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At least 1,171 records · Page 65Linked to original sources
PubMed2005

Evolving shifts in otitis media pathogens: relevance to a managed care organization.

The microbiological landscape of acute otitis media (AOM) has been relatively constant over the past half century. Because of this stability, empiric management of AOM was a common and efficient practice. Recently, there has been a proportional shift in the microbiology of AOM, bringing the choices for empiric therapy into question. Because of this shift, managed care organizations should review their formularies to ensure that they are structured to include and promote the use of appropriate antibiotics. This article explores the background and events leading up to the shift in AOM microbiology; discusses the clinical consequences and the future implications of the shift, such as increased costs associated with treatment failures, its impact on new vaccines and new-onset AOM and related disease states, such as sinusitis; and describes why these factors should be considered by managed care decision makers in their formulary deliberations.

Acute Disease↗
PubMed2005

Medicare prescription drug coverage: preparing for January 1, 2006.

After many years of effort by health advocates, Congress passed the Medicare Prescription Drug, Improvement, and Modernization Act of 2003 (called the MMA) in December 2003. The law updates the benefits provided to Medicare beneficiaries by adding coverage for prescription drugs beginning January 1, 2006. Prescription drugs play a central role in modern health care, and extending drug coverage to Medicare beneficiaries is an important goal. The way in which Congress tackled this problem, however, has been highly contentious. This article will describe the law as it was passed, the issues that remain to be resolved, and what ia all means for people with HIV/AIDS.

Fees and Charges↗
PubMed2005

Prescription drug formulary design, preferred-product marketshare, and formulary noncompliance: a study of proton-pump inhibitors.

The intent of a prescription drug formulary is to shift utilization toward preferred products, but health plans must balance the benefit of these products' lower price with the cost of potential formulary noncompliance. Using proton-pump inhibitors as a model, the authors studied the influence of formulary restrictiveness and drug preference status on formulary noncompliance and marketshare. They found that although drug formulary restrictiveness increases the use of preferred products, it also leads to a high level of formulary noncompliance. The net financial effect on drug spending is ambiguous.

Drug Costs↗
PubMedDate not supplied

Understanding developments in non-medical prescribing.

As part of the government's NHS modernisation programme much attention has been given to patient safety, improving patient access to NHS prescription medicines and making better use of nurses' professional skills. This article aims to describe the current prescribing options for nurses and provides an indication of the likely situations in which nurses (and others) could prescribe.

Credentialing↗
PubMed2005

Evaluating the nondrug costs of formulary coverage restrictions.

PURPOSE: Clinicians often are required to switch prescribed therapy for their patients in response to health plan initiatives for controlling drug expenditures. To explore the effect of these initiatives, we sought clinicians' feedback regarding their practices and processes for switching patients' medications to accommodate insurance coverage. DESIGN: Self-administered Intranet-based survey of clinicians at an urban, tertiary-care hospital. METHODOLOGY: Using survey responses, we calculate nondrug costs induced by formulary cost-saving measures. PRINCIPAL FINDINGS: A total of 91 responses were received from 569 providers who were sent a request to complete the questionnaire via electronic mail (18 percent response rate). It took an average of 11.1, 18.9, and 16.4 minutes for physicians, nurses, and nurse practitioners/physician assistants, respectively, to make the medication switch. The mean number of switches per month ranged from 10.6 to 36.9. More than half the time spent on these switches is not directly reimbursed. Specific switch-induced intervention costs differed for different drug types. The effect on clinician workload tended to be an inconvenience. While the majority of physicians and nurse practitioners/physician assistants did not feel this process damaged patient-provider relations, most nurses did. CONCLUSIONS: In response to formulary restrictions, other costs are induced and incurred by providers and patients. The extent of patient costs, including those from adverse drug reactions, needs further study. More research is needed to elucidate costs and burden shifts as all parties involved evaluate and modify plans to moderate prescription drug expenditures.

Cost Control↗
PubMed2005

Medicare HIV Fact Sheet: Caution re January 2006.

About 20 percent of people in HIV care are on Medicare, and will need to decide on a Medicare drug plan by January 2006. It will be especially important for those who are also on Medicaid to avoid interruption of treatment in early 2006, when Medicaid will no longer cover their drugs and people might not be signed up for the Medicare drug benefit in time. A revised two-page fact sheet from the Kaiser Family Foundation provides a brief overview of the Medicare program--helpful background for understanding the additional information needed for selecting a plan.

Eligibility Determination↗
PubMed2005

PBS medications--improving access for Aboriginal and Torres Strait Islander peoples.

BACKGROUND: Expenditure through major commonwealth funded health programs such as the Pharmaceutical Benefits Scheme (PBS) is much lower for Aboriginal and Torres Strait Islander peoples than other Australians. Section 100 of the National Health Act (1953) allows for special access arrangements where pharmaceutical benefits cannot be conveniently supplied. OBJECTIVE: This article discusses the barriers to accessing PBS medications for Aboriginal and Torres Strait Islander peoples and the S100 access scheme. DISCUSSION: The implementation of S100 medications for remote area Aboriginal health services (AHSs) represents a breakthrough in medicines access, and is one of the most significant improvements in health service delivery for many years. If we are to achieve equity in access to the PBS for all Aboriginal and Torres Strait Islander peoples, an extension of this initiative is necessary for rural and urban AHSs.

Australia↗
PubMed2005

Impact of 3-tier pharmacy benefit design and increased consumer cost-sharing on drug utilization.

OBJECTIVE: To estimate responsiveness of prescription demand within 9 therapeutic classes to increased cost-sharing compared with constant cost-sharing. STUDY DESIGN: Retrospective prescription claims analysis. METHODS: Between 1999 and 2001, 3 benefit plans changed from a 2-tier to a 3-tier design (cases); 1 plan kept a 2-tier design (controls). Study subjects needed 24 months of continuous coverage and a prescription filled < OR = 3 months before the benefit change for a nonsteroidal anti-inflammatory agent (NSAID), a cyclooxygenase (COX-2) inhibitor, a selective serotonin reuptake inhibitor (SSRI), a tricyclic antidepressant (TCA), an angiotensin-converting enzyme (ACE) inhibitor, a calcium-channel blocker (CCB), an angiotensin-receptor blocker (ARB), a statin, or a triptan. Changes in use were compared with the Wilcoxon signed rank test. Elasticity of demand among cases was calculated. RESULTS: Generally, medication possession ratios decreased for cases and increased for controls between 1999 and 2000. Switch rates increased for cases and decreased for controls for all classes but CCBs. Switches to lower copayments for ACE inhibitors, statins, and triptans occurred more often for cases. Discontinuation-rate changes for cases were 2 to 8 times those for controls. Generic-substitution rates depended on availability and initial generic utilization. Elasticity of demand for drugs was generally low, -0.16 to -0.10, for asymptomatic conditions (ACE inhibitors, ARBs, CCBs, statins), and moderate, -0.60 to -0.24, for symptomatic conditions (COX-2 inhibitors, NSAIDs, triptans, SSRIs). CONCLUSION: Use of retail prescription medications within 9 specific therapeutic classes decreased as copayment increased. Demand for pharmaceuticals was relatively inelastic with these copayment increases.

Cost Sharing↗
PubMed2005

Implications of an SSRI generic step therapy pharmacy benefit design: an economic model in anxiety disorders.

As the antidepressant market continues to expand, it is important for healthcare decision makers to develop clinically and economically sound drug benefit designs. As such, the purpose of this study was to determine the economic implications of a generic step therapy (GST) formulary compared with an open formulary for selective serotonin reuptake inhibitors (SSRIs) in patients with anxiety disorders. A model simulating the SSRI treatment patterns of patients diagnosed with an anxiety disorder in a hypothetical health plan with 1 million members was developed. Treatment options were generic SSRI agents (ie, fluoxetine, paroxetine immediate release, and citalopram) and branded SSRI agents (ie, sertraline, paroxetine controlled release, and escitalopram). After treatment initiation, patients could achieve 180 days or more of continuous therapy with no evidence of therapy change, achieve less than 180 days of therapy with no evidence of therapy change, or have a change in therapy. Consequently, patients incurred differential average annual medical and prescription costs. Model probabilities and costs were estimated from published literature and database analyses. The GST formulary resulted in a greater frequency of therapy change than the open formulary (41.3% vs 36.8%) and a lower frequency of continuous therapy for at least 6 months (25.3% vs 29.8%). Costs of SSRI medication were lower for the GST formulary than for the open formulary (11.6 million US dollars vs 14.8 million US dollars ). Medical costs were considerably greater for the GST formulary than for the open formulary, however (178.7 US dollars million vs 174.9 million US dollars, respectively), with a total cost of 190.3 US dollars million for the GST formulary versus 189.6 US dollars million for the open formulary. The incremental cost of implementing a GST formulary over 1 year was 684 360 US dollars , or 0.06 US dollars per member per month. A sensitivity analysis indicated that the model was most sensitive to changes in the cost of SSRI drug therapy and the average annual medical costs for patients with evidence of therapy change. The results of this model indicate that implementing a GST formulary for SSRIs in patients with anxiety disorders may be associated with an increased amount of therapy change and early treatment discontinuation, resulting in an overall cost increase to a health plan.

Anxiety Disorders↗