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Pharmacy benefit management

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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
#1
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
#2
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
#3
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
#4
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
#5
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
#6
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
#7
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
#8
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
#9
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
#10
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
https://www.readbyqxmd.com/read/28465766/biologic-disease-modifying-antirheumatic-drugs-in-a-national-privately-insured-population-utilization-expenditures-and-price-trends
#11
Christopher B Atzinger, Jeff J Guo
BACKGROUND: Spending on biologic drugs is a significant driver of drug expenditures for payers in private health plans. Biologic disease-modifying antirheumatic drugs (DMARDs) are some of the most effective and costly treatments in a physician's arsenal. Understanding the total annual expenditure, the average cost per prescription, and the impact of cost-sharing is important for drug benefit managers. OBJECTIVE: To assess drug utilization, expenditures, out-of-pocket (OOP) cost, and price trends of biologic DMARDs in patients with rheumatoid arthritis (RA) in a large managed care organization...
February 2017: American Health & Drug Benefits
https://www.readbyqxmd.com/read/28462741/medicines-reablement-in-intermediate-health-and-social-care-services
#12
Kate Gerrish, Sara Laker, Sarah Wright, Wendy Stainrod
Aim To evaluate a medicines reablement initiative involving health and social care, to include consideration of the training package, proportion of patients reabled successfully, and patient and staff perspectives of the service. BACKGROUND: Intermediate care services provide short-term intervention to support patients with chronic conditions transition from hospital to community-based services and involves maximising patients' independence through reablement. The term 'medicines reablement' describes the process of rehabilitating patients to be independent with their medication...
May 2, 2017: Primary Health Care Research & Development
https://www.readbyqxmd.com/read/28448782/amcp-partnership-forum-driving-value-and-outcomes-in-oncology
#13
(no author information available yet)
Innovation in cancer treatment has provided a wealth of recently available therapeutic agents and a healthy drug pipeline that promises to change the way we approach this disease and the lives of those affected in the years to come. However, the majority of these new agents, many of which are targeted to specific genomic features of various tumors, may challenge the health care system's ability to afford cancer care. This innovation drives the need to focus on the value of the treatments provided to patients with cancer and on methods to optimize the efficiency of the dollars we spend, in addition to the clinical value itself...
May 2017: Journal of Managed Care & Specialty Pharmacy
https://www.readbyqxmd.com/read/28448780/integration-strategies-of-pharmacists-in-primary-care-based-accountable-care-organizations-a-report-from-the-accountable-care-organization-research-network-services-and-education
#14
Tina Joseph, Genevieve M Hale, Sara M Eltaki, Yesenia Prados, Renee Jones, Matthew J Seamon, Cynthia Moreau, Stephanie A Gernant
BACKGROUND: The accountable care organization (ACO) is an innovative health care delivery model centered on value-based care. ACOs consisting of primary care providers are increasingly becoming commonplace in practice; however, medication management remains suboptimal. PROGRAM DESCRIPTION: As experts in medication management, pharmacists perform direct patient care and assist in the transition from one provider to another, which places them in an ideal position to manage multiple aspects of patient care...
May 2017: Journal of Managed Care & Specialty Pharmacy
https://www.readbyqxmd.com/read/28436158/collaborating-on-medication-errors-in-nursing
#15
Marketa Marvanova, Paul J Henkel
BACKGROUND: Nurse educators are faced with changing roles and expanding responsibilities for medication administration and monitoring in pursuit of improved patient safety. The aims of this study were to develop, implement and evaluate clinical simulation experiences that included, along with nursing faculty members, a pharmacist educator for the teaching of preventable medication errors in undergraduate nursing education. METHODS: Four clinical simulation scenarios using high-fidelity patient simulators were developed focusing on select medication problems in nursing practice...
April 24, 2017: Clinical Teacher
https://www.readbyqxmd.com/read/28415046/cost-benefit-effectiveness-of-angiotensin-ii-receptor-blockers-in-patients-with-uncomplicated-hypertension-a-comparative-analysis
#16
Alberto Mazza, Antonella Paola Sacco, Danyelle M Townsend, Gianni Bregola, Edgardo Contatto, Isabella Cappello, Laura Schiavon, Emilio Ramazzina, Domenico Rubello
OBJECTIVE: The treatment of hypertensive patients (HTs) requires a long-term commitment of compliance for the patient and resources by the healthcare system. This poses an economic dilemma in countries where universal healthcare is standard. The aim of this study was to evaluate the costs/health benefit and effectiveness of treatment with angiotensin-II receptor blockers (ARBs) in uncomplicated essential hypertension. DESIGN AND METHODS: The daily and annual economic commitment for treating patients with ARBs was estimated using pharmacy dispensing records and the BP-lowering effects of candesartan, irbesartan, losartan, olmesartan, telmisartan and valsartan was evaluated retrospectively...
June 2017: Biomedicine & Pharmacotherapy, Biomédecine & Pharmacothérapie
https://www.readbyqxmd.com/read/28363381/professional-identity-development-learning-and-journeying-together
#17
Stephanie J Bridges
BACKGROUND: Pharmacy students start to develop their professional values through engagement with the course, practice exposure, staff and fellow students. Group working is an element of pedagogy which draws on the social aspects of learning to facilitate knowledge and skills development, but its potential role in facilitating professional identity formation has as yet been under researched. OBJECTIVES: This study aimed to explore the potential of mutual learning through group work to contribute not only to academic knowledge and understanding, but also to the development of students' professional values and selves...
March 25, 2017: Research in Social & Administrative Pharmacy: RSAP
https://www.readbyqxmd.com/read/28352463/pervasive-antibiotic-misuse-in-the-cambodian-community-antibiotic-seeking-behaviour-with-unrestricted-access
#18
Chhorvoin Om, Frances Daily, Erika Vlieghe, James C McLaughlin, Mary-Louise McLaws
BACKGROUND: Antibiotic misuse is widespread in resource-limited countries such as Cambodia where the burden of infectious diseases is high and access to antibiotics is unrestricted. We explored healthcare seeking behaviour related to obtaining antibiotics and drivers of antibiotic misuse in the Cambodian community. METHODS: In-depth interviews were held with family members of patients being admitted in hospitals and private pharmacies termed pharmacy attendants in the catchment areas of the hospitals...
2017: Antimicrobial Resistance and Infection Control
https://www.readbyqxmd.com/read/28350229/commercial-health-plan-coverage-of-selected-treatments-for-opioid-use-disorders-from-2003-to-2014
#19
Sharon Reif, Timothy B Creedon, Constance M Horgan, Maureen T Stewart, Deborah W Garnick
Opioid use disorders (OUDs) are receiving significant attention in the U.S. as a public health crisis. Access to treatment for OUDs is essential and was expected to improve following implementation of the federal parity law and the Affordable Care Act. This study examines changes in coverage and management of treatments for OUDs (opioid treatment programs (OTPs) as a covered service benefit, buprenorphine as a pharmacy benefit) before, during, and after parity and ACA implementation. Data are from three rounds of a nationally representative survey conducted with commercial health plans regarding behavioral health services in benefit years 2003, 2010, and 2014...
March 28, 2017: Journal of Psychoactive Drugs
https://www.readbyqxmd.com/read/28349623/managing-workplace-stress-in-community-pharmacy-organisations-lessons-from-a-review-of-the-wider-stress-management-and-prevention-literature
#20
REVIEW
Sally Jacobs, Sheena Johnson, Karen Hassell
BACKGROUND: Workplace stress in community pharmacy is increasing internationally due, in part, to pharmacists' expanding roles and escalating workloads. Whilst the business case for preventing and managing workplace stress by employers is strong, there is little evidence for the effectiveness of organisational stress management interventions in community pharmacy settings. AIM: To identify and synthesise existing evidence for the effectiveness of organisational solutions to workplace stress from the wider organisational literature which may be adaptable to community pharmacies...
March 27, 2017: International Journal of Pharmacy Practice
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