Journal of Managed Care Pharmacy : JMCP

No abstract text is available yet for this article.

The Patient Protection and Affordable Care Act has greatly accelerated the formation of team-based models of care delivery, primarily accountable care organizations (ACOs) and patient-centered medical homes (PCMHs).  Many have written about the need to incorporate medication management services into these systems in order to improve care and reduce total health care costs. Two primary ways of doing so have emerged: (1) an embedded model, whereby pharmacists are employed directly by a physician practice, or (2) a "virtual care team" model, whereby a PCMH or ACO develops an arrangement with external pharmacists in community settings to provide coordinated services...

BACKGROUND: The number of patients using methotrexate (MTX) has increased during the last decade. Because of the narrow therapeutic range and potential risks of incorrect use, vigilance is required when dispensing MTX. In 2009, the Royal Dutch Pharmacists Society, in accordance with the Dutch Health Care Inspectorate, published safe MTX dispensing recommendations for community pharmacies. OBJECTIVE: To examine adherence to recommendations aimed at safe 
MTX dispensing...

BACKGROUND: Dual antiplatelet therapy (DAPT) has been found to reduce the risk of cardiac death, myocardial infarction, stroke, and stent thrombosis following acute coronary syndrome and percutaneous coronary intervention. However, this therapy has also been shown to increase the risk of gastrointestinal (GI) bleeding as high as 2-fold, especially in patients with multiple risk factors. Proton pump inhibitor (PPI) therapy decreases this risk. The current consensus document on reducing GI risks associated with antiplatelet agents no longer recommends PPI therapy for all patients receiving aspirin (ASA) and clopidogrel...

BACKGROUND: The third leading cause of cardiovascular-associated death, venous thromboembolism (VTE), represents a significant health care and economic burden. Although the burden of a one-time VTE event has been assessed, there are limited data regarding the burden of VTE recurrence. OBJECTIVE: To assess the rate and predictors of VTE recurrence within 1 year in the United States and evaluate the incremental health care resource utilization and costs associated with such VTE recurrences...

BACKGROUND: The University of Florida College of Pharmacy's Medication Therapy Management Communication and Care Center (UF MTMCCC) provides medication therapy management (MTM) services to patients enrolled in a State of Florida Medicaid Waiver Program: Medicaid for the Aged and Disabled. To provide these services, UF MTMCCC was given access to patients' prescription claims data and diagnostic billing data in the form of ICD-9 codes. Prior to calling a patient, a precomprehensive medication review (CMR) work-up was performed to identify potential medication-related problems (MRPs) and/or health-related problems (HRPs)...

BACKGROUND: Health plans may achieve cost savings by limiting the daily average consumption (DACON) of certain medications and encouraging members and prescribers to select lower cost dosing options. Various strengths of a given medication may be similarly priced per unit; therefore, a single unit of a higher-strength medication may cost less than multiple lower-strength units that provide the same dose. For instance, a single 10 mg tablet may cost less than two 5 mg tablets.  OBJECTIVE: To measure the economic impact of implementing DACON limits for selected medications...

BACKGROUND: Traditional education about hemophilia B in hemophilia treatment centers (HTCs) and episodic contact with HTCs limit the amount of education patients and their caregivers receive. Specialty care providers have frequent, continuing contact with patients. Each contact with a specialty care provider (e.g., coordinating a refill or addressing a patient inquiry) is another opportunity to support patient self-management of the disease and to give counsel on appropriate medication administration...

BACKGROUND: A major employer implemented a change to its employee health benefits program to allow beneficiaries with diabetes or high cholesterol to obtain preselected generic antidiabetic or generic antihyperlipidemic medications with a zero dollar copayment. To receive this benefit, plan beneficiaries were required to participate in a contracted vendor's case management and/or wellness program.  OBJECTIVE: To assess changes in medication adherence and the costs for generic antidiabetic and generic antihyperlipidemic medications resulting from participation in a zero copay (ZCP) program...

BACKGROUND: The International Continence Society (ICS) identifies several urinary incontinence (UI) subtypes: urgency urinary incontinence (UUI), stress UI (SUI), and mixed UI (MUI). UUI is a common symptom of overactive bladder (OAB) syndrome. Based on the current ICS definition of OAB, all patients with UUI have OAB, whereas not all patients with OAB have UUI. Because UUI is a chronic condition that is expected to increase in prevalence as the population of elderly individuals grows, it is important to understand its economic burden on society and patients and its cost components...

BACKGROUND: Oral antihyperglycemic drugs used to treat type 2 diabetes mellitus (T2DM) vary in safety and tolerability. Treatment-related hypoglycemia and weight gain can exacerbate underlying disease.  OBJECTIVE: To evaluate the tolerability of saxagliptin using data from phase III clinical trials.  METHODS: Six 24-week randomized studies in 4,214 patients with T2DM were assessed. Saxagliptin 2.5 mg or 5 mg was compared with placebo in 2 trials of monotherapy in treatment-naïve patients and in 3 trials of add-on therapy to metformin, glyburide, or a thiazolidinedione; initial combination therapy with saxagliptin 5 mg plus metformin was compared with metformin monotherapy in treatment-naïve patients...

BACKGROUND: Medicare Part D prescription drug plans must offer medication therapy management (MTM) services to qualified enrollees. Eligibility criteria used by plan sponsors are restrictive, and fewer than 10% of Part D enrollees receive MTM services. The extent to which plan criteria identify beneficiaries most at risk for suboptimal medication use is unknown. OBJECTIVES: To (a) evaluate potential underuse of and poor adherence to evidence-based medications used in the treatment of Medicare beneficiaries with diabetes, heart failure, and chronic obstructive pulmonary disease (COPD) over 3 years; (b) determine whether MTM eligibility criteria used by the modal Part D plan in 2011 (drug spending ≥ $3,000, ≥ 3 chronic conditions, ≥ 8 Part D medications) identified Part D enrollees at greatest risk for underuse of and poor adherence to these drugs; and (c) demonstrate how sensitive MTM eligibility is to variations in criteria levels...

BACKGROUND: Although many advances in the management of hypertension have been made, success in hypertension control in real-life practice is limited. Control of hypertension is paramount in primary as well as secondary prevention of cardiovascular disease. Poor adherence to antihypertensive medication is one possible reason why success in clinical trials has not been translated into everyday practice. Despite many years of study, questions remain about why patients do or do not take medicines and what can be done to change their behavior...

BACKGROUND: Anaphylaxis is a serious allergic reaction, often caused by food allergies, insect venom, medications, latex, or exercise. The condition is rapid in onset and may cause death. Because of the potential risk of death, it is critical to recognize anaphylaxis quickly and be prepared to treat it appropriately. OBJECTIVES: To review the current trends and challenges related to anaphylaxis management, treatment, and prevention and explore strategies for how to improve access and awareness for patients who are at high risk for anaphylaxis...

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BACKGROUND: Antiretroviral therapy (ART) extends life for patients with human immunodeficiency virus (HIV) infection. However, HIV treatment is lifelong, and adherence presents a special challenge. Suboptimal adherence to ART may lead to disease progression and virologic failure. Earlier studies with combination ART demonstrated that as much as 90%-95% adherence was needed to prevent disease progression. OBJECTIVE: To measure adherence to ART regimens in commercially insured patients with HIV infection and analyze the clinical and demographic factors associated with ≥ 90% adherence...

BACKGROUND: Antidepressant monotherapy is effective in achieving treatment remission in only approximately one third of patients with depression, and even switching to a second antidepressant brings the cumulative remission rate to only 50%-55%. This has led to an interest in augmentation therapy for the management of treatment-resistant depression. OBJECTIVES: To assess (a) selective serotonin reuptake inhibitor/selective norepinephrine reuptake inhibitor (SSRI/SNRI) adherence when augmented with second-generation atypical antipsychotics (SGAs) or L-methylfolate using a modified application of the Healthcare Effectiveness Data and Information Set (HEDIS) acute medication management (AMM) measures at the time of augmentation, and (b) the depression-specific and total health care cost, comparing the 2 forms of augmentation therapy in the treatment of depressive disorder...

BACKGROUND: Adherence to statins in real-world practice settings is known to be suboptimal. However, less is known about how adherence changes over time and whether changes in adherence are associated with adverse cardiovascular (CV) outcomes. OBJECTIVES: To (a) characterize yearly changes in adherence among initially adherent patients taking statins for primary prevention and (b) assess the association between changes in statin adherence with subsequent risk of CV events...

BACKGROUND: Statins remain a fundamental component of pharmacologic therapy for hyperlipidemia. Health benefits of statin therapy are jeopardized when adherence is reduced. OBJECTIVES: To (a) assess the association between copayment and copayment type on statin adherence using 2 different thresholds of adherence and (b) identify the incremental change in statin adherence associated with presence of copayment and copayment type. METHODS: We executed a retrospective cohort study of new users of statins with dyslipidemia from the Veterans Health Administration (VHA) within the Veterans Integrated Service Network 22 who initiated a statin between November 30, 2006, and December 2, 2007...

BACKGROUND: Statins are efficacious in reducing the risk of major cardiovascular events for both primary and secondary prevention, yet long-term adherence is poor. Their effectiveness could be compromised in actual practice when patients are not adherent to the treatments. Higher copayments have been shown to be associated with lower adherence to statins. OBJECTIVE: To assess the effect on patient adherence of moving branded atorvastatin and rosuvastatin from the second to the first tier by a Medicare Part D plan sponsor...