The American journal of managed care
-
Medication nonadherence, clinical inertia, and contradictory clinical evidence on aggressive disease management contribute to poor outcomes in diabetes management, leading to increased healthcare utilization and costs. As plans increase their focus on the management of type 2 diabetes as an area of high healthcare resource utilization, the importance of appropriate antihyperglycemic agent selection is receiving more attention. The selection process is further complicated by the crowded diabetes drug category, which features several agents with diverse mechanisms of action and routes of administration. ⋯ Essentially, this innovative form of benefit design dictates that the more clinically beneficial the therapy, the lower patients' cost share will be. Other interventions, such as motivational interviewing, pay-for-performance, and medication therapy management, are also being applied to improve treatment adherence and outcomes in the managed care environment, with varying levels of success. Regardless of the specific inventions applied at health plans for improving treatment success in type 2 diabetes, pharmacy director leadership and involvement can contribute to the success of these efforts.
-
To conduct a systematic literature review analyzing cost-effectiveness or cost savings associated with use of recombinant tissue plasminogen activator (rt-PA), stroke centers, and telemedicine programs for acute ischemic stroke. ⋯ More high-quality, current cost-effectiveness research for stroke centers, care networks, and telemedicine is needed to inform treatment decisions and resource utilization.
-
To develop guidelines to monitor high-risk medications and to assess the prevalence of laboratory testing for these medications among a multispecialty group practice. ⋯ Even among drugs for which there is general consensus that laboratory monitoring is important, the prevalence of monitoring is highly variable. Furthermore, infrequently prescribed medications are at higher risk for poor monitoring.
-
To test the hypotheses that African American patients and older patients with stage IV colorectal cancer were less likely to receive newer chemotherapy agents. ⋯ Disparities in chemotherapy selection exist among patients receiving chemotherapy for stage IV colorectal cancer. On initiating chemotherapy, African American patients and older patients were less likely to receive a newer agent.
-
Comparative Study
Healthcare utilization and cost effects of prior authorization for pregabalin in commercial health plans.
To compare changes in medication use and costs over time for management of painful diabetic peripheral neuropathy (pDPN) or postherpetic neuralgia (PHN) among patients in commercial health plans requiring prior authorization (PA) for pregabalin versus patients in plans without pregabalin PA policies. ⋯ A PA policy for pregabalin was associated with lower pregabalin utilization, but there was no statistically significant effect on pDPN- or PHN-specific medication or healthcare expenditures.