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Pharmacy benefit management

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https://www.readbyqxmd.com/read/28025924/improving-comprehensive-medication-review-acceptance-by-using-a-standardized-recruitment-script-a-randomized-control-trial
#1
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
#2
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...
December 19, 2016: 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
#3
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
#4
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
#5
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
#6
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...
November 25, 2016: 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
#7
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
#8
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
#9
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
#10
(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
#11
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
#12
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...
November 23, 2016: Medical Education
https://www.readbyqxmd.com/read/27836481/a-systematic-review-of-rapid-diagnostic-tests-for-influenza-considerations-for-the-community-pharmacist
#13
REVIEW
Renee R Koski, Michael E Klepser
OBJECTIVES: Rapid influenza diagnostic tests (RIDTs) have a potential role in community pharmacy to optimize influenza infection management. The U.S. Food and Drug Administration (FDA) proposed changes to the classification of RIDTs may affect their use in community pharmacy. We reviewed the performance and features of RIDTs likely to meet FDA-proposed reclassification requirements. DATA SOURCES: PubMed and Medline database searches were performed using the terms "Sofia Influenza A and B Fluorescent Immunoassay," "BD Veritor System for Rapid Detection of Flu A and B", and "Alere i Influenza A and B...
January 2017: Journal of the American Pharmacists Association: JAPhA
https://www.readbyqxmd.com/read/27832054/epilepsy-among-iraq-and-afghanistan-war-veterans-united-states-2002-2015
#14
Mary Jo Pugh, Anne C Van Cott, Megan Amuan, Christine Baca, Paul Rutecki, Matthew M Zack, Rosemarie Kobau
The age-adjusted prevalence of seizure disorder in United States veterans deployed in Iraq and Afghanistan conflicts (IAV) is 6.1 per 1,000 persons (1), compared with 7.1 to 10 per 1,000 persons in the general population (2,3). Persons with epilepsy are at risk of excess mortality in part because of comorbidity (4). Although patterns of comorbidity have been associated with mortality in IAV (5), the unique contribution of epilepsy to excess mortality in IAV is unknown. A cohort study was developed using inpatient, outpatient, and pharmacy data from the U...
November 11, 2016: MMWR. Morbidity and Mortality Weekly Report
https://www.readbyqxmd.com/read/27798025/views-of-patients-and-professionals-about-electronic-multicompartment-medication-devices-a-qualitative-study
#15
Jill Hall, Christine Bond, Moira Kinnear, Brian McKinstry
OBJECTIVES: To explore the perceived acceptability, advantages and disadvantages of electronic multicompartment medication devices. DESIGN: Qualitative study using 8 focus groups and 10 individual semistructured interviews. Recordings were transcribed and analysed thematically. Strategies were employed to ensure the findings were credible and trustworthy. PARTICIPANTS AND SETTING: Community pharmacists (n=11), general practitioners (n=9), community nurses (n=12) and social care managers (n=8) were recruited from the National Health Service (NHS) and local authority services...
October 17, 2016: BMJ Open
https://www.readbyqxmd.com/read/27783555/integrated-pharmacies-at-community-mental-health-centers-medication-adherence-and-outcomes
#16
W Abel Wright, Jack M Gorman, Melissa Odorzynski, Mark J Peterson, Carol Clayton
BACKGROUND: Patients receiving psychiatric services at community mental health centers (CMHCs) are often prescribed medication that is critical to the treatment of behavioral health conditions, including schizophrenia, bipolar disorder, anxiety, and depression. Previous studies have shown correlation between rates of medication adherence and risk of hospitalization, but potential differences in medication adherence and other outcomes for patients of CMHCs by pharmacy type have not been widely studied...
November 2016: Journal of Managed Care & Specialty Pharmacy
https://www.readbyqxmd.com/read/27783554/is-the-currently-used-prescription-adjudication-date-a-good-proxy-for-calculating-medication-refill-adherence
#17
Corey A Lester, Kevin A Look, Michelle A Chui
BACKGROUND: The Centers for Medicare & Medicaid Services (CMS) adopted the proportion of days covered (PDC) calculation for use in their Five-Star Quality Rating System for Medicare Advantage and Prescription Drug Plans. This calculation uses the prescription adjudication date (i.e., date the prescription is billed to the benefits manager by a pharmacy) as a proxy for medication adherence. Adherence programs, such as automatic refill programs, have become commonplace in community pharmacy and have been identified by industry leaders as interfering with the ability to accurately measure adherence using PDC...
November 2016: Journal of Managed Care & Specialty Pharmacy
https://www.readbyqxmd.com/read/27783550/impact-of-a-combined-value-based-insurance-design-and-medication-therapy-management-program-on-diabetes-medication-adherence
#18
Alex Peaslee, Marleen Wickizer, Julie Olson, Robert Topp
BACKGROUND: Value-based insurance design (VBID) waives or reduces prescription copayments in order to decrease member cost barriers to refilling medications. Medication therapy management (MTM) is a member clinical intervention designed to reinforce members' knowledge of their medications, which addresses barriers to medication adherence. Both methods have been shown to increase adherence in members, particularly when used in combination. To date, studies of such combined programs have often been completed within integrated health systems but have rarely included control populations...
November 2016: Journal of Managed Care & Specialty Pharmacy
https://www.readbyqxmd.com/read/27783545/estimating-the-value-of-new-technologies-that-provide-more-accurate-drug-adherence-information-to-providers-for-their-patients-with-schizophrenia
#19
Jason Shafrin, Taylor T Schwartz, Darius N Lakdawalla, Felicia M Forma
BACKGROUND: Nonadherence to antipsychotic medication among patients with schizophrenia results in poor symptom management and increased health care and other costs. Despite its health impact, medication adherence remains difficult to accurately assess. New technologies offer the possibility of real-time patient monitoring data on adherence, which may in turn improve clinical decision making. However, the economic benefit of accurate patient drug adherence information (PDAI) has yet to be evaluated...
November 2016: Journal of Managed Care & Specialty Pharmacy
https://www.readbyqxmd.com/read/27729683/usp-800-key-considerations-and-changes-for-health-systems
#20
EDITORIAL
Priya Sahadeo, Robert J Weber
On March 28, 2014, The United States Pharmacopeia and The National Formulary (USP-NF) published USP General Chapter <800> Hazardous Drugs-Handling in Healthcare Settings, as open for public comment in the USP Pharmacopeial Forum (PF) 40(3). Pharmacy directors must be proactive in understanding the impact that USP <800> will have on their processes for preparing sterile products. USP General Chapter <797> pertains to the compounding of both hazardous and nonhazardous drugs. USP <800> serves as a new standard to guide the handling of hazardous drugs in order to protect patients, health care personnel, and the environment...
November 2015: Hospital Pharmacy
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