representations as to the accuracy or completeness of any information on this site or found by following any link on this site.  The owner will not be liable for any errors or omissions in information nor for the availability of information in this blog.  The owner will not be liable for any losses, injuries, or damages from the display or use of information in this blog.

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