Journal of managed care pharmacy : JMCP
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Generic drug discount programs: are prescriptions being submitted for pharmacy benefit adjudication?
⋯ Among levothyroxine utilizers in 2006 (prior to the advent of drug discount programs), those with claims from a pharmacy that subsequently implemented a nonmembership generic drug discount program did not appear to have a different rate of levothyroxine claims capture than members from the reference group when followed through June 2010. Utilizers with claims from a pharmacy that subsequently implemented a membership program had a significantly lower levothyroxine claims capture rate. Increasing index levothyroxine member cost was associated with higher levothyroxine claims capture loss. Because the analysis could not directly measure claims capture loss associated with members who switched to a new pharmacy group without presenting their insurance information (e.g., membership discount programs), further research is needed to confirm these findings.
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Educational interventions have long been used as a means of influencing prescribing behavior. Various techniques including educational mailings, academic detailing, prescriber feedback with or without disclosing patient-identifying data, and supplemental patient information have been used to promote appropriate prescribing habits, reduce costs, and optimize patient care. While the effects of educational intervention programs are widely reported, little information is available regarding the effectiveness of various mailed intervention techniques. ⋯ Though the degree of heterogeneity between articles prevents provision of definite results, it appears that a well-constructed mailed intervention program has the potential to evoke significant changes in prescribing patterns. Prescribers appear to be receptive to mailed interventions; however, there are limited data to determine the association between acceptance and actual prescribing change. Future research should focus on identifying barriers that may prohibit acceptance of recommendations from translating into changes in therapy. Additionally, future projects should include longer assessment periods to determine the duration of impact following final intervention mailing and potential effect on health care and economic outcomes.
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Little is known about U.S. outpatient prescribing trends for type 2 diabetes (T2DM) in adolescents and young adults. ⋯ The prescribing of pharmacological treatment for T2DM increased with emphasis on oral agents, while reports of nonpharmacological therapy for T2DM decreased over the 9-year study period with increased use of oral medications in both adolescents and young adults. Health care providers should consistently consider both treatment approaches when prescribing patient care as recommended by treatment guidelines.
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Chronic pain is a prevalent condition in the United States. Musculoskeletal pain, including joint and back pain, is the most common type of chronic pain, and many patients with back pain have a neuropathic component. Pain has direct economic consequences. While oxycodone controlled-release (CR) is one of the most widely used oral long-acting opioids for pain, including pain with a neuropathic component, it is often associated with bothersome side effects, resulting in additional medical resource use (MRU) and costs. ⋯ Among adults taking oxycodone CR for chronic noncancer pain (with or without a neuropathic pain component), over three-fourths reported being bothered by side effects. Respondents who reported higher levels of side-effect bother also reported greater MRU, resulting in increased payer costs. The results of this study provide further support of the econo-mic burden to payers associated with opioid-related side effects in patients with chronic noncancer pain, with and without neuropathic pain.
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Chronic obstructive pulmonary disease (COPD) is prevalent in nursing home residents. National and international guidelines exist for management of COPD; however, little is known about "real-world" management of COPD in this population. Nursing home patients with significant cognitive impairment may have difficulty utilizing handheld device (HHD) formulations of respiratory medications and may be clinically appropriate candidates for nebulized therapy. ⋯ In this retrospective analysis of administrative data, 21.5% of nursing home residents had a diagnosis of COPD, and 17% of these residents received no respiratory medications. These residents had significant cognitive and functional impairment and concurrent diagnoses. 22% of residents experienced at least 2 exacerbations of COPD during the 12 months of study. As many as 60% were not receiving inhaled LABA/ICS or inhaled tiotropium, and 33% exhibited SOB. There is significant use of nebulized SABA monotherapy, which may be contributing to SOB and exacerbations or hospitalizations in nursing home residents with COPD.