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Pharmacy benefit management

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https://www.readbyqxmd.com/read/29047143/rising-drug-costs-drives-the-growth-of-pharmacy-benefit-managers-exclusion-lists-are-exclusion-decisions-value-based
#1
Joshua P Cohen, Christelle El Khoury, Christopher-Paul Milne, Sandra M Peters
OBJECTIVE: We examine whether drugs' excluded versus recommended status on pharmacy benefit manager exclusion lists corresponds to evidence from cost-effectiveness analyses, lack of evidence, or rebates. DATA SOURCES: To find cost-effectiveness data for drugs on 2016 exclusion lists of CVS Caremark and Express Scripts, we searched the Tufts Cost-Effectiveness Analysis Registry and the peer-reviewed literature. STUDY DESIGN: For each excluded and recommended drug, we compared the mean cost-per-QALY, and we calculated the difference between the numbers of excluded and recommended drugs for which we could find no cost-effectiveness evidence...
October 18, 2017: Health Services Research
https://www.readbyqxmd.com/read/29041950/convenience-without-disclosure-a-formative-research-study-of-a-proposed-integrated-methadone-and-antiretroviral-therapy-service-delivery-model-in-dar-es-salaam-tanzania
#2
Alexis Cooke, Haneefa Saleem, Dorothy Mushi, Jessie Mbwambo, Saria Hassan, Barrot H Lambdin
BACKGROUND: Though timely initiation of antiretroviral therapy (ART) is a vital component of effective HIV prevention, care and treatment, people who inject drugs are less likely to receive ART than their non-drug using counterparts. In an effort to increase access to ART for people who inject drugs, we examined perceived benefits, challenges, and recommendations for implementing an integrated methadone and ART service delivery model at an opioid treatment program (OTP) clinic in Dar es Salaam, Tanzania...
October 18, 2017: Addiction Science & Clinical Practice
https://www.readbyqxmd.com/read/29036296/unintended-adverse-consequences-of-a-clinical-decision-support-system-two-cases
#3
Erin G Stone
Many institutions have implemented clinical decision support systems (CDSSs). While CDSS research papers have focused on benefits of these systems, there is a smaller body of literature showing that CDSSs may also produce unintended adverse consequences (UACs). Detailed here are 2 cases of UACs resulting from a CDSS. Both of these cases were related to external systems that fed data into the CDSS. In the first case, lack of knowledge of data categorization in an external pharmacy system produced a UAC; in the second case, the change of a clinical laboratory instrument produced the UAC...
September 23, 2017: Journal of the American Medical Informatics Association: JAMIA
https://www.readbyqxmd.com/read/28979100/acceptability-of-community-based-adherence-clubs-among-health-facility-staff-in-south-africa-a-qualitative-study
#4
Ndumiso Tshuma, Ofentse Mosikare, Jessica A Yun, Olufunke A Alaba, Meera S Maheedhariah, Keith Muloongo, Peter S Nyasulu
BACKGROUND: Patient retention in care for HIV/AIDS is a critical challenge for antiretroviral treatment programs. Community-based adherence programs (CBAPs) as compared to health care facility-based adherence programs have been considered as one of the options to provide treatment maintenance support for groups of patients on antiretroviral therapy. Such an approach provides a way of enhancing self-management of the patient's condition. In addition, CBAPs have been implemented to support antiretroviral treatment expansion in resource-limited settings...
2017: Patient Preference and Adherence
https://www.readbyqxmd.com/read/28973087/association-of-prior-authorization-and-out-of-pocket-costs-with-patient-access-to-pcsk9-inhibitor-therapy
#5
Ann Marie Navar, Benjamin Taylor, Hillary Mulder, Eugene Fievitz, Keri L Monda, Anna Fievitz, Juan F Maya, J Antonio G López, Eric D Peterson
Importance: Although PCSK9 inhibitors (PCSK9i) were approved in 2015, their high cost has led to strict prior authorization practices and high copays, and use of PSCK9i in clinical practice has been low. Objective: To evaluate patient access to PCSK9i among those prescribed therapy. Design, Setting, and Participants: Using pharmacy transaction data, we evaluated 45 029 patients who were newly prescribed PCSK9i in the United States between August 1, 2015, and July 31, 2016...
September 27, 2017: JAMA Cardiology
https://www.readbyqxmd.com/read/28960678/documentation-of-pharmaceutical-care-validation-of-an-intervention-oriented-classification-system
#6
Karen A Maes, Helene Studer, Jérôme Berger, Kurt E Hersberger, Markus L Lampert
RATIONALE, AIMS, AND OBJECTIVES: During the dispensing process, pharmacists may come across technical and clinical issues requiring a pharmaceutical intervention (PI). An intervention-oriented classification system is a helpful tool to document these PIs in a structured manner. Therefore, we developed the PharmDISC classification system (Pharmacists' Documentation of Interventions in Seamless Care). The aim of this study was to evaluate the PharmDISC system in the daily practice environment (in terms of interrater reliability, appropriateness, interpretability, acceptability, feasibility, and validity); to assess its user satisfaction, the descriptive manual, and the online training; and to explore first implementation aspects...
September 29, 2017: Journal of Evaluation in Clinical Practice
https://www.readbyqxmd.com/read/28950021/competencies-for-the-provision-of-comprehensive-medication-management-services-in-an-experiential-learning-project
#7
Simone de Araújo Medina Mendonça, Erika Lourenço de Freitas, Djenane Ramalho de Oliveira
OBJECTIVE: To understand students' and tutors' perceptions of the development of clinical competencies for the delivery of comprehensive medication management services in an experiential learning project linked to a Brazilian school of pharmacy. METHODS: An autoethnographic qualitative study was carried out based on participant observation, focus groups and individual interviews with students and tutors involved in an experiential learning project. RESULTS: The study revealed the development of competencies related to the philosophy of practice, the pharmacotherapy workup of drug therapy and interprofessional relationships...
2017: PloS One
https://www.readbyqxmd.com/read/28944733/performance-based-risk-sharing-arrangements-for-pharmaceutical-products-in-the-united-states-a-systematic-review
#8
Justin S Yu, Lauren Chin, Jennifer Oh, Jorge Farias
BACKGROUND: Value for money is a growing necessity in today's U.S. health care system in which drug spending is expected to increase by an average rate of 6.7% yearly through 2025. In response to uncertainty about real-world clinical and economic outcomes for many drugs, health insurers and pharmacy benefit managers (PBMs) have implemented various contracts and arrangements with drug manufacturers that can collectively be described as performance-based risk-sharing arrangements (PBRSAs)...
October 2017: Journal of Managed Care & Specialty Pharmacy
https://www.readbyqxmd.com/read/28944726/paying-for-cures-how-can-we-afford-it-managed-care-pharmacy-stakeholder-perceptions-of-policy-options-to-address-affordability-of-prescription-drugs
#9
Kai Yeung, Kangho Suh, Anirban Basu, Louis P Garrison, Aasthaa Bansal, Josh J Carlson
BACKGROUND: High-priced medications with curative potential, such as the newer hepatitis C therapies, have contributed to the recent growth in pharmaceutical expenditure. Despite the obvious benefits, health care decision makers are just beginning to grapple with questions of how to value and pay for curative therapies that may feature large upfront cost, followed by health benefits that are reaped over a patient's lifespan. Alternative policy options have been proposed to promote high value and financially sustainable use of these therapies...
October 2017: Journal of Managed Care & Specialty Pharmacy
https://www.readbyqxmd.com/read/28941554/an-evaluation-of-dental-antibiotic-prescribing-practices-in-the-united-states
#10
Michael J Durkin, Kevin Hsueh, Ya Haddy Sallah, Qianxi Feng, S Reza Jafarzadeh, Kiraat D Munshi, Peter B Lockhart, Martin H Thornhill, Rochelle R Henderson, Victoria J Fraser
BACKGROUND: Antibiotic prescribing practices among general dentists and dental specialists in the United States remains poorly understood. The purpose of this study was to compare prescribing practices across dental specialties, evaluate the duration of antibiotics dentists prescribed, and determine variation in antibiotic selection among dentists. METHODS: The authors performed a retrospective cross-sectional analysis of dental care provider specialties linked to deidentified antibiotic claims data from a large pharmacy benefits manager during the 2015 calendar year...
September 16, 2017: Journal of the American Dental Association
https://www.readbyqxmd.com/read/28854074/implementation-of-a-new-clinic-based-pharmacist-managed-pcsk9-inhibitor-consultation-service
#11
Adenike Atanda, Nancy L Shapiro, JoAnn Stubbings, Vicki Groo
BACKGROUND: The proprotein convertase subtilisin/kexin type 9 (PCSK9) inhibitors alirocumab and evolocumab were approved by the FDA in 2015. In anticipation of provider interest and a potential increase in referrals to the on-site specialty pharmacy, we created a pharmacist-managed consultation service. PROGRAM DESCRIPTION: The development of a clinic-based pharmacist-managed consultation service for the management of the PCSK9 inhibitor agents alirocumab and evolocumab is described...
September 2017: Journal of Managed Care & Specialty Pharmacy
https://www.readbyqxmd.com/read/28854072/acclimating-to-the-increase-in-statin-use-in-accountable-care-organizations-based-on-changes-in-quality-measures-a-report-from-the-accountable-care-organization-research-network-services-and-education
#12
Leah Bensimon, Genevieve Hale
The Accountable Care Organization Research Network, Services, and Education (ACORN SEED), founded by faculty members at Nova Southeastern University College of Pharmacy, is a group of pharmacists that provides unique pharmacy services to accountable care organizations (ACOs), patient-centered medical homes, and management services organizations to help maximize shared savings and target medication-related issues, while promoting the pharmacy profession and unique learning experiences for pharmacy students within these settings...
September 2017: Journal of Managed Care & Specialty Pharmacy
https://www.readbyqxmd.com/read/28835370/screening-for-atrial-fibrillation-in-canadian-pharmacies-an-economic-evaluation
#13
Jean-Eric Tarride, Lisa Dolovich, Gordon Blackhouse, Jason Robert Guertin, Natasha Burke, Veena Manja, Alex Grinvalds, Ting Lim, Jeff S Healey, Roopinder K Sandhu
BACKGROUND: Screening for undiagnosed atrial fibrillation may lead to treatment with oral anticoagulation therapy, which can decrease the risk of ischemic stroke. The objective of this study was to conduct an economic evaluation of the Program for the Identification of 'Actionable' Atrial Fibrillation in the Pharmacy Setting (PIAAF-Pharmacy), which screened 1145 participants aged 65 years or more at 30 community pharmacies in Ontario and Alberta between October 2014 and April 2015. METHODS: We used a 2-part decision model to evaluate the short- and long-term costs and quality-adjusted life-years (QALYs) of a pharmacy screening program for atrial fibrillation compared to no screening...
August 22, 2017: CMAJ Open
https://www.readbyqxmd.com/read/28782339/role-of-generics-in-treatment-of-hepatitis-c-infection
#14
Muhammad Umar, Tayyab Saeed Akhter, Ibrar Akbar, Gul Nisar, Muhammad Osama, Tayyab Saeed Akhter
With the discovery of newer and newer DAAs, the cure of Hepatitis C seems to be a reality. But their high price and availability is a big hindrance. Sofosbuvir launched by Gilead costs about $ 84000 per 12-week course. Since its launch there is a huge debate regarding the complex pricing mechanism of DAAs. The pricing involves negotiation of patent holder with health insurance companies through their Pharmacy Benefit Managers (PBMs). Several rebates are also involved in this pricing mechanism amongst which only few are declared ones...
October 2016: Journal of Ayub Medical College, Abbottabad: JAMC
https://www.readbyqxmd.com/read/28765380/high-expenditure-pharmaceutical-use-among-children-in-medicaid
#15
Eyal Cohen, Matt Hall, Ruth Lopert, Brian Bruen, Lisa J Chamberlain, Naomi Bardach, Jennifer Gedney, Bonnie T Zima, Jay G Berry
BACKGROUND AND OBJECTIVES: Medication use may be a target for quality improvement, cost containment, and research. We aimed to identify medication classes associated with the highest expenditures among pediatric Medicaid enrollees and to characterize the demographic, clinical, and health service use of children prescribed these medications. METHODS: Retrospective, cross-sectional study of 3 271 081 Medicaid-enrolled children. Outpatient medication spending among high-expenditure medication classes, defined as the 10 most expensive among 261 mutually exclusive medication classes, was determined by using transaction prices paid to pharmacies by Medicaid agencies and managed care plans among prescriptions filled and dispensed in 2013...
September 2017: Pediatrics
https://www.readbyqxmd.com/read/28737990/cost-effectiveness-of-novel-agents-in-medicare-patients-with-multiple-myeloma-findings-from-a-u-s-payer-s-perspective
#16
Ying Chen, David R Lairson, Wenyaw Chan, Jinhai Huo, Xianglin L Du
BACKGROUND: Since multiple myeloma (MM) incurs a substantial economic burden in care management, more and more discussion has been generated in recent years about the costs of novel antimyeloma drugs and their associated value. Because of these costs, economic assessment that quantifies value of care over the long-term is essential. OBJECTIVE: To determine the cost-effectiveness (measured as cost per life-year saved) of front-line novel agent-based therapy use among a cohort of elderly patients with MM in a real-world setting...
August 2017: Journal of Managed Care & Specialty Pharmacy
https://www.readbyqxmd.com/read/28737983/advancing-patient-care-through-specialty-pharmacy-services-in-an-academic-health-system
#17
Autumn Bagwell, Tara Kelley, Alicia Carver, Jennifer B Lee, Brandon Newman
BACKGROUND: With the rapid growth of specialty pharmacies, including those within academic health systems, pharmacists have the opportunity to improve patient care through the management of specialty medications. Specialty pharmacists within academic health systems are uniquely positioned to overcome restrictions to medication access, financial constraints, and provider burdens that often lead to obstacles for patients to start and maintain necessary treatments. The Vanderbilt Specialty Pharmacy (VSP) model at Vanderbilt University Medical Center (VUMC) provides an example of a patient-centered, collaborative care prototype that places pharmacists directly into specialty clinics to assist with comprehensive management of patients on specialty medications...
August 2017: Journal of Managed Care & Specialty Pharmacy
https://www.readbyqxmd.com/read/28719222/how-drug-life-cycle-management-patent-strategies-may-impact-formulary-management
#18
Jan Berger, Jeffrey D Dunn, Margaret M Johnson, Kurt R Karst, W Chad Shear
Drug manufacturers may employ various life-cycle management patent strategies, which may impact managed care decision making regarding formulary planning and management strategies when single-source, branded oral pharmaceutical products move to generic status. Passage of the Hatch-Waxman Act enabled more rapid access to generic medications through the abbreviated new drug application process. Patent expirations of small-molecule medications and approvals of generic versions have led to substantial cost savings for health plans, government programs, insurers, pharmacy benefits managers, and their customers...
October 2016: American Journal of Managed Care
https://www.readbyqxmd.com/read/28671083/drug-cost-management-in-pharmacy-management-based-on-pharmacoeconomics-antimicrobial-treatment-cases
#19
Suiliang Liu, Li He, Lei Sun, Yantao Wang
With the increasing demand for health care, the consumption and cost of drugs have increased dramatically. Pharmacoeconomics is a new interdisciplinary subject in recent years. It mainly focuses on the cost and benefit of drug treatment. In this paper, the authors analyze the drug cost management based on an antimicrobial treatment case. The results show that by using cost-effectiveness method, we could reduce the cost of drugs in the course of treatment, the proportion of antimicrobial drugs are also reduced accordingly...
May 2017: Pakistan Journal of Pharmaceutical Sciences
https://www.readbyqxmd.com/read/28671079/analysis-of-antimicrobial-use-and-cost-benefit-rationality-in-medical-emergency-department
#20
Lijing Jia, Wei Cui, Shaoqing Tang, Yuanyuan Xiu
Rational use of antimicrobial agents can reduce the burden of patients, reduce adverse drug reactions and effectively cure bacterial infections. In this paper the analysis is done on the antimicrobial use and cost-benefit rationality in medical emergency department. Based on the analysis of the use of antibiotics in hospital emergency department, Antimicrobial prescription accounting for 44.26% of the total prescription, involving cephalosporins, fluoroquinolones, macrolides, cephalosporins. According to the stakeholder theory, the use of antimicrobial agents involves multiple interests, too much emphasis on any party also affect the rational use of antimicrobial drugs...
May 2017: Pakistan Journal of Pharmaceutical Sciences
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