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Pharmacy benefit management

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https://www.readbyqxmd.com/read/28650251/managed-care-peer-led-teaching-an-innovative-learning-approach-outside-the-college-of-pharmacy-core-curriculum
#1
SyHui Tang, Julia Smith, Wilson Lau, Isaac Tse, Christine Tan, Ryan Cotten, Amy Pittenger
BACKGROUND: Managed care pharmacy is a growing field, but there are still limited educational opportunities available in pharmacy school core curricula. Students often seek self-directed learning opportunities to further explore the field. OBJECTIVES: To (a) evaluate practicality and effectiveness of a student-designed managed care pharmacy elective and (b) determine emerging best practices for design and sustainability of peer-led, self-directed courses. METHODS: A managed care elective course was designed as a student, peer-led course during the 2012-2013 school year at the University of Minnesota College of Pharmacy...
July 2017: Journal of Managed Care & Specialty Pharmacy
https://www.readbyqxmd.com/read/28638617/clinical-pharmacists-in-primary-care-provider-satisfaction-and-perceived-impact-on-quality-of-care-provided
#2
Havan Truong, Miranda E Kroehl, Carmen Lewis, Robin Pettigrew, Marialice Bennett, Joseph J Saseen, Katy E Trinkley
PURPOSE: The purpose of this study is to evaluate primary care provider satisfaction and perceived impact of clinical pharmacy services on the disease state management in primary care. METHODS: A cross-sectional survey with 24 items and 4 domains was distributed anonymously to pharmacy residency program directors across the United States who were requested to forward the survey to their primary care provider colleagues. Primary care providers were asked to complete the survey...
2017: SAGE Open Medicine
https://www.readbyqxmd.com/read/28617022/reducing-hospital-readmission-through-team-based-primary-care-a-7-week-pilot-study-integrating-behavioral-health-and-pharmacy
#3
Lauren N DeCaporale-Ryan, Nabila Ahmed-Sarwar, Robbyn Upham, Karen Mahler, Katie Lashway
INTRODUCTION: A team-based service delivery model was applied to provide patients with biopsychosocial care following hospital discharge to reduce hospital readmission. Most previous interventions focused on transitions of care occurred in the inpatient setting with attention to predischarge strategies. These interventions have not considered psychosocial stressors, and few have explored management in primary care settings. METHOD: A 7-week team-based service delivery model was implemented in a family medicine practice emphasizing a biopsychosocial approach...
June 2017: Families, Systems & Health: the Journal of Collaborative Family Healthcare
https://www.readbyqxmd.com/read/28587644/current-and-future-perspectives-on-the-management-of-polypharmacy
#4
Mariam Molokhia, Azeem Majeed
BACKGROUND: Because of ageing populations, the growth in the number of people with multi-morbidity and greater compliance with disease-specific guidelines, polypharmacy is becoming increasingly common. Although the correct drug treatment in patients with complex medical problems can improve clinical outcomes, quality of life and life expectancy, polypharmacy is also associated with an increased risk of adverse drug events, some severe enough to result in hospital admission and even death...
June 6, 2017: BMC Family Practice
https://www.readbyqxmd.com/read/28583300/testing-evidence-routine-practice-using-an-implementation-framework-to-embed-a-clinically-proven-asthma-service-in-australian-community-pharmacy
#5
Joanne M Fuller, Bandana Saini, Sinthia Bosnic-Anticevich, Victoria Garcia Cardenas, Shalom I Benrimoj, Carol Armour
INTRODUCTION: Community pharmacists are well placed and evidence clearly demonstrates that they can be suitably trained to deliver professional services that improve the management of asthma patients in clinical, economic and humanistic terms. However the gap between this evidence and practice reality remains wide. In this study we measure the implementation process as well as the service benefits of an asthma service model. METHODS: Using an effectiveness-implementation hybrid design, a defined implementation process (progression from Exploration through Preparation and Testing to Operation stages) supporting an asthma service (promoting asthma control and inhaler technique) was tested in 17 community pharmacies across metropolitan Sydney...
May 30, 2017: Research in Social & Administrative Pharmacy: RSAP
https://www.readbyqxmd.com/read/28581206/upcoming-challenges-in-multidisciplinary-heart-failure-management-active-role-of-future-clinical-pharmacists
#6
J Motiejunaite, T Chouihed, A Mebazaa
In their article "Role and Value of Clinical Pharmacy in Heart Failure Management" Stough and Patterson discuss the potential benefits that clinical pharmacists could bring to heart failure management. They mostly focused on chronic stable heart failure. The objective of this commentary is to provide future perspectives for clinical pharmacist involvement in multidisciplinary heart failure team in the management of patients admitted in emergency for decompensation of their heart condition.
June 5, 2017: Clinical Pharmacology and Therapeutics
https://www.readbyqxmd.com/read/28569660/use-of-telemedicine-to-enhance-pharmacist-services-in-the-nursing-facility
#7
Sandra L Kane-Gill, Joshua D Niznik, John A Kellum, Colleen M Culley, Richard D Boyce, Zachary A Marcum, Harvey He, Subashan Perera, Steven M Handler
OBJECTIVE: To conduct a systematic literature review to determine what telemedicine services are provided by pharmacists and the impact of these services in the nursing facility setting. DATA SOURCES: MEDLINE®, Scopus®, and Embase® databases. STUDY SELECTION: The terms "telemedicine" or "telehealth" were combined by "and" with the terms "pharmacist" or "pharmacy" to identify pharmacists' use of telemedicine. Also, "telepharmacy" was added as a search term...
February 1, 2017: Consultant Pharmacist: the Journal of the American Society of Consultant Pharmacists
https://www.readbyqxmd.com/read/28561731/pain-and-opioids-in-cancer-care-benefits-risks-and-alternatives
#8
Mike Bennett, Judith A Paice, Mark Wallace
Pain remains common in the setting of malignancy, occurring as a consequence of cancer and its treatment. Several high-quality studies confirm that more than 50% of all patients with cancer experience moderate to severe pain. The prevalence of pain in cancer survivors is estimated to be 40%, while close to two-thirds of those with advanced disease live with pain. Progress has occurred in the management of cancer pain, yet undertreatment persists. Additionally, new challenges are threatening these advances. These challenges are numerous and include educational deficits, time restraints, and limited access to all types of care...
2017: American Society of Clinical Oncology Educational Book
https://www.readbyqxmd.com/read/28558108/association-of-prescription-drug-price-rebates-in-medicare-part-d-with-patient-out-of-pocket-and-federal-spending
#9
Stacie B Dusetzina, Rena M Conti, Nancy L Yu, Peter B Bach
The increasing cost of prescription drugs is a burden for patients and threatens the financial stability of the US health care system. Rebates are a form of price concession paid by a pharmaceutical manufacturer to the health plan sponsor or the pharmacy benefit manager working on the plan's behalf. Proponents argue that rebates result from vigorous negotiations that help lower overall drug costs. Critics argue that rebates have perversely increased the costs patients pay out of pocket, as well as the costs for Medicare as a whole...
May 30, 2017: JAMA Internal Medicine
https://www.readbyqxmd.com/read/28557515/connected-care-improving-outcomes-for-adults-with-serious-mental-illness
#10
James M Schuster, Suzanne M Kinsky, Jung Y Kim, Jane N Kogan, Allison Hamblin, Cara Nikolajski, John Lovelace
OBJECTIVES: To evaluate the effectiveness of Connected Care-a care coordination effort of physical and behavioral health managed care partners in Pennsylvania-on acute service use among adult Medicaid beneficiaries with serious mental illness (SMI). STUDY DESIGN: We examined changes in service utilization using a difference-in-differences model, comparing study group with a comparison group, and conducted key informant interviews to better understand aspects of program implementation...
October 2016: American Journal of Managed Care
https://www.readbyqxmd.com/read/28535103/value-frameworks-for-the-patient-provider-interaction-a-comparison-of-the-asco-value-framework-versus-nccn-evidence-blocks-in-determining-value-in-oncology
#11
Bijal Shah-Manek, Joseph S Galanto, Huong Nguyen, Robert Ignoffo
BACKGROUND: To address the rising concern about oncology drug costs, the American Society of Clinical Oncology (ASCO) and the National Comprehensive Cancer Network (NCCN) recently developed unique tools to help providers and patients make informed decisions about the value of an anticancer regimen. The ASCO Value Framework (AVF) allows users to generate a net health benefit (NHB) score along with drug acquisition costs for oncology regimens that have been compared in a prospective randomized clinical trial...
June 2017: Journal of Managed Care & Specialty Pharmacy
https://www.readbyqxmd.com/read/28530524/is-real-world-evidence-used-in-p-t-monographs-and-therapeutic-class-reviews
#12
Jason T Hurwitz, Mary Brown, Jennifer S Graff, Loretta Peters, Daniel C Malone
BACKGROUND: Payers are faced with making coverage and reimbursement decisions based on the best available evidence. Often these decisions apply to patient populations, provider networks, and care settings not typically studied in clinical trials. Treatment effectiveness evidence is increasingly available from electronic health records, registries, and administrative claims. However, little is known about when and what types of real-world evidence (RWE) studies inform pharmacy and therapeutic (P&T) committee decisions...
June 2017: Journal of Managed Care & Specialty Pharmacy
https://www.readbyqxmd.com/read/28530519/does-a-one-size-fits-all-cost-sharing-approach-incentivize-appropriate-medication-use-a-roundtable-on-the-fairness-and-ethics-associated-with-variable-cost-sharing
#13
Jennifer S Graff, Chuck Shih, Thomas Barker, Gabriela Dieguez, Cheryl Larson, Helen Sherman, Robert W Dubois
BACKGROUND: Tiered formularies, in which patients pay copays or coinsurance out-of-pocket (OOP), are used to manage costs and encourage more efficient health care resource use. Formulary tiers are typically based on the cost of treatment rather than the medical appropriateness for the patient. Cost sharing may have unintended consequences on treatment adherence and health outcomes. Use of higher-cost, higher-tier medications can be due to a variety of factors, including unsuccessful treatment because of lack of efficacy or side effects, patient clinical or genetic characteristics, patient preferences to avoid potential side effects, or patient preferences based on the route of administration...
June 2017: Journal of Managed Care & Specialty Pharmacy
https://www.readbyqxmd.com/read/28510520/novel-devices-for-delivering-diabetes-medications-their-value-and-some-coverage-considerations
#14
Bruce W Sherman
Insurers should consider covering new drug-delivery devices that can improve outcomes while lowering disease-specific pharmacy and long-term overall health care costs. Managing these devices in the pharmacy benefit will consolidate volume-based purchasing and capitalize on PBM strategies for improving adherence.
March 2017: Managed Care
https://www.readbyqxmd.com/read/28510519/health-insurers-often-foot-bill-when-drug-coupons-are-used
#15
Howard Wolinsky
While coupons help individual consumers, they are also having a major impact on the insurance industry and anyone responsible for paying health care bills. Insurers and pharmacy benefit managers complain that they foil formularies and other pricing strategies designed to steer consumers to less-expensive drugs.
March 2017: Managed Care
https://www.readbyqxmd.com/read/28506398/integration-of-pharmacists-into-patient-centered-medical-homes-in-federally-qualified-health-centers-in-texas
#16
Shui Ling Wong, Jamie C Barner, Kristina Sucic, Michelle Nguyen, Karen L Rascati
OBJECTIVES: To describe the integration and implementation of pharmacy services in patient-centered medical homes (PCMHs) as adopted by federally qualified health centers (FQHCs) and compare them with usual care (UC). SETTING: Four FQHCs (3 PCMHs, 1 UC) in Austin, TX, that provide care to the underserved populations. PRACTICE DESCRIPTION: Pharmacists have worked under a collaborative practice agreement with internal medicine physicians since 2005...
May 2017: Journal of the American Pharmacists Association: JAPhA
https://www.readbyqxmd.com/read/28479842/pbm-p-t-practices-the-heat-initiative-is-gaining-momentum
#17
Martha M Rumore, F Randy Vogenberg
The pharmacy benefit management (PBM) industry has recently fallen into the crosshairs of government investigations about the high cost of pharmaceuticals. The authors focus on the PBM-based P&T and formulary practices under scrutiny.
May 2017: P & T: a Peer-reviewed Journal for Formulary Management
https://www.readbyqxmd.com/read/28473405/initiation-patterns-of-statins-in-the-2%C3%A2-years-after-release-of-the-2013-american-college-of-cardiology-american-heart-association-acc-aha-cholesterol-management-guideline-in-a-large-us-health-plan
#18
Temitope Olufade, Siting Zhou, Deborah Anzalone, David M Kern, Ozgur Tunceli, Mark J Cziraky, Vincent J Willey
BACKGROUND: The purpose of this study was to characterize changes in statin utilization patterns in patients newly initiated on therapy in the 2 years following the release of the 2013 American College of Cardiology/American Heart Association (ACC/AHA) cholesterol management guideline in a large US health plan population. METHODS AND RESULTS: This retrospective, observational study used administrative medical and pharmacy claims data to identify patients newly initiated on statin therapy over 4 quarters prior to and 8 quarters following the release of the guideline (average N/quarter=3596)...
May 4, 2017: Journal of the American Heart Association
https://www.readbyqxmd.com/read/28465778/the-challenge-of-managing-psoriasis-unmet-medical-needs-and-stakeholder-perspectives
#19
REVIEW
Steven R Feldman, Bernard Goffe, Gary Rice, Matthew Mitchell, Mandeep Kaur, Debbie Robertson, Debra Sierka, Jeffrey A Bourret, Tamara S Evans, Alice Gottlieb
BACKGROUND: Psoriasis is a debilitating chronic inflammatory autoimmune disease affecting approximately 7.4 million adults in the United States. Plaque psoriasis is the most common form, affecting 80% to 90% of patients. OBJECTIVES: To describe the impact and challenges that psoriasis presents for various stakeholders, and to provide nondermatologist healthcare decision makers with information to enhance their contributions to drug and pharmacy benefit design discussions...
December 2016: American Health & Drug Benefits
https://www.readbyqxmd.com/read/28465770/effects-of-specialty-pharmacy-care-on-health-outcomes-in-multiple-sclerosis
#20
Jun Tang, James Bailey, Cyril Chang, Richard Faris, Song Hee Hong, Michael Levin, Junling Wang
BACKGROUND: Increasingly, third-party payers are requiring patients with multiple sclerosis (MS) to participate in specialty pharmacy management programs to improve their adherence to their prescribed medications. The effects of specialty pharmacy care on MS clinical outcomes have not yet been comprehensively examined in the literature. OBJECTIVE: To compare the effectiveness of specialty pharmacy care and usual community pharmacy care MS outcomes. METHODS: Inpatient, outpatient, and pharmacy claims for patients with MS were extracted from a major national pharmacy benefit management company's databases for this retrospective cohort study...
November 2016: American Health & Drug Benefits
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