Journal of managed care pharmacy : JMCP
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We reported previously the results of a 6-month controlled trial in which the use of a commercially available electronic prescribing system with integrated clinical decision support and evidence-based message capability was associated with significantly lower primary care drug costs. The original study focused on new prescriptions, defined as claims for a medication that the patient had not received in the previous 12 months. The main objectives of this follow-up report were to (a) determine if the 6-month savings on new prescriptions were sustained during 12 months of follow-up, (b) evaluate the impact of the computerized decision support system (CDSS) on all pharmacy claims and per-member-per-month (PMPM) expenditures, and (c) evaluate the prescribing behaviors within 8 high-cost therapeutic categories that were frequently targeted by the electronic messages to prescribers to help verify that the drug cost savings were due to the recommendations in the electronic prescribing system. ⋯ An electronic prescribing system with integrated decision support shifted prescribing behavior away from high-cost therapies and significantly lowered prescription drug costs. The savings associated with altered prescribing behavior offset the monthly subscription cost of the system.
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The Medicare Modernization Act of 2003 calls for medication therapy management programs (MTMPs) to control anticipated growth in drug use and expenditures. In 2006, prescription drug plan sponsors, including health plans, pharmacy benefit managers, and other entities, will be required to offer MTMP services performed by pharmacists or other health professionals. The Pharmacist Review to Increase Cost Effectiveness (PRICE) Clinic in Sacramento, California, is a pharmacist-directed, multidisciplinary model that is adaptable to providing MTMP services in a managed care setting. The PRICE Clinic serves a 3-fold mission: (1) to help low-income elderly patients decrease out-of-pocket (OOP) drug expenses; (2) to ensure that patients receive clinically appropriate, cost-effective drug regimens; and (3) to improve access to needed medications. The objectives of this study were to characterize and document the number and type of PRICE clinic interventions; measure changes in generic drug use; document savings in OOP drug costs; and measure patient access to drugs that had been, or would have been, discontinued because of cost. ⋯ Results from this pilot study indicate the benefits of providing pharmacist-directed services to the population targeted by MTMP services, which encompasses Medicare beneficiaries with multiple chronic diseases, multiple drugs, and high drug costs. By providing pharmacist consultation at the point of care to ensure appropriate drug use, decrease OOP expenditures, and improve access to needed drugs, the PRICE Clinic is a possible model for further development in the implementation of MTMP services.
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To compare levels of persistency with 2 cholinesterase (ChE) inhibitors--rivastigmine and donepezil--for the treatment of Alzheimer's disease (AD) through the use of administrative claims data. ⋯ Newly treated AD patients in a usual care setting who initiate therapy with either rivastigmine or donepezil have similar levels of persistency with treatment.
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Comparative Study
Costs and utilization of triptan users who receive drug prophylaxis for migraine versus triptan users who do not receive drug prophylaxis.
The objectives were 2-fold: (1) to describe the utilization patterns of new users of triptan therapy and (2) to measure the direct (pharmacy and medical) costs of migraine-related health care services in moderate-to-severe migraine patients treated with drug prophylaxis compared with migraine patients who are not treated with drug prophylaxis. ⋯ High utilizers of migraine therapy can be identified early in treatment. Drug prophylaxis for migraine is cost saving, and an intervention program that increases the use of migraine prophylaxis in potential candidates could be cost beneficial.
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To determine severe sepsis (SS) incidence, hospital mortality, 1-year mortality, and costs associated with care in a sample of enrollees in a nationally representative individual practice association (IPA)-network managed care organization (MCO). ⋯ Incidence, hospital, and 1-year mortality rates were lower in this population compared with literature reports and were associated with a lower average age in this managed care population. Mean SS hospitalization costs were high, and nearly one half of survivors required rehospitalization within 1 year. Study results suggest the need to evaluate SS interventions for improvement in health outcomes and cost outcomes, particularly in postsurgical patients.