Journal of managed care & specialty pharmacy
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J Manag Care Spec Pharm · May 2014
ReviewAssessing the present state and potential of Medicaid controlled substance lock-in programs.
Nonmedical use of prescription medications--particularly controlled substances--has risen dramatically in recent decades, resulting in alarming increases in overdose-related health care utilization, costs, and mortality. The Centers for Disease Control and Prevention estimate that 80% of abused and misused controlled substances originate as legal prescriptions. As such, policymakers and payers have the opportunity to combat nonmedical use by regulating controlled substance accessibility within legal prescribing and dispensing processes. ⋯ Nearly all outcomes evidence stemmed from publicly accessible internal Medicaid program evaluations, which largely investigated cost savings to the state. Lock-in programs are highly prevalent and poised to play a meaningful role in curbing the prescription drug abuse epidemic. However, achieving these ends requires a concerted effort from the academic and policy communities to rigorously evaluate the effect of lock-in programs on patient outcomes, determine optimal program design, and explore opportunities to enhance lock-in program impact through coordination with parallel controlled substance policy efforts, namely prescription drug-monitoring programs.
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J Manag Care Spec Pharm · May 2014
Implementation of an opioid management initiative by a state Medicaid program.
The utilization of prescription opioids has increased over the last 2 decades. Associated with this is the misuse of prescription opioids for nonmedical purposes. Medicaid programs have struggled with developing strategies that balance best practice models, appropriate utilization, and reduction in costs associated with the opioid medication class. ⋯ Our study successfully demonstrated that a state Medicaid program initiative can result in a significant overall decrease in opioid class utilization specifically for the targeted, more costly agents. This was achieved via the implementation of a Therapeutic Class Management multidisciplinary workgroup that established a prior authorization process implementing limits on dose, as well as identified preferred less costly agents. It further facilitated the direct opportunity for pharmacy-prescriber collaboration for LAOA medication management.
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J Manag Care Spec Pharm · Apr 2014
ReviewCurrent and future roles of targeted therapy and immunotherapy in advanced melanoma.
Melanoma is an aggressive disease that accounts for approximately 75% of skin cancer-related deaths. Historically, treatment options for patients with advanced stage melanoma have been limited by modest response rates and failure to improve overall survival. The treatment landscape for advanced stage melanoma was revolutionized in 2011 with the approval of ipilimumab and vemurafenib, both of which improved overall survival in phase III clinical trials. More recently, the targeted inhibitors dabrafenib and trametinib have demonstrated similar therapeutic profiles. ⋯ The immunotherapy ipilimumab and the MAPK-targeted inhibitors vemurafenib, dabrafenib, and trametinib have forever changed the treatment landscape for melanoma. Indeed, these new therapies have demonstrated long-term improvement in patient outcome, a benefit not afforded by traditional therapeutics. Important research continues on the molecular basis of melanoma, and new targets are likely to emerge. Other areas of work include optimization of sequencing and/or combination of current treatments, which may increase the number of patients who experience clinical benefit.
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J Manag Care Spec Pharm · Apr 2014
Health care resource utilization following initiation of a triptan: a retrospective claims analysis.
23 million Americans suffer from migraine headaches, incurring more than $1 billion in direct medical costs each year (with another $13 billion in indirect productivity losses). Triptans are the most common treatment of choice for these patients; however, adherence and persistence to triptans are poor. Partly due to poor adherence to therapy, the ability of triptans to reduce the utilization of other medical services and prescription drugs remains unclear. ⋯ Contrary to the findings of some previous research, the initiation of triptan therapy did not significantly reduce the utilization of migraine-related medical services or other relevant prescription drugs in this retrospective claims analysis. This may have been due to higher and more realistic rates of triptan switching and discontinuation. Consistent with previous findings, patients using concomitant opioids used more migraine-related health care resources.