Scenario Analysis: This scenario is professionally challenging because it requires the pharmacist to navigate a patient’s resistance to a crucial health intervention while upholding their professional responsibility to promote patient well-being and adherence. The patient’s expressed skepticism and desire to avoid further discussion create a conflict between the pharmacist’s duty to counsel and the patient’s autonomy. Balancing these requires skillful communication and an understanding of patient psychology, going beyond simply dispensing medication. Correct Approach Analysis: The best professional practice involves employing motivational interviewing techniques to explore the patient’s ambivalence and concerns without judgment. This approach begins by acknowledging the patient’s feelings and then gently probing for their reasons behind their reluctance. By asking open-ended questions about their understanding of the medication’s importance and their personal health goals, the pharmacist can foster a collaborative dialogue. This respects the patient’s autonomy while creating an opportunity to address their health literacy gaps and build rapport. This aligns with the ethical principles of beneficence and respect for autonomy, and implicitly supports the pharmacist’s role in patient education and adherence as outlined by professional pharmacy standards in North America, which emphasize patient-centered care and effective communication. Incorrect Approaches Analysis: One incorrect approach involves dismissing the patient’s concerns and proceeding with a standard, brief counseling session, assuming the patient will eventually comply. This fails to address the underlying reasons for the patient’s resistance, potentially leading to poor adherence and suboptimal health outcomes. It neglects the pharmacist’s duty to ensure patient understanding and may be perceived as dismissive, eroding trust. Another incorrect approach is to insist on a lengthy counseling session despite the patient’s clear discomfort and desire to leave. While well-intentioned, this can be perceived as coercive and may alienate the patient, making them less receptive to future health advice. This approach disregards the patient’s autonomy and can create a negative experience, hindering the therapeutic relationship. A third incorrect approach is to simply document that the patient refused counseling and proceed with dispensing without further attempt to engage. This abdicates the pharmacist’s responsibility to promote health and prevent disease through effective communication and education. It prioritizes transactional dispensing over the pharmacist’s role as a healthcare provider and fails to address potential health literacy barriers that may be contributing to the patient’s reluctance. Professional Reasoning: Professionals should approach such situations by first recognizing the patient’s emotional state and stated preferences. The initial step is to validate their feelings and then seek to understand the root cause of their resistance. Employing active listening and open-ended questions, as in motivational interviewing, allows for a patient-centered exploration of their concerns. If the patient remains resistant after a genuine attempt at engagement, the pharmacist should document the interaction and the patient’s decision, while also considering if there are any immediate safety concerns that necessitate further intervention or referral. The goal is to empower the patient to make informed decisions about their health, even if that decision is to delay or decline a particular intervention at that moment.

This scenario is professionally challenging because it requires balancing patient autonomy, public health mandates, and the pharmacist’s professional responsibility to provide accurate and unbiased information. The pharmacist must navigate potential conflicts between a patient’s expressed wishes and evidence-based public health recommendations, all while adhering to professional standards and legal requirements. Careful judgment is needed to ensure patient safety and public well-being without overstepping professional boundaries or engaging in discriminatory practices. The best professional approach involves providing the patient with comprehensive, evidence-based information about the recommended vaccine, including its benefits, risks, and alternatives, while respecting their right to make an informed decision. This approach aligns with the ethical principles of beneficence (acting in the patient’s best interest by providing accurate information) and autonomy (respecting the patient’s right to self-determination). It also adheres to professional guidelines that emphasize patient counseling and shared decision-making. By presenting factual information and addressing concerns without coercion, the pharmacist empowers the patient to make a choice that is best for them, while fulfilling their duty to inform. An incorrect approach would be to refuse to dispense the vaccine or to strongly pressure the patient into vaccination based on personal beliefs or assumptions about their reasons for hesitation. This fails to respect patient autonomy and could be construed as discriminatory if the pharmacist’s judgment is influenced by factors unrelated to the patient’s clinical suitability for the vaccine. Such an action could violate professional codes of conduct that prohibit coercion and mandate respectful patient care. Another incorrect approach would be to provide incomplete or misleading information about the vaccine, such as downplaying potential side effects or exaggerating benefits. This violates the principle of veracity and could lead to an uninformed decision by the patient, potentially compromising their health and public health efforts. It also breaches the pharmacist’s duty to provide accurate and comprehensive counseling. Finally, an incorrect approach would be to dismiss the patient’s concerns without attempting to understand or address them. This demonstrates a lack of empathy and professional engagement, hindering the pharmacist’s ability to provide effective patient care and potentially alienating the patient from future health interventions. It fails to uphold the professional standard of patient-centered care. Professionals should employ a decision-making framework that prioritizes patient-centered care, evidence-based practice, and ethical principles. This involves active listening to understand patient concerns, providing clear and accurate information, exploring alternatives, and respecting the patient’s final decision, all within the bounds of legal and professional regulations.

Scenario Analysis: This scenario presents a professional challenge due to the inherent risks associated with sterile product compounding. Ensuring the sterility, potency, and accuracy of compounded sterile preparations (CSPs) is paramount to patient safety. The pharmacist must navigate potential deviations from established protocols, assess their impact, and implement corrective actions that uphold quality control standards and regulatory compliance without compromising patient care or product integrity. This requires a thorough understanding of aseptic technique, environmental monitoring, and the principles of quality assurance. Correct Approach Analysis: The best professional practice involves a systematic and documented approach to investigating the deviation. This includes immediately quarantining the affected batch of CSPs to prevent their administration to patients. A thorough root cause analysis must then be conducted to identify the specific factors contributing to the environmental monitoring failure. This analysis should involve reviewing compounding procedures, personnel training, equipment calibration, and environmental control systems. Based on the findings, appropriate corrective and preventative actions (CAPAs) must be implemented, such as retraining personnel, recalibrating equipment, or adjusting environmental controls. All steps, findings, and CAPAs must be meticulously documented in the pharmacy’s quality management system. This approach aligns with the principles of USP and other relevant North American guidelines for sterile compounding, emphasizing a proactive and evidence-based approach to quality assurance and risk mitigation. Incorrect Approaches Analysis: One incorrect approach involves proceeding with the administration of the CSPs after a single failed environmental monitoring test without further investigation. This is a significant regulatory and ethical failure because it disregards a critical quality indicator that suggests a potential breach in aseptic technique or environmental control, thereby exposing patients to an unacceptable risk of infection or adverse events. It directly violates the principles of USP which mandates investigation and remediation of environmental monitoring failures. Another incorrect approach is to simply discard the entire batch of CSPs without conducting a root cause analysis. While discarding potentially compromised products is a safety measure, failing to investigate the cause means the underlying issue remains unaddressed, increasing the likelihood of future failures and continued risk to patients. This approach is inefficient and fails to fulfill the pharmacy’s responsibility for continuous quality improvement and adherence to regulatory requirements for investigating deviations. A third incorrect approach is to rely solely on the visual inspection of the CSPs for particulate matter or clarity as sufficient evidence of sterility. Visual inspection is a limited assessment and does not guarantee sterility. Environmental monitoring failures indicate a potential breakdown in the aseptic process that visual inspection cannot detect, and therefore, it is an inadequate substitute for a comprehensive investigation and remediation process. This approach neglects the critical role of environmental monitoring in ensuring the sterility of CSPs as outlined in regulatory standards. Professional Reasoning: Professionals should employ a structured problem-solving framework when faced with deviations. This framework typically involves: 1) immediate containment of the issue (e.g., quarantining product), 2) thorough investigation to determine the root cause, 3) implementation of effective corrective and preventative actions, and 4) comprehensive documentation of the entire process. This systematic approach ensures patient safety, regulatory compliance, and fosters a culture of continuous quality improvement within the pharmacy practice.

Scenario Analysis: This scenario presents a professional challenge due to the inherent tension between a pharmacist’s duty to protect patient privacy and the need to comply with public health reporting requirements. Navigating these competing obligations requires a thorough understanding of relevant regulations and ethical principles. Misinterpreting or misapplying these can lead to significant legal and professional repercussions. Correct Approach Analysis: The best professional practice involves proactively identifying and understanding the specific reporting requirements mandated by the Comprehensive North American Population Health Pharmacy Board Certification framework and applicable state/provincial public health laws. This includes determining what conditions or diseases necessitate reporting, the timeframe for reporting, and the specific information that must be disclosed. Upon identifying a reportable condition, the pharmacist should then confidentially report the required information to the designated public health authority through secure, approved channels, ensuring all patient-identifying information is handled with the utmost care and in compliance with privacy laws like HIPAA (in the US) or PIPEDA (in Canada), as applicable within the North American context. This approach prioritizes both patient confidentiality and public health safety by adhering strictly to established legal and ethical guidelines. Incorrect Approaches Analysis: One incorrect approach involves delaying reporting until directly contacted by a public health official. This failure to act proactively can result in missed reporting deadlines, hindering the public health response and potentially violating reporting mandates. It demonstrates a lack of understanding of the pharmacist’s responsibility in disease surveillance and prevention. Another incorrect approach is to report all suspected cases of a particular condition without first verifying if the case meets the specific criteria for mandatory reporting as defined by the relevant public health authorities. This can lead to an unnecessary burden on public health resources and may also constitute an over-disclosure of patient information, potentially violating privacy regulations. A third incorrect approach is to disclose patient information to a public health authority through an insecure method, such as a standard email or fax without proper encryption or verification protocols. This directly contravenes privacy laws and ethical obligations to protect sensitive patient data, exposing both the patient and the pharmacist to significant risks. Professional Reasoning: Professionals should adopt a proactive and informed approach. This involves continuous education on regulatory requirements, establishing clear internal protocols for identifying and reporting public health concerns, and utilizing secure communication channels. When faced with uncertainty, seeking guidance from professional organizations, regulatory bodies, or legal counsel is paramount. The decision-making process should always weigh the imperative of public health against the fundamental right to patient privacy, ensuring that actions taken are both legally compliant and ethically sound.

This scenario is professionally challenging because it requires balancing the immediate need to address a potential medication safety issue with the imperative to maintain accurate and compliant electronic health records (EHRs). The pharmacist must act decisively to protect patient safety while adhering to strict regulatory requirements for documentation and data integrity. Careful judgment is required to ensure that any corrective actions are both effective and legally sound. The best professional approach involves immediately documenting the identified discrepancy in the EHR, clearly noting the nature of the error, the patient affected, and the corrective action taken. This approach is correct because it directly addresses the medication safety concern by ensuring the patient’s record reflects the accurate medication and dosage. Furthermore, it aligns with regulatory expectations for comprehensive and accurate patient charting, which is crucial for continuity of care, legal defensibility, and quality improvement initiatives. Regulatory frameworks, such as those enforced by the U.S. Food and Drug Administration (FDA) and state boards of pharmacy, mandate accurate record-keeping to ensure patient safety and facilitate oversight. An incorrect approach would be to verbally inform the prescriber and the patient about the error but fail to update the EHR. This is professionally unacceptable because it leaves the patient’s official medical record inaccurate, potentially leading to future medication errors if other healthcare providers rely on the outdated information. It also fails to meet regulatory requirements for complete and accurate documentation, which are essential for audits and legal purposes. Another incorrect approach would be to correct the EHR without any notation of the original error or the corrective action. This is professionally unacceptable as it obscures the history of the medication error, hindering any potential quality improvement efforts or investigations into the root cause of the discrepancy. Regulatory bodies expect transparency in record-keeping, allowing for a clear audit trail of interventions and changes. Finally, an incorrect approach would be to delay updating the EHR until the end of the shift or the next business day. This is professionally unacceptable because it creates a period where the patient’s record is inaccurate, posing an immediate risk to patient safety. Regulatory compliance emphasizes timely documentation to ensure that critical patient information is current and accessible to all members of the healthcare team. Professionals should employ a decision-making framework that prioritizes patient safety, followed by adherence to regulatory requirements for documentation and data integrity. This involves a systematic process of identifying the issue, assessing the immediate risk, implementing corrective actions, and meticulously documenting all steps taken in accordance with established protocols and legal mandates.

Scenario Analysis: This scenario presents a professional challenge because it requires the pharmacist to integrate complex clinical pharmacology, pharmacokinetics, and medicinal chemistry principles to optimize patient therapy while adhering to strict regulatory requirements for drug selection and patient monitoring. The challenge lies in balancing evidence-based practice with the specific limitations and guidelines imposed by regulatory bodies, ensuring patient safety and therapeutic efficacy without compromising legal and ethical obligations. Correct Approach Analysis: The best professional approach involves a thorough review of the patient’s current medication regimen, considering the pharmacokinetic and pharmacodynamic profiles of all prescribed drugs, and evaluating potential drug-drug interactions from a medicinal chemistry perspective. This includes assessing the patient’s renal and hepatic function, age, and other relevant clinical factors to predict drug absorption, distribution, metabolism, and excretion. The pharmacist should then consult relevant clinical pharmacology literature and drug compendia, specifically referencing guidelines from the U.S. Food and Drug Administration (FDA) and the U.S. Pharmacopeia (USP) for evidence-based recommendations on drug selection, dosing, and monitoring parameters. This approach ensures that any proposed therapeutic adjustments are grounded in scientific evidence and align with regulatory standards for safe and effective medication use, prioritizing patient outcomes within the established legal framework. Incorrect Approaches Analysis: One incorrect approach involves solely relying on the patient’s reported subjective experience without objective clinical data or regulatory guidance. This fails to acknowledge the importance of pharmacokinetic variability and potential drug interactions that may not be immediately apparent from patient self-reporting, potentially leading to suboptimal or harmful therapeutic outcomes and violating the professional duty to provide evidence-based care as mandated by regulatory bodies like the FDA. Another incorrect approach is to make therapeutic recommendations based on anecdotal evidence or personal experience without consulting peer-reviewed literature or established clinical guidelines. This bypasses the rigorous scientific validation required by regulatory agencies and can lead to the use of unproven or potentially unsafe therapies, contravening the principles of evidence-based practice and the oversight provided by organizations like the USP. A further incorrect approach is to prioritize cost-effectiveness above all other considerations, such as therapeutic efficacy, safety, and pharmacokinetic suitability. While cost is a factor, making decisions solely on price without a comprehensive assessment of the drug’s clinical profile and regulatory approval status can lead to the selection of less effective or potentially riskier medications, violating the ethical and regulatory imperative to act in the patient’s best interest. Professional Reasoning: Professionals should employ a systematic decision-making process that begins with a comprehensive patient assessment, integrating clinical data with knowledge of pharmacology, pharmacokinetics, and medicinal chemistry. This should be followed by a thorough review of current evidence-based guidelines and regulatory recommendations from authoritative bodies such as the FDA and USP. Any proposed therapeutic interventions must be evaluated for their safety, efficacy, and suitability within the patient’s specific context, ensuring compliance with all applicable laws and ethical standards. Continuous professional development and critical appraisal of new scientific information are essential to maintain competence in this dynamic field.

Scenario Analysis: This scenario is professionally challenging because it requires a pharmacist to navigate the complex and often nuanced policies of a certification board, specifically concerning exam retakes and scoring. Misinterpreting these policies can lead to significant personal and professional consequences, including wasted time, financial loss, and potential delays in career advancement. Careful judgment is required to ensure adherence to the board’s established procedures and to make informed decisions about future certification attempts. Correct Approach Analysis: The best professional approach involves proactively seeking and thoroughly understanding the official documentation provided by the North American Pharmacist Certification Board (NAPCB) regarding their blueprint, scoring, and retake policies. This includes reviewing the candidate handbook, the official website, and any direct communications from the board. This approach is correct because it relies on the most authoritative and up-to-date information, ensuring that decisions are made in full compliance with the board’s regulations. Adhering to these official guidelines is ethically imperative and professionally responsible, as it demonstrates a commitment to following established procedures and avoids assumptions or reliance on hearsay. Incorrect Approaches Analysis: Relying solely on anecdotal evidence from colleagues or online forums about retake policies is professionally unacceptable. This approach is flawed because such information can be outdated, inaccurate, or specific to different certification cycles or previous policy versions. It lacks the authority of official documentation and can lead to incorrect assumptions about eligibility, timing, or required steps for retaking the exam. Assuming that the scoring methodology or retake frequency is the same as other professional certifications the pharmacist may hold is also professionally unsound. Each certification board establishes its own unique policies, and assuming universality across different organizations is a significant oversight. This can lead to missed deadlines, incorrect preparation strategies, or failure to meet specific prerequisites for retaking the exam, thereby violating the specific regulations of the NAPCB. Contacting the NAPCB directly with a vague inquiry about “how to retake the exam” without first consulting the readily available official documentation is inefficient and potentially unprofessional. While direct contact is valuable, it should be a last resort after exhausting self-help resources. This approach fails to demonstrate due diligence in researching the information that is likely clearly outlined in the board’s published materials, potentially wasting the board’s resources and indicating a lack of proactive problem-solving. Professional Reasoning: Professionals facing such situations should adopt a systematic approach. First, identify the governing body and the specific policies in question. Second, prioritize accessing and meticulously reviewing official documentation from that body. Third, if ambiguities persist after thorough review, then and only then, should direct communication with the governing body be initiated, armed with specific questions derived from the official documentation. This ensures informed decision-making, compliance, and efficient use of resources.

Scenario Analysis: This scenario presents a professional challenge due to the inherent conflict between a pharmacist’s duty to ensure patient safety and the potential for financial incentives to influence prescribing decisions. The pharmacist must navigate a complex ethical landscape where professional judgment could be compromised by external pressures, requiring a robust understanding of regulatory boundaries and professional ethics. Correct Approach Analysis: The best professional practice involves a direct and transparent communication with the prescribing physician regarding the formulary exception and the patient’s clinical needs. This approach prioritizes patient well-being by ensuring the most appropriate and cost-effective medication is utilized, while also adhering to the spirit of formulary management. Specifically, by initiating a conversation with the prescriber to explore alternative formulary options or to formally request a formulary exception based on clinical necessity, the pharmacist upholds their responsibility to the patient and the healthcare system. This aligns with the ethical obligation to act in the patient’s best interest and the regulatory requirement to dispense medications appropriately. Incorrect Approaches Analysis: One incorrect approach involves dispensing the non-formulary medication without further inquiry or discussion with the prescriber, especially if the pharmacist suspects the physician is aware of the formulary restriction and is potentially receiving an incentive. This fails to uphold the pharmacist’s professional responsibility to ensure cost-effective care and may inadvertently facilitate a practice that could be considered unethical or even a violation of anti-kickback statutes if the incentive is tied to prescribing specific drugs. Another incorrect approach is to immediately report the physician to regulatory bodies without first attempting to resolve the issue through professional channels. While reporting potential violations is important, bypassing direct communication and collaborative problem-solving can damage the prescriber-pharmacist relationship and may not be the most efficient or effective way to address the situation, especially if the physician was unaware of the formulary restriction or if there is a legitimate clinical reason for the non-formulary choice that can be addressed through an exception process. A third incorrect approach is to passively accept the prescription and inform the patient that the medication is not covered by the formulary without exploring any potential solutions or alternatives. This places the full burden of cost and access on the patient and fails to leverage the pharmacist’s expertise in medication management and cost-effective care. It neglects the pharmacist’s role in advocating for the patient and optimizing their medication therapy within the available resources. Professional Reasoning: Professionals should approach such situations by first gathering all relevant information, including the patient’s clinical condition, the prescribed medication, and the formulary guidelines. The next step is to assess the potential for conflicts of interest or regulatory non-compliance. The primary course of action should always be to engage in open and professional communication with the prescriber to understand their rationale and to collaboratively identify the best course of action for the patient, prioritizing their health and access to appropriate medication while adhering to all applicable regulations and ethical standards. If direct communication does not resolve the issue or if there is clear evidence of regulatory violation, then escalation to appropriate authorities should be considered.

Scenario Analysis: This scenario is professionally challenging because it requires a pharmacist to balance the immediate need for patient care with the ethical and regulatory obligation to ensure adequate preparation for a high-stakes certification exam. The pressure to perform well on the Comprehensive North American Population Health Pharmacy Board Certification can lead to shortcuts in study habits, potentially compromising both the pharmacist’s knowledge and, by extension, patient safety in population health settings. Careful judgment is required to select study resources that are both effective and compliant with professional standards. Correct Approach Analysis: The best professional practice involves a systematic and evidence-based approach to candidate preparation. This includes identifying and utilizing resources that are specifically recommended or endorsed by the certifying body, such as official study guides, accredited continuing education programs focused on population health pharmacy, and reputable peer-reviewed literature. A structured timeline, developed in conjunction with these resources, allows for comprehensive coverage of the exam’s domain and sufficient time for knowledge consolidation and practice assessment. This approach aligns with the ethical duty to maintain professional competence and the regulatory expectation that pharmacists possess up-to-date knowledge in their practice areas, particularly in specialized fields like population health. Incorrect Approaches Analysis: One incorrect approach involves relying solely on informal online forums and anecdotal advice from colleagues without verifying the accuracy or relevance of the information. This can lead to the use of outdated or inaccurate material, potentially misinterpreting complex population health concepts, and failing to cover essential topics mandated by the certification. This practice lacks the rigor required for professional development and can result in a superficial understanding that does not meet the standards of population health pharmacy practice. Another unacceptable approach is to cram for the exam in the weeks immediately preceding it, using only condensed review materials. While this might seem efficient, it often leads to rote memorization rather than deep understanding and the ability to apply knowledge in real-world population health scenarios. This method neglects the importance of spaced repetition and critical thinking, which are crucial for mastering the nuances of population health management and can result in a failure to meet the competency requirements for board certification. A further professionally unsound approach is to prioritize study materials that are not directly related to population health pharmacy, such as general clinical pharmacy review books, under the assumption that foundational knowledge is sufficient. While general knowledge is important, population health pharmacy requires specific expertise in areas like health economics, epidemiology, health policy, and program evaluation. Focusing on irrelevant materials demonstrates a lack of understanding of the certification’s scope and a failure to engage with the specialized knowledge base necessary for effective population health practice. Professional Reasoning: Professionals should approach certification preparation with the same diligence and ethical considerations as they approach patient care. This involves a commitment to lifelong learning, the use of credible and relevant resources, and a structured plan for knowledge acquisition and retention. When selecting preparation materials, pharmacists should always consider the source, its alignment with the examination’s objectives, and its contribution to developing practical, evidence-based skills in population health pharmacy. A proactive and systematic study plan, rather than a reactive or superficial one, is essential for achieving both certification and competent practice.

This scenario presents a professional challenge because it requires balancing the imperative to provide evidence-based, cost-effective patient care with the potential for bias in evaluating new pharmaceutical interventions. Formulary decision-making committees are entrusted with significant responsibility, and their processes must be transparent, objective, and grounded in robust evidence appraisal to ensure optimal resource allocation and patient outcomes. The pressure to adopt innovative, but potentially expensive, treatments necessitates a rigorous and unbiased approach to evidence appraisal and pharmacoeconomic evaluation. The best approach involves a systematic and objective appraisal of all available evidence, prioritizing peer-reviewed literature and robust clinical trial data, while also considering pharmacoeconomic analyses that demonstrate value for money within the North American healthcare context. This includes a thorough review of comparative effectiveness studies, cost-effectiveness ratios, and budget impact analyses, all evaluated against established clinical guidelines and the specific needs of the patient population served by the formulary. This method aligns with the principles of evidence-based practice and responsible stewardship of healthcare resources, ensuring that formulary decisions are driven by clinical efficacy, safety, and economic value, thereby maximizing patient benefit and system sustainability. An approach that relies heavily on manufacturer-provided data without independent verification is professionally unacceptable. This failure stems from a lack of objectivity and a susceptibility to bias, as manufacturer-sponsored studies may be designed or interpreted in a way that favors their product. Regulatory frameworks emphasize the need for independent assessment of evidence to prevent undue influence and ensure that decisions are based on the most reliable and unbiased information available. Another professionally unacceptable approach is to prioritize cost savings above all else, without adequately considering clinical efficacy and patient outcomes. While pharmacoeconomics is crucial, a purely cost-driven decision can lead to the exclusion of effective treatments, potentially harming patients and increasing overall healthcare costs due to suboptimal management of conditions. Ethical obligations mandate that patient well-being remains a primary consideration, and cost should be evaluated in conjunction with clinical benefit. Furthermore, an approach that neglects to consider the broader impact on the patient population and healthcare system, focusing solely on the immediate cost of a new drug, is flawed. Formulary decisions have ripple effects, influencing prescribing patterns, patient adherence, and the utilization of other healthcare services. A comprehensive evaluation must account for these downstream consequences to make truly informed and responsible decisions. Professionals should employ a structured decision-making framework that includes: 1) defining the clinical question and scope of the review; 2) systematically searching for and appraising all relevant evidence (clinical trials, observational studies, systematic reviews); 3) conducting or critically evaluating pharmacoeconomic analyses (cost-effectiveness, cost-utility, budget impact); 4) considering expert opinion and clinical guidelines; and 5) transparently documenting the rationale for the final formulary decision, ensuring it is aligned with evidence, value, and patient needs.