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Pharmacy benefit management

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https://www.readbyqxmd.com/read/28223842/development-of-a-novel-algorithm-to-determine-adherence-to-chronic-pain-treatment-guidelines-using-administrative-claims
#1
Jay M Margolis, Nicole Princic, David M Smith, Lucy Abraham, Joseph C Cappelleri, Sonali N Shah, Peter W Park
OBJECTIVE: To develop a claims-based algorithm for identifying patients who are adherent versus nonadherent to published guidelines for chronic pain management. METHODS: Using medical and pharmacy health care claims from the MarketScan® Commercial and Medicare Supplemental Databases, patients were selected during July 1, 2010, to June 30, 2012, with the following chronic pain conditions: osteoarthritis (OA), gout (GT), painful diabetic peripheral neuropathy (pDPN), post-herpetic neuralgia (PHN), and fibromyalgia (FM)...
2017: Journal of Pain Research
https://www.readbyqxmd.com/read/28210864/pharmacy-benefit-management-companies-do-they-create-value-in-the-us-healthcare-system
#2
Alan Lyles
Pharmacy benefit management companies (PBMs) perform functions in the US market-based healthcare system that may be performed by public agencies or quasi-public institutions in other nations. By aggregating lives covered under their many individual contracts with payers, PBMs have formidable negotiating power. They influence pharmaceutical insurance coverage, design the terms of coverage in a plan's drug benefit, and create competition among providers for inclusion in a plan's network. PBMs have, through intermediation, the potential to secure lower drug prices and to improve rational prescribing...
February 16, 2017: PharmacoEconomics
https://www.readbyqxmd.com/read/28186715/adoption-of-the-nova-scotia-canada-community-pharmacy-medication-management-program-1-year-post-initiation
#3
Heidi J Deal, Charmaine A Cooke, Ethel M Langille Ingram, Ingrid S Sketris
BACKGROUND: Pharmacists conduct medication reviews to optimize drug therapy. Each jurisdiction implements and funds these programs differently. OBJECTIVE: To describe the uptake of the first year of a community pharmacy medication review program reimbursed by the publically insured seniors' drug benefit program in Nova Scotia, Canada. METHODS: This retrospective analysis included 294 pharmacies and 105,000 beneficiaries enrolled in the Nova Scotia Seniors' Pharmacare Program...
February 1, 2017: Journal of Population Therapeutics and Clinical Pharmacology
https://www.readbyqxmd.com/read/28184172/practically-prepared-pre-intern-student-views-following-an-education-package
#4
Susan McKenzie, Craig Mellis
BACKGROUND: Graduating medical students enter their internship with varied levels of practical experience in procedural skills. To address this problem, many medical schools have introduced intensive skill training courses immediately prior to graduation. This study examines the impact of a pre-intern (PrInt) education package, consisting of a short intensive course, followed by a one-month clinical attachment. METHODS: In September 2014, all PrInt students (n = 53) at the Central Clinical School (Sydney, NSW, Australia) attended three days of intensive training...
2017: Advances in Medical Education and Practice
https://www.readbyqxmd.com/read/28179741/innovations-in-medication-preparation-safety-and-wastage-reduction-use-of-a-workflow-management-system-in-a-pediatric-hospital
#5
Stephen Jerome Davis, Josephine Hurtado, Rosemary Nguyen, Tran Huynh, Ivan Lindon, Cedric Hudnall, Sara Bork
Background: USP <797> regulatory requirements have mandated that pharmacies improve aseptic techniques and cleanliness of the medication preparation areas. In addition, the Institute for Safe Medication Practices (ISMP) recommends that technology and automation be used as much as possible for preparing and verifying compounded sterile products. Objective: To determine the benefits associated with the implementation of the workflow management system, such as reducing medication preparation and delivery errors, reducing quantity and frequency of medication errors, avoiding costs, and enhancing the organization's decision to move toward positive patient identification (PPID)...
January 2017: Hospital Pharmacy
https://www.readbyqxmd.com/read/28118918/acceptance-model-of-a-hospital-information-system
#6
P W Handayani, A N Hidayanto, A A Pinem, I C Hapsari, P I Sandhyaduhita, I Budi
PURPOSE: The purpose of this study is to develop a model of Hospital Information System (HIS) user acceptance focusing on human, technological, and organizational characteristics for supporting government eHealth programs. This model was then tested to see which hospital type in Indonesia would benefit from the model to resolve problems related to HIS user acceptance. METHOD: This study used qualitative and quantitative approaches with case studies at four privately owned hospitals and three government-owned hospitals, which are general hospitals in Indonesia...
March 2017: International Journal of Medical Informatics
https://www.readbyqxmd.com/read/28108642/the-potential-role-for-smartphones-among-older-adults-with-chronic-noncancer-pain-a-qualitative-study
#7
Joshua E Richardson, Jennifer I Lee, Anita Nirenberg, M Carrington Reid
: OBJECTIVE : To determine the role that smartphones may play in supporting older adults with chronic noncancer pain (CNCP) in order to improve pain management in this expanding population. DESIGN:  Qualitative study. SETTING:  One academically affiliated primary care practice serving older adults with CNCP in New York City. SUBJECTS : Thirteen older adults (age 65-85 years) with CNCP on chronic opioid therapy, that is, continuous use of opioids for at least six months...
January 20, 2017: Pain Medicine: the Official Journal of the American Academy of Pain Medicine
https://www.readbyqxmd.com/read/28089522/the-impact-of-medication-synchronization-on-quality-care-criteria-in-an-independent-community-pharmacy
#8
Jessica L Hinson, Gretchen K Garofoli, Betsy M Elswick
OBJECTIVES: To determine the impact of a comprehensive medication synchronization program in an independent community pharmacy by (1) evaluating changes in Electronic Quality Improvement Platform for Plans and Pharmacies (EQuIPP) scores and (2) examining the change in monthly prescription volume. SETTING: Independent community pharmacy in Morgantown, WV. PRACTICE DESCRIPTION: Waterfront Family Pharmacy is a single-location independent community pharmacy located in Morgantown, WV...
January 11, 2017: Journal of the American Pharmacists Association: JAPhA
https://www.readbyqxmd.com/read/28025924/improving-comprehensive-medication-review-acceptance-by-using-a-standardized-recruitment-script-a-randomized-control-trial
#9
Alexander Miguel, Anna Hall, Wei Liu, Jeremy Garrett, Angel Ballew, Tsu-Hsaun Yang, Richard Segal
BACKGROUND: The Centers for Medicare & Medicaid Services (CMS) require prescription drug plan sponsors to offer a comprehensive medication review (CMR) annually to eligible beneficiaries through the plans' Medication Therapy Management Programs (MTMPs). In 2011, the Pharmacy Quality Alliance endorsed the CMR completion rate as a quality measure for MTMPs, and CMS has adopted the measure into the 2016 CMS star ratings. CMS star ratings are used to describe the quality of plans to assist Medicare plan enrollees in choosing a plan and to determine quality bonus payments for Medicare Advantage plans...
January 2017: Journal of Managed Care & Specialty Pharmacy
https://www.readbyqxmd.com/read/27992624/association-of-perioperative-statin-use-with-mortality-and-morbidity-after-major-noncardiac-surgery
#10
Martin J London, Gregory G Schwartz, Kwan Hur, William G Henderson
Importance: The efficacy of statins in reducing perioperative cardiovascular and other organ system complications in patients undergoing noncardiac surgery remains controversial. Owing to a paucity of randomized clinical trials, analyses of large databases may facilitate informed hypothesis generation and more efficient trial design. Objective: To evaluate associations of early perioperative statin use with outcomes in a national cohort of veterans undergoing noncardiac surgery...
February 1, 2017: JAMA Internal Medicine
https://www.readbyqxmd.com/read/27981858/budget-impact-of-everolimus-for-the-treatment-of-progressive-well-differentiated-non-functional-neuroendocrine-tumors-of-gastrointestinal-or-lung-origin-that-are-advanced-or-metastatic
#11
Darya B Rose, Dave Nellesen, Maureen P Neary, Beilei Cai
BACKGROUND: Advanced neuroendocrine tumors (NETs) are a rare malignancy with considerable need for effective therapies. Everolimus is a mammalian target of rapamycin (mTOR) inhibitor approved by the US Food and Drug Administration (FDA) and European Medicines Agency (EMA) in 2016 for treatment of adults with progressive, well-differentiated, non-functional NETs of gastrointestinal (GI) or lung origin that are unresectable, locally advanced, or metastatic. OBJECTIVE: To assess the 3-year budget impact for a typical US health plan following availability of everolimus for treatment of GI and lung NETs...
December 16, 2016: Journal of Medical Economics
https://www.readbyqxmd.com/read/27955977/healthcare-professionals-can-assist-patients-with-managing-post-kidney-transplant-expectations
#12
Kimberley Crawford, Jac Kee Low, Elizabeth Manias, Allison Williams
Kidney transplantation is the preferred treatment option for end-stage kidney disease. However, transplantation is not a cure and the prospective recipient needs to carefully evaluate the risks and benefits of receiving a transplant before agreeing to have the transplant. The objective of this commentary is to demonstrate that many kidney transplant recipients have unrealistic expectations of what life after transplantation involves. After monitoring participants in a randomised controlled trial through the first 12 months post-transplantation, we question whether patients understood the impact of receiving a transplant...
December 2, 2016: Research in Social & Administrative Pharmacy: RSAP
https://www.readbyqxmd.com/read/27940633/supporting-underserved-patients-with-their-medicines-a-study-protocol-for-a-patient-professional-coproduced-education-intervention-for-community-pharmacy-staff-to-improve-the-provision-and-delivery-of-medicine-use-reviews-murs
#13
Asam Latif, Kristian Pollock, Claire Anderson, Justin Waring, Josie Solomon, Li-Chia Chen, Emma Anderson, Sulma Gulzar, Nasa Abbasi, Heather Wharrad
INTRODUCTION: Community pharmacy increasingly features in global strategies to modernise the delivery of primary healthcare. Medicine Use Reviews (MURs) form part of the English Government's medicines management strategy to improve adherence and reduce medicine waste. MURs provide space for patient-pharmacist dialogue to discuss the well-known problems patients experience with medicine taking. However, 'underserved' communities (eg, black and minority ethnic communities, people with mental illness), who may benefit the most, may not receive this support...
December 9, 2016: BMJ Open
https://www.readbyqxmd.com/read/27888437/estimated-budget-impact-of-adopting-the-affordable-care-act-s-required-smoking-cessation-coverage-on-united-states-healthcare-payers
#14
Christine L Baker, Cheryl P Ferrufino, Marianna Bruno, Stacey Kowal
INTRODUCTION: Despite abundant information on the negative impacts of smoking, more than 40 million adult Americans continue to smoke. The Affordable Care Act (ACA) requires tobacco cessation as a preventive service with no patient cost share for all FDA-approved cessation medications. Health plans have a vital role in supporting smoking cessation by managing medication access, but uncertainty remains on the gaps between smoking cessation requirements and what is actually occurring in practice...
January 2017: Advances in Therapy
https://www.readbyqxmd.com/read/27887691/cost-effectiveness-of-achieving-targets-of-low-density-lipoprotein-particle-number-versus-low-density-lipoprotein-cholesterol-level
#15
Michael Grabner, Deborah A Winegar, Rajeshwari S Punekar, Ralph A Quimbo, Mark J Cziraky, William C Cromwell
A recent analysis of a commercially insured US population found fewer cardiovascular disease (CVD) events in high-risk patients attaining low levels of low-density lipoprotein (LDL), as measured by LDL particle number (LDL-P) versus low LDL cholesterol (LDL-C). Here, we investigated the cost effectiveness of LDL-lowering therapy guided by LDL-P. Patients were selected from the HealthCore Integrated Research Database and followed for 12 to 36 months. Patients who achieved LDL-P <1,000 nmol/l were placed into the LDL-P cohort, whereas those without LDL-P tests, but who achieved LDL-C <100 mg/dl, were placed into the LDL-C cohort...
February 1, 2017: American Journal of Cardiology
https://www.readbyqxmd.com/read/27882841/association-of-a-controlled-substance-scoring-algorithm-with-health-care-costs-and-hospitalizations-a-cohort-study
#16
Catherine I Starner, Yang Qiu, Pinar Karaca-Mandic, Patrick P Gleason
BACKGROUND: Patients often misuse a combination of prescription drugs including opioids; however, the relationship between a controlled substance (CS) score and health outcomes is unknown. OBJECTIVE: To examine the association between a CS scoring algorithm and health care use, specifically total cost of care, hospitalizations, and emergency room (ER) visits. METHODS: This analysis was a retrospective cohort study using administrative claims data from a large U...
December 2016: Journal of Managed Care & Specialty Pharmacy
https://www.readbyqxmd.com/read/27882838/a-pragmatic-randomized-trial-comparing-telephone-based-enhanced-pharmacy-care-and-usual-care-to-support-smoking-cessation
#17
Jason Gong, Christine L Baker, Kelly H Zou, Marianna Bruno, Zhanna Jumadilova, David Lawrence, Beth Wilson, Cynthia Ewel
BACKGROUND: Smoking is the leading preventable cause of death, and tobacco control professionals continue to make progress in cessation efforts. Pharmacists can assist smokers seeking to quit by offering counseling on smoking cessation pharmacotherapies. Pragmatic randomized trials are useful for investigating practical questions about an intervention's risks, benefits, and costs in routine clinical practice. OBJECTIVE: To evaluate an enhanced pharmacy care (EPC) program involving personalized pharmacist-provided telephone counseling for supporting prescription smoking cessation medications compared with usual care (UC)...
December 2016: Journal of Managed Care & Specialty Pharmacy
https://www.readbyqxmd.com/read/27882834/amcp-partnership-forum-navigating-innovations-in-diabetes-care
#18
(no author information available yet)
: New developments that provide opportunities to enhance cost-effective diabetes care include advances in the pharmacologic treatment of diabetes, new drug delivery devices, innovations in patient management strategies, contracting strategies that incentivize effective interventions, and mobile health technologies. Payers must carefully consider the utility of these advances when making coverage decisions and designing benefits. To engage national stakeholders in a discussion about how to utilize innovations in diabetes care to optimize patient outcomes, the Academy of Managed Care Pharmacy organized the Partnership Forum on Navigating Innovations in Diabetes Care in Arlington, Virginia, on July 19-20, 2016...
December 2016: Journal of Managed Care & Specialty Pharmacy
https://www.readbyqxmd.com/read/27882831/quantifying-differences-in-health-care-consumption-for-the-management-of-multiple-sclerosis-within-privately-and-publicly-insured-health-care-programs
#19
Terrie Livingston, Monica Fay, Ravi Iyer, Wendy Wells, Michael W Pill
BACKGROUND: Multiple sclerosis (MS) is a chronic and debilitating disease of the central nervous system that affects more than 570,000 persons in the United States and 2.3 million worldwide. Since most individuals experience initial symptoms between the ages of 20 and 40 years, MS can have a significant effect on health care consumption, quality of life, productivity, and employment over the long-term disease course. Opportunities exist to better understand how benefit design and other nonclinical factors can affect health care delivery and associated costs...
December 2016: Journal of Managed Care & Specialty Pharmacy
https://www.readbyqxmd.com/read/27882579/learner%C3%A2-%C3%A2-preceptor-ratios-for-practice-based-learning-across-health-disciplines-a-systematic-review
#20
Peter Loewen, Michael Legal, Allison Gamble, Kieran Shah, Stacey Tkachuk, Peter Zed
CONTEXT: Practice-based learning is a cornerstone of developing clinical and professional competence in health disciplines. Practice-based learning systems have many interacting components, but a key facet is the number of learners per preceptor. Different learner : preceptor ratios may have unique benefits and pose unique challenges for participants. This is the first comprehensive systematic review of the topic. Our research questions were: What are the benefits and challenges of each learner : preceptor ratio in practice-based learning from the perspectives of the learners, preceptors, patients and stakeholder organisations (i...
February 2017: Medical Education
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