Impact of a Comprehensive COPD Therapeutic Interchange Program on 30-Day Readmission Rates in Hospitalized Patients

Size: px
Start display at page:

Download "Impact of a Comprehensive COPD Therapeutic Interchange Program on 30-Day Readmission Rates in Hospitalized Patients"

Transcription

1 Impact of a Comprehensive COPD Therapeutic Interchange Program on 30-Day Readmission Rates in Hospitalized Patients Maren A. McGurran, PharmD, BCPS; Lisa M. Richter, PharmD, BCPS, BCCCP; Nathan D. Leedahl, PharmD, BCPS; and David D. Leedahl, PharmD, BCPS-AQ ID, BCCCP ABSTRACT Purpose: Chronic obstructive pulmonary disease (COPD) is the third leading cause of death in the United States. The economic effect of COPD management is substantial, and the prevalence of the disease continues to rise with the growth of older populations. The purpose of this study was to evaluate the clinical and financial impact of a comprehensive therapeutic interchange program (CTIP) in hospitalized patients with COPD. The primary outcome was a 30-day readmission rate, with the following secondary outcomes: 30-day mortality and pharmacy-inhaled medication cost per patient. Methods: This study was a multi-center, retrospective, electronic chart review of patients with a diagnosis of COPD admitted to two hospitals from July, 206 to June 30, 207. Our intervention group was admitted to a 550-bed tertiary care hospital and was managed with a pharmacist-led CTIP for inhaled products used in COPD. Our control group was admitted to a 545-bed tertiary care hospital, which did not have a CTIP in place. Results: 2,885 hospitalized patients with a diagnosis of COPD were included in the analysis (,350 in the intervention group and,535 in the control group). Univariable analysis demonstrated that the intervention group was associated with a lower 30-day readmission rate (5.8% vs. 8.3%; P = 0.02) and a lower average pharmacy-inhaled medication cost ($22 vs. $3; P = < 0.0). There was no statistical difference in 30-day mortality. Conclusion: This study demonstrates that the use of a pharmacist-led CTIP of COPD inhalers does not worsen patient outcomes and may provide pharmacy cost savings. The cohort managed with a CTIP was statistically associated with a lower 30-day readmission rate and lower pharmacy-inhaled medication costs without any difference in 30-day mortality. Keywords: chronic obstructive pulmonary disease, COPD, formulary, interchange BACKGROUND Chronic obstructive pulmonary disease (COPD) is the third Dr. McGurran is a PGY2 pharmacy resident at Parkland Health & Hospital System in Dallas, Texas. Dr. N. Leedahl is the Lead Pharmacist for Sanford Health Enterprise Pharmacy in Fargo, North Dakota. Dr. D. Leedahl is a Clinical Pharmacy Manager for Sanford Medical Center in Fargo, North Dakota and a Clinical Investigator with Sanford Research in Sioux Falls, South Dakota. Dr. Richter is the Director of Experiential Outreach and Assessment and Assistant Professor of Practice at North Dakota State University in Fargo. leading cause of death in the United States, and nearly 6.4% of Americans reported that they have been diagnosed with the disease. -2 This number is likely an underestimate as a result of the more than 50% of adults with low pulmonary function who reported that they were not aware that they had COPD. 3 The prevalence of COPD is expected to increase over the next 30 years because of the aging population. 4 The direct economic costs attributable to COPD and asthma have been estimated at $53.7 billion, with the cost for prescription medicines at $20.4 billion and hospital inpatient stays at $3. billion. 5 Pharmacological therapy for COPD is used to reduce symptoms, reduce the frequency and severity of exacerbations, and improve exercise tolerance and health status. 6 According to the Global Initiative for Chronic Obstructive Lung Disease 207 report, bronchodilators, anticholinergics, inhaled corticosteroids, and combination products are the mainstays for inhaled COPD pharmacological treatment. 6 The choice within each class depends largely on multiple patient-specific factors, including availability, cost, delivery mechanism, clinical response, and side effects. 6 There are over 20 inhaled medications approved by the Food and Drug Administration (FDA) that can be used for the pharmacological management of COPD. Because of the many different inhaler options, patients who are admitted to the hospital with a COPD diagnosis are maintained on various pharmacologic regimens to manage their disease outside the hospital. This creates a problem for inpatient pharmacies in maintaining a cost-effective inventory and for respiratory therapists or nurses in administering treatment with the appropriate technique. Therapeutic interchange is defined by the American Society of Health-System Pharmacists as an authorized exchange of therapeutic alternatives in accordance with previously established and approved written guidelines or protocols within a formulary system. 7 Interchanges can be used as a method of pharmaceutical cost management and are a way to standardize hospital therapy. They also offer one proposed way for managing the variety of different COPD inhalers that patients may present with on their home medication list. What is unknown is how therapeutic interchange programs for COPD medications produce clinical effectiveness while also taking into account pharmacy costs. The aim of this study was to evaluate the clinical and financial impact of a CTIP in hospitalized patients with COPD. Disclosure: The authors report no commercial or financial interests in regard to this article. Vol. 44 No. 4 April 209 P&T 85

2 METHODS Study Design The study groups consisted of two hospital systems within the same health care enterprise system. Our intervention group was admitted to a 550-bed tertiary hospital and managed with a pharmacist-led CTIP for inhaled products used in COPD, and our control group was admitted to a 545-bed tertiary care hospital, which did not have a CTIP in place. Our intervention group utilizes a pharmacist-led CTIP, approved by the local pharmacy and therapeutics (P&T) committee, for all known inhaled products used for COPD management during the study period (Table ). These products will be interchanged at time of verification for one of the nine approved respiratory products. Our control group did not have CTIP for any inpatient medications. The study was approved by the institutional review board with a waiver of informed consent and HIPAA authorization, and was performed in accordance with the ethical standards of the 964 Declaration of Helsinki and its later amendments. Table CTIP Inhaled Medications Generic Brand Manufacturer Dosing Therapeutic Substitution Generic, brand name, manufacturer, dosing LAMA/LABA Combination Inhalers Tiotropium bromide/ Stiolto Respimat Boehringer Ingelheim 2 inhalations once daily olodaterol Umeclidinium/vilanterol, Anoro Ellipta, Glycopyrrolate/ Bevespi Aerosphere AstraZeneca 2 inhalations once daily 62.5/25 mcg: formoterol fumarate Indacaterol/glycopyrrolate Utibron Neohaler Sunovion ICS/LABA Combination Inhalers Fluticasone propionate/ salmeterol Advair HFA, Advair Diskus, Advair Airduo GlaxoSmithKline 45/2 mcg: 55/4 mcg: 00/50 mcg: 5/2 mcg: 3/4 mcg: 250/50 mcg: Budesonide/formoterol Symbicort AstraZeneca 80/4.5 mcg: Mometasone/formoterol Dulera Merck 00/5 mcg: Fluticasone propionate/ salmeterol Advair HFA, Advair Diskus, Advair Airduo GlaxoSmithKline 230/2 mcg: 232/4 mcg: 500/50 mcg: Budesonide/formoterol Symbicort AstraZeneca 60/4.5 mcg: Mometasone/formoterol Dulera Merck 200/5 mcg: LAMA Inhalers Fluticasone furoate/ vilanterol, Breo Ellipta, 00/25 mcg: Fluticasone furoate/ vilanterol, Breo Ellipta, 200/25 mcg: Tiotropium Spiriva Respimat Boehringer Ingelheim 2.5 mcg: 2 inhalations once daily Umeclidinium, Tiotropium Spiriva Handihaler Boehringer Ingelheim 8 mcg: Aclidinium Tudorza Pressair AstraZeneca 400 mcg: Glycopyrrolate Seebri Neohaler Sunovion 5.6 mcg: Incruse Ellipta, 62.5 mcg: 86 P&T April 209 Vol. 44 No. 4

3 Table CTIP Inhaled Medications (continued) Generic Brand Manufacturer Dosing Therapeutic Substitution Generic, brand name, manufacturer, dosing LABA Inhalers Salmeterol Serevent Diskus GlaxoSmithKline 50 mcg Formoterol nebulization, Mylan, 20 mcg, same frequency as Serevent Diskus Arformoterol Brovana Sunovion 5 mcg Formoterol nebulization, Mylan, 20 mcg, same frequency as Brovana Indacaterol Arcapta Neohaler Sunovion 75 mcg: Olodaterol Striverdi Respimat Boehringer Ingelheim 2.5 mcg: 2 inhalations once daily SABA Inhalers Albuterol ProAir HFA Proventil HFA Ventolin HFA Teva Merck GlaxoSmithKline 90 mcg: 2 inhalations every 4 6 hours Levalbuterol Xopenex HFA Sunovion 45 mcg: 2 inhalations every 4 6 hours as needed ICS Inhalers Formoterol nebulization, Mylan, 20 mcg: nebulization b.i.d. Formoterol nebulization, Mylan, 20 mcg: nebulization b.i.d. Albuterol nebulization, Nephron, 2.5 mg/3 ml, same frequency as albuterol inhaler Levalbuterol nebulization, Teva,.25 mg, same frequency as Xopenex Beclomethasone QVAR Redihaler Teva mcg/day Budesonide nebulization, Nephron, mcg/day Budesonide nebulization, Nephron, > 48 mcg/day Budesonide nebulization, Nephron, Budesonide Pulmicort AstraZeneca mcg/day Budesonide nebulization, Nephron, 60,200 mcg/day Budesonide nebulization, Nephron, >,20 mcg/day Budesonide nebulization, Nephron, Ciclesonide Alvesco Colvis 60 mcg/day Budesonide nebulization, Nephron, 320 mcg/day Budesonide nebulization, Nephron, 640 mcg/day Budesonide nebulization, Nephron, Fluticasone Flovent GlaxoSmithKline mcg/day Budesonide nebulization, Nephron, mcg/day Budesonide nebulization, Nephron, > 66 mcg/day Budesonide nebulization, Nephron, Mometasone Asmanex Merck 200 mcg/day Budesonide nebulization, Nephron, mcg/day Budesonide nebulization, Nephron, > 440 mcg/day Budesonide nebulization, Nephron, Abbreviations: b.i.d.: twice daily; mcg: microgram; mg: milligram; ICS: inhaled corticosteroid; LABA: long-acting beta agonist; LAMA: long-acting muscarinic antagonist; SABA: short-acting beta agonist; SAMA: short-acting muscarinic antagonist table continues Vol. 44 No. 4 April 209 P&T 87

4 Table CTIP Inhaled Medications (continued) Generic Brand Manufacturer Dosing Therapeutic Substitution Generic, brand name, manufacturer, dosing SABA/SAMA Combination Inhalers Albuterol/ipratropium Combivent Respimat Boehringer Ingelheim 2.5/0.5 mg: inhalation four times daily SAMA Inhalers Ipratropium Atrovent HFA Boehringer Ingelheim 7 mcg: 2 inhalations four times daily Study Population Electronic medical records were identified with the presence of COPD on diagnosis at time of discharge, as determined by International Classification of Diseases, 0 th Revision (ICD- 0) code starting with J44: J44.0 (COPD, with acute lower respiratory infection), J44. (COPD with acute exacerbation), or J44.9 (COPD, unspecified). COPD did not have to be the primary reason for admission. The intervention group had,350 patients and the control group had,535 patients included in the analysis. Patients under the age of 8 were excluded from analysis. Only the index hospitalization was included in the analysis, and subsequent readmissions were not included. Data Collection In addition to 30-day mortality, readmission rates, and pharmacy inhaler and nebulized-product costs, the following information was collected for each patient: length of stay, age, sex, payer, comorbidities, and case-mix index (CMI). The severity of illness was determined by the CMI. The charge report for the patient population included only inhalers and/ or unit-dosed nebulized products that were administered. All pharmacy costs for inhalers and unit-dose nebulized products were determined by the average wholesale price (AWP) in June 208. Only patients with pharmacy charges for inhalers and unit-dose nebulized products were included in the cost analysis. Baseline characteristics related to comorbidities were determined by ICD-0 codes associated with those conditions. OUTCOMES We performed a retrospective, cohort analysis from July, 206 through June 30, 207. The primary outcome was 30-day readmission rate. The secondary outcomes were 30-day mortality rates and pharmacy cost for inhaled products. Statistical Analysis Pearson s Chi-squared tests were used for categorical variables. T-tests and Wilcoxon rank-sum tests were used for statistical analysis of parametric and non-parametric continuous variables, respectively. Data are percentages with the mean ± standard deviation (SD). Data were assessed by univariable analysis, with a P-value of 0.05 being considered as statistically significant. Data were analyzed with JMP software, version (Cary, North Carolina). Albuterol/ipratropium nebulization, Nephron, 3/0.5 mg, same frequency as Combivent Respimat Ipratropium nebulization, Nephron, 500 mcg, same frequency as Atrovent HFA Abbreviations: b.i.d.: twice daily; mcg: microgram; mg: milligram; ICS: inhaled corticosteroid; LABA: long-acting beta agonist; LAMA: long-acting muscarinic antagonist; SABA: short-acting beta agonist; SAMA: short-acting muscarinic antagonist RESULTS We reviewed 2,885 patients index hospitalization with the presence of COPD diagnosis at time of discharge (,350 in the intervention group and,535 in the control group). The acuity of these two hospital systems, as determined by fiscal year 7 average CMI, was 2 and.58 for our intervention and control groups, respectively. Baseline characteristics between the groups were similar; however, the intervention group had a statistically higher rate of asthma, depression, and hypertension, and a higher severity of illness, as illustrated by CMI (2.3 vs..6; P = < 0.0). Overall, Medicare was the primary payer for both groups, but there were statistically significant differences in the primary payer between the two groups. The intervention group had a statistically significant, greater number of patients on Medicare (79% vs. 75.%; P = 0.0) and Medicaid (8.5% vs. 5.9%; P = < 0.0), but the control group had a statistically significant, greater number of patients with private insurance (4.7% vs. 9.2%; P = < 0.0) and self-paid patients (.3% vs. 0.4%; P = 0.0). A full summary of baseline characteristics can be found in Table 2. Univariable analysis demonstrated that the patients in the intervention group, who utilized a CTIP, had a statistically significant, lower 30-day readmission rate (5.8% vs. 8.3%; P = 0.02). The difference in 30-day mortality was not statistically significant (Table 3). In the intervention group and the control group,,006 (75%) patients and,94 (78%) patients, respectively, received at least one inhaler and/or unit-dose nebulized products. The intervention group was statistically associated with a lower average pharmacy-inhaler cost per patient ($22 vs. $3; P = < 0.0). However, the intervention group was associated with a statistically significant, longer length of stay (6.2 days vs. 4.6 days; P = < 0.0). A full summary of clinical outcomes and pharmacy-inhaler and nebulizedproduct costs per patient can be found in Tables 3 and 4, respectively. DISCUSSION Therapeutic interchanges are implemented as a method for pharmaceutical cost management and a way to standardize therapy. There are no studies comparing patient outcomes and pharmacy costs in a facility with a CTIP for COPD inhalers with a facility that does not utilize formulary interchanges. We noted a decreased rate of 30-day readmissions and 88 P&T April 209 Vol. 44 No. 4

5 Table 2 Characteristics of Patients Discharged With the Presence of COPD Diagnosis Table 3 Association of Formulary Substitution With Clinical Outcomes Intervention (n =,350) Control (n =,535) P value 30-day readmission rates (%) day mortality (%) Hospital length of stay (days ± SD) 6.2 ± ± 4.5 < 0.0 SD: standard deviation Table 4 Pharmacy Inhaler and Nebulized Products Cost Pharmacy cost for inhalers and unitdose nebulized products per patient ($ ± SD) SD: standard deviation; $: U.S. dollar Intervention (n =,350) Intervention (n =,006) Control (n =,535) Control (n =,94) P value 22 ± ± 352 < 0.0 decreased pharmacy-inhaled medication costs per patient in the intervention group. The control group had a decreased length of hospital stay, and no statistically significant difference in 30-day mortality was noted between the groups. Patients admitted in the two groups exhibited similar characteristics, with the exception that more patients had asthma, depression, hypertension, and a higher severity of illness in the intervention group. This is consistent with our intervention hospital system s P value Male, n (%) 708 (52) 824 (54) Female, n (%) 642 (48) 7 (46) 0.52 Age (years ± SD) 7 ±.2 70 ± Case-mix index (score ± SD) 2.3 ± ± 0.43 < 0.0 Comorbid conditions Asthma (%) CKD (%) Depression (%) < 0.0 Diabetes Mellitus (%) Heart Failure (%) Hypertension (%) < 0.0 Ischemic Heart Disease (%) Insurance type Medicaid (%) < 0.0 Medicare (%) Private (%) < 0.0 Self (%) Veterans affairs (%) CKD: chronic kidney disease; COPD: chronic obstructive pulmonary disease; SD: standard deviation higher acuity during our study period. Although there was a lower 30-day readmission rate in our intervention group, this may have been influenced by the longer length of stay. While we cannot exclude the possibility that the CTIP was responsible for the increased length of stay, there may have been other factors that affected the length of stay, such as the higher severity of illness found in our intervention group, issues with placement post-discharge, or other unmeasured confounding variables. There are conflicting financial studies looking at the use of multidose inhalers (MDI) compared with nebulizers. One study found that pharmacy inhaler charges were lower when using MDI versus handheld nebulizers. 8 Another study found that there were savings in switching to nebulizer treatments from MDI. 9 Neither of these studies evaluated patient outcomes. A study assessing the interchange of a combination of long-acting beta agonist (LABA)/long-acting muscarinic antagonist (LAMA) product for patients with COPD over a daily anticholinergic inhaler plus a twice-daily LABA, found that the interchange was not statistically associated with an increased 30-day readmission rate, but was associated with a lower cost of care. 0 In addition to pharmacy costs, other aspects of health care are affected by formulary substitutions. In the intervention group, three primary inhalers were utilized (Figure ) versus a more robust spread of inhalers in the control group (Figure 2). The three primary inhalers utilized in the intervention group were all once-daily inhalers. For the control group, two of the three most frequently dispensed inhalers are FDA-approved for twice-daily dosing. Using once-daily medications leads to fewer administrations needing to be delivered, and could save time. Moreover, doing so allows respiratory therapists or nurses to focus on the administration of these inhalers, instead of having to rotate through different inhaler types and administration techniques. A CTIP also could aid in inventory control. Being able to primarily use three inhalers allows for the acquisition of a smaller variety of inhalers, and avoids having to obtain inhalers from outside sources and having to label and identify the patient s own inhalers for use inside the hospital. The intervention group was associated with statistically fewer pharmacy costs for inhalers and unit-dose nebulized products. Another cost-saving measure, which was unaccounted for in this Vol. 44 No. 4 April 209 P&T 89

6 Figure Intervention Group: Inhaler Distribution Umeclidinium and Vilanterol Fluticasone and Vilanterol Umeclidinium Tiotropium (Spiriva Handihaler) Albuterol (Ventolin HFA) Albuterol (Proair HFA) Fluticasone and Salmeterol (Advair Diskus) Budesonide and Formoterol Fluticasone (Flovent Diskus) Ipratropium and Albuterol Mometasone and Formoterol Number Used Brand name included for products with multiple formulations used HFA: hydrofluoroalkanes Figure 2 Control Group: Inhaler Distribution Tiotropium (Spiriva Handihaler) Budesonide and Formoterol Fluticasone and Salmeterol (Advair Diskus) Albuterol (Proair HFA) Umeclidinium Umeclidinium and Vilanterol Albuterol (Ventolin HFA) Fluticasone and Vilanterol Tiotropium (Spiriva Respimat) Fluticasone (Flovent Diskus) Mometasone Mometasone and Formoterol Ipratropium and Albuterol Fluticasone and Salmeterol (Advair HFA) Beclomethasone Salmeterol Budesonide Levalbuterol Tiotropium and Olodaterol Ipratropium Albuterol (Proventil HFA) Fluticasone (Arnuity Ellipta) Formoterol Aclidinium Number Used Brand name included for products with multiple formulations used HFA: hydrofluoroalkanes P&T April 209 Vol. 44 No. 4

7 study and could come about through formulary substitution, is pharmacy reimbursements through rebates. This could lead to greater pharmacy department cost savings in some cases. The results of this study may have some applicability to the therapeutic and financial effect of a CTIP on asthma patients. There is overlap with the inhaled and unit-dose medications. However, only 8.5% of our patient population had asthma, and additional research would need to be carried out to evaluate these effects. Furthermore, this study has internal validity, as demonstrated by the fact that the CTIP implemented by our intervention group did not harm patients and was associated with pharmacy cost savings. However, we cannot directly apply these findings to a CTIP that uses different inhaler interchanges. There are several limitations to our study, which was conducted at a single health care system and was retrospective in nature. We relied on the use of ICD-0 codes for the diagnosis of COPD, as opposed to clinical diagnosis. An additional limitation is that patients discharge medication lists were not evaluated to see if patients were returned to their home inhaler. Although this limitation exists, the CTIP process at this health care system was to link the home and formulary-substituted products upon discharge. This provided transparency to the prescriber regarding what medication the patient was taking at home. Moreover, a previous study that looked at an automatic therapeutic substitution (ATS) at an academic center found that only 5% of patients were discharged on the ATS medication. Lastly, pharmacy costs were calculated from the AWP in June 208. We cannot exclude the possibility that varying charges for the same product existed at certain points in time during our study. Also, these pharmacy costs do not include potential rebates and group purchasing rates. CONCLUSION This study demonstrates that the use of a CTIP of COPD inhalers through an approved therapeutic interchange policy does not worsen patient outcomes and may provide pharmacy cost savings. The automatic therapeutic formulary substitution was statistically associated with a decreased 30-day readmission rate (5.8% vs. 8.3%; P = 0.02) and decreased pharmacy costs for inhalers and unit-dose nebulized products ($22 vs. $3; P = < 0.0), but also with an increased length of hospital stay (6.2 days vs. 4.6 days; P = < 0.0). Randomized prospective trials are needed to validate whether a CTIP of COPD inhalers is safe and cost-effective. REFERENCES. National Center for Health Statistics. Health, United States, 205 with special feature on racial and ethnic health disparities. Department of Health and Human Services, Centers for Disease Control and Prevention, National Center for Health Statistics. June 22, 207. Available at: pdf. Accessed February 9, Wheaton AG, Cunningham, TJ, Ford ES, Croft JB. Employment and activity limitations among adults with chronic obstructive pulmonary disease United States, 203. Morbidity and Mortality Weekly Report (MMWR), 205;64(): Available at: htm. 3. Mannino DM, Gagnon RC, Petty TL, Lydick E. Obstructive lung disease and low lung function in adults in the United States: data from the National Health and Nutrition Examination Survey Arch Intern Med 2000;60(): World Health Organization. Projections of mortality and causes of death, 205 and Available at: healthinfo/global_burden_disease/projections205_2030/en/. Accessed February 9, National Institutes of Health, National Heart, Lung, and Blood Institute. Morbidity & mortality: 202 chartbook on cardiovascular, lung, and blood diseases. February 202. Available at: Accessed February 9, Global initiative for chronic obstructive lung disease (GOLD). Pocket guide to COPD diagnosis, management, and prevention: a guide for health care professionals Available at: goldcopd.org/wp-content/uploads/206/2/wms-gold-207- Pocket-Guide.pdf. Accessed February 9, Coalition Working Group. Principles of a sound drug formulary system. In: Hawkins BH, ed. Best practices for hospital & healthsystem pharmacy, ed. Bethesda, Maryland: American Society of Health-System Pharmacists;2009: Niggemann B. Substitution of metered-dose inhalers for hand-held nebulizers. Chest 993;03(): Loborec SM, Johnson SE, Keating EA. Financial effect of converting ipratropium-albuterol therapy from inhalers to nebulizer treatments at an academic health system. Am J Health Syst Pharm 206;73(3):2 25. doi: 0.246/ajhp Chapin TW, Mann MA, Brown GL, et al. Effectiveness of umeclidinium-vilanterol for protocolized management of chronic obstructive pulmonary disease exacerbation in hospitalized patients: a sequential period analysis. Chronic Obstr Pulm Dis 208;5(): doi: /jcopdf Glaholt S, Hayes GL, Wisniewski CS. Evaluation of discharge medication orders following automatic therapeutic substitution of commonly exchanged drug classes. P T 204;39(4): Available at: Accessed February 9, 209. n Vol. 44 No. 4 April 209 P&T 9

TRELEGY ELLIPTA (fluticasone-umeclidinium-vilanterol) aerosol powder

TRELEGY ELLIPTA (fluticasone-umeclidinium-vilanterol) aerosol powder TRELEGY ELLIPTA (fluticasone-umeclidinium-vilanterol) aerosol powder Coverage for services, procedures, medical devices and drugs are dependent upon benefit eligibility as outlined in the member's specific

More information

Select Inhaled Respiratory Agents

Select Inhaled Respiratory Agents Applies to all products administered or underwritten by Blue Cross and Blue Shield of Louisiana and its subsidiary, HMO Louisiana, Inc.(collectively referred to as the Company ), unless otherwise provided

More information

Up in FLAMES: Stable Chronic Obstructive Pulmonary Disease (COPD) Management. Colleen Sakon, PharmD BCPS September 27, 2018

Up in FLAMES: Stable Chronic Obstructive Pulmonary Disease (COPD) Management. Colleen Sakon, PharmD BCPS September 27, 2018 Up in FLAMES: Stable Chronic Obstructive Pulmonary Disease (COPD) Management Colleen Sakon, PharmD BCPS September 27, 2018 Disclosures I have no actual or potential conflicts of interest 2 Objectives Summarize

More information

A Visual Approach to Simplifying Respiratory Drug Regimens

A Visual Approach to Simplifying Respiratory Drug Regimens A Visual Approach to Simplifying Respiratory Drug Regimens Stephanie Cheng, PharmD, MPH, BCGP 3 Main Categories Inhaled Respiratory Drugs Binds to beta-2 receptors Relaxation of smooth muscles in the lung

More information

COPD Update. Plus New and Improved Products for Inhaled Therapy. Catherine Bourg Rebitch, PharmD, BCACP Clinical Associate Professor

COPD Update. Plus New and Improved Products for Inhaled Therapy. Catherine Bourg Rebitch, PharmD, BCACP Clinical Associate Professor COPD Update Plus New and Improved Products for Inhaled Therapy Catherine Bourg Rebitch, PharmD, BCACP Clinical Associate Professor Disclosure The presenter has nothing to disclose concerning possible financial

More information

Ferris State University College of Pharmacy MPA CE Symposium 2016 Paul Thill, PharmD, BCPS

Ferris State University College of Pharmacy MPA CE Symposium 2016 Paul Thill, PharmD, BCPS Ferris State University College of Pharmacy MPA CE Symposium 2016 Paul Thill, PharmD, BCPS Objectives Categorize the new asthma and COPD inhalers in to existing or newly created categories Discuss the

More information

AIRDUO RESPICLICK (fluticasone-salmeterol) aerosol DULERA (mometasone furoate and formoterol fumarate dihydrate) aerosol

AIRDUO RESPICLICK (fluticasone-salmeterol) aerosol DULERA (mometasone furoate and formoterol fumarate dihydrate) aerosol DULERA (mometasone furoate and formoterol fumarate dihydrate) aerosol Coverage for services, procedures, medical devices and drugs are dependent upon benefit eligibility as outlined in the member's specific

More information

QUANTITY LIMIT CRITERIA. BROVANA (arformoterol tartrate) SEREVENT DISKUS (salmeterol) STRIVERDI RESPIMAT (olodaterol)

QUANTITY LIMIT CRITERIA. BROVANA (arformoterol tartrate) SEREVENT DISKUS (salmeterol) STRIVERDI RESPIMAT (olodaterol) Carelirst. +.V Family of health care plans DRUG CLASS COMBINATIONS QUANTITY LIMIT CRITERIA LONG ACTING BETA2-ADRENERGIC AGONIST, ORAL INHALATION BRAND NAME (generic) LONG-ACTING BETA2-ADRENERGIC AGONISTS:

More information

A Visual Approach to Simplifying Respiratory Drug Regimens

A Visual Approach to Simplifying Respiratory Drug Regimens Adverse Effects of Inhaled Medications A Visual Approach to Simplifying Respiratory Drug Regimens Stephanie Cheng, PharmD, MPH, BCGP June 28, 2017 Drug Category Beta 2 agonists antagonists Adverse Effects

More information

A Visual Approach to Simplifying Respiratory Drug Regimens

A Visual Approach to Simplifying Respiratory Drug Regimens A Visual Approach to Simplifying Respiratory Drug Regimens Stephanie Cheng, PharmD, MPH, BCGP October 23, 2017 Learning Objectives Be able to list at least 3 major adverse effects of inhaled medications

More information

Drug Class Monograph

Drug Class Monograph Drug Class Monograph Class: Inhaled Corticosteroids Drugs: Aerospan (flunisolide), Advair Diskus, Advair HFA (fluticasone/salmeterol), Alvesco (ciclesonide), Arnuity Ellipta (fluticasone furoate), Asmanex

More information

Clinical Policy: Roflumilast (Daliresp) Reference Number: CP.PMN.46 Effective Date: Last Review Date: 08.18

Clinical Policy: Roflumilast (Daliresp) Reference Number: CP.PMN.46 Effective Date: Last Review Date: 08.18 Clinical Policy: (Daliresp) Reference Number: CP.PMN.46 Effective Date: 11.01.11 Last Review Date: 08.18 Line of Business: Medicaid Revision Log See Important Reminder at the end of this policy for important

More information

MDI Bonanza. Dwayne Griffin, DO

MDI Bonanza. Dwayne Griffin, DO MDI Bonanza Dwayne Griffin, DO Bonanza 3. A MDI costing $200 - $500 per month SISYPHUS MDI Griffin Mountain Evolution of Deliver Systems for COPD in the US 2003 2009 2011 2013 2004 2012 2014 Prescribing

More information

The Medical Letter. on Drugs and Therapeutics

The Medical Letter. on Drugs and Therapeutics The Medical Letter publications are protected by US and international copyright laws. Forwarding, copying or any other distribution of this material is strictly prohibited. For further information call:

More information

COPD Medications Coverage Summary Non-Insured Health Benefits Coverage SABA Bricanyl turbuhaler Yes Yes

COPD Medications Coverage Summary Non-Insured Health Benefits Coverage SABA Bricanyl turbuhaler Yes Yes COPD Medications Coverage Summary Drug Non-Insured Health Benefits Coverage SABA Bricanyl turbuhaler Yes Yes Ventolin MDI + generics Yes Yes Ventolin Diskus NO NO Yukon Pharmacare/Chronic Disease Program

More information

STRIVERDI RESPIMAT (olodaterol hcl) aerosol

STRIVERDI RESPIMAT (olodaterol hcl) aerosol STRIVERDI RESPIMAT (olodaterol hcl) aerosol Coverage for services, procedures, medical devices and drugs are dependent upon benefit eligibility as outlined in the member's specific benefit plan. This Pharmacy

More information

Global Strategy for the Diagnosis, Management and Prevention of COPD 2016 Clinical Practice Guideline. MedStar Health

Global Strategy for the Diagnosis, Management and Prevention of COPD 2016 Clinical Practice Guideline. MedStar Health Global Strategy for the Diagnosis, Management and Prevention of COPD 2016 Clinical Practice Guideline MedStar Health These guidelines are provided to assist physicians and other clinicians in making decisions

More information

MEDICAL COVERAGE GUIDELINES ORIGINAL EFFECTIVE DATE: 07/05/18 SECTION: DRUGS LAST REVIEW DATE: LAST CRITERIA REVISION DATE: ARCHIVE DATE:

MEDICAL COVERAGE GUIDELINES ORIGINAL EFFECTIVE DATE: 07/05/18 SECTION: DRUGS LAST REVIEW DATE: LAST CRITERIA REVISION DATE: ARCHIVE DATE: CINQAIR (reslizumab) Non-Discrimination Statement and Multi-Language Interpreter Services information are located at the end of this document. Coverage for services, procedures, medical devices and drugs

More information

COPD Medicine. No one ever showed me how to use this. Wendy Happel; RRT, COPD Educator Krystal Fedoris; RRT-NPS, BA, COPD Educator

COPD Medicine. No one ever showed me how to use this. Wendy Happel; RRT, COPD Educator Krystal Fedoris; RRT-NPS, BA, COPD Educator Medicine. No one ever showed me how to use this. Wendy Happel; RRT, Educator Krystal Fedoris; RRT-NPS, BA, Educator 1 Taking prescriptions correctly Taking prescriptions can be a challenge Busy schedules

More information

Three s Company - The role of triple therapy in chronic obstructive pulmonary

Three s Company - The role of triple therapy in chronic obstructive pulmonary Three s Company - The role of triple therapy in chronic obstructive pulmonary disease (COPD) October 26 th, 2018 Zahava Picado, PharmD PGY1 Pharmacy Resident Central Texas Veterans Healthcare System Zahava.Picado@va.gov

More information

Inhaled Corticosteroids Drug Class Prior Authorization Protocol

Inhaled Corticosteroids Drug Class Prior Authorization Protocol Inhaled Corticosteroids Drug Class Prior Authorization Protocol Line of Business: Medicaid P&T Approval Date: February 21, 2018 Effective Date: April 1, 2018 This policy has been developed through review

More information

Inhaled Corticosteroids Drug Class Prior Authorization Protocol

Inhaled Corticosteroids Drug Class Prior Authorization Protocol Inhaled Corticosteroids Drug Class Prior Authorization Protocol Line of Business: Medi-Cal P&T Approval Date: February 21, 2018 Effective Date: April 1, 2018 This policy has been developed through review

More information

FASENRA (benralizumab)

FASENRA (benralizumab) FASENRA (benralizumab) Non-Discrimination Statement and Multi-Language Interpreter Services information are located at the end of this document. Coverage for services, procedures, medical devices and drugs

More information

Diagnosis and Management of Asthma

Diagnosis and Management of Asthma Supporting Evidence: Diagnosis and Management of Asthma The subdivision of this section is: Appendix B Tables Copyright 2016 by 1 Eleventh Edition/December 2016 Appendix B Asthma Summary Tables Class:

More information

Drug Effectiveness Review Project Summary Report

Drug Effectiveness Review Project Summary Report Copyright 2012 Oregon State University. All Rights Reserved Drug Use Research & Management Program Oregon State University, 500 Summer Street NE, E35 Salem, Oregon 97301-1079 Phone 503-947-5220 Fax 503-947-1119

More information

Test Your Inhaler Knowledge

Test Your Inhaler Knowledge A Breath of Fresh Air: Updates in COPD Management Jennifer Austin Szwak, PharmD, BCPS, DPLA University of Chicago Medicine The speaker has nothing to disclose Abbreviations COPD: Chronic obstructive pulmonary

More information

COPD: Treatment Update Property of Presenter. Not for Reproduction. Barry Make, MD Professor of Medicine National Jewish Health

COPD: Treatment Update Property of Presenter. Not for Reproduction. Barry Make, MD Professor of Medicine National Jewish Health COPD: Treatment Update Barry Make, MD Professor of Medicine National Jewish Health Disclosures Advisory board, consultant, multi-center trial, research funding, Data Safety Monitoring Board (DSMB), or

More information

Asthma/COPD Update with Inhaler Workshop

Asthma/COPD Update with Inhaler Workshop Asthma/COPD Update with Inhaler Workshop October 8, 2017 Nathan Samsa, DO, Pharm D, RPh, FACOI None Disclosures Agenda Asthma Updates COPD Updates Inhaler Workshop Medication Acronyms SABA: Short acting

More information

See Important Reminder at the end of this policy for important regulatory and legal information.

See Important Reminder at the end of this policy for important regulatory and legal information. Clinical Policy: (Seebri Neohaler) Reference Number: CP.CPA.150 Effective Date: 11.16.16 Last Review Date: 11.17 Line of Business: Commercial Revision Log See Important Reminder at the end of this policy

More information

REVISED RESPIRATORY MEDICATION USE QUESTIONNAIRE

REVISED RESPIRATORY MEDICATION USE QUESTIONNAIRE REVISED RESPIRATORY MEDICATION USE QUESTIONNAIRE ID NUMBER: 0a) Date of Collection / / 0b) Staff Code Instructions: This form should be completed during the participant s clinic visit. 1) Are you regularly

More information

THE COPD PRESCRIBING TOOL

THE COPD PRESCRIBING TOOL THE COPD PRESCRIBING TOOL Revised edition, 2017 www.bpac.org.nz/copd CLASSIFICATION The COPD prescribing tool This tool provides pharmacological treatment options for patients with COPD based on their

More information

Asthma/COPD Update with Inhaler Workshop

Asthma/COPD Update with Inhaler Workshop Asthma/COPD Update with Inhaler Workshop October 8, 2017 Nathan Samsa, DO, Pharm D, RPh, FACOI None Disclosures Agenda Asthma Updates COPD Updates Inhaler Workshop Asthma Updates Asthma Updates SMART Trial

More information

Asthma COPD Update 2018

Asthma COPD Update 2018 Asthma COPD Update 2018 Roger Hefflinger, Pharm.D. Clinical Associate Professor ISU COP Clinical Teaching Pharmacist Family Medicine Residency of Idaho In support of improving patient care, Idaho State

More information

reslizumab (Cinqair )

reslizumab (Cinqair ) Applies to all products administered or underwritten by Blue Cross and Blue Shield of Louisiana and its subsidiary, HMO Louisiana, Inc.(collectively referred to as the Company ), unless otherwise provided

More information

New and Novel Medications for Respiratory Care

New and Novel Medications for Respiratory Care New and Novel Medications for Respiratory Care JASON MOORE, PHARM.D. BCCCP CLINICAL STAFF PHARMACIST STORMONT-VAIL HEALTH Objectives Quick overview of the newest FDA-approved repiratory-related medications

More information

Asthma Management Updates: A Focus on Long-acting Muscarinic Antagonists and Intermittent Inhaled Corticosteroid Dosing

Asthma Management Updates: A Focus on Long-acting Muscarinic Antagonists and Intermittent Inhaled Corticosteroid Dosing Asthma Management Updates: A Focus on Long-acting Muscarinic Antagonists and Intermittent Inhaled Corticosteroid Dosing Diana M. Sobieraj, PharmD, BCPS Assistant Professor University of Connecticut School

More information

Inhaled Corticosteroid Dose Comparison in Asthma

Inhaled Corticosteroid Dose Comparison in Asthma This Clinical Resource gives subscribers additional insight related to the Recommendations published in April 2017 ~ Resource #330402 Inhaled Corticosteroid Dose Comparison in Asthma The chart below provides

More information

Asthma & COPD Medication Review. Hutchison Disclosures 2/16/2017. Objectives

Asthma & COPD Medication Review. Hutchison Disclosures 2/16/2017. Objectives Asthma & COPD Medication Review Anna Meador, PharmD, BCACP Assistant Professor/ Pharmacy Director McWhorter School of Pharmacy/ Christ Health Center Amber Hutchison, PharmD, BCPS Assistant Clinical Professor

More information

Respiratory Inhalers. Identification Guide Version 3

Respiratory Inhalers. Identification Guide Version 3 Respiratory Inhalers Identification Guide Version 3 This booklet has been prepared by NHSGGC Medicines Information. Endorsed by NHSGGC Respiratory Managed Clinical Network, February 2017. Designed by Medical

More information

COPD The New Epidemic. Peter Lin MD CCFP Director Primary Care Initiatives Canadian Heart Research Centre

COPD The New Epidemic. Peter Lin MD CCFP Director Primary Care Initiatives Canadian Heart Research Centre COPD The New Epidemic Peter Lin MD CCFP Director Primary Care Initiatives Canadian Heart Research Centre Conflict Disclosure Information Speaker: Dr. Peter Lin Title of Talk: COPD The New Epidemic Financial

More information

12/18/2017. Disclosures. Asthma Management Updates: A Focus on Long-acting Muscarinic Antagonists and Intermittent Inhaled Corticosteroid Dosing

12/18/2017. Disclosures. Asthma Management Updates: A Focus on Long-acting Muscarinic Antagonists and Intermittent Inhaled Corticosteroid Dosing Asthma Management Updates: A Focus on Long-acting Muscarinic Antagonists and Intermittent Inhaled Corticosteroid Dosing Diana M. Sobieraj, PharmD, BCPS Assistant Professor University of Connecticut School

More information

Improving Outcomes in COPD

Improving Outcomes in COPD Neil MacIntyre MD Duke University Durham NC Current treatment guidelines f COPD focus Barriers to providing optimal treatment Diagnosis of COPD EXPOSURE TO RISK FACTORS AND/ OR SYMPTOMS sputum cough dyspnea

More information

MEDICATION COVERAGE POLICY PHARMACY AND THERAPEUTICS ADVISORY COMMITTEE POLICY: Asthma/COPD P&T DATE 12/14/2017 CLASS:

MEDICATION COVERAGE POLICY PHARMACY AND THERAPEUTICS ADVISORY COMMITTEE POLICY: Asthma/COPD P&T DATE 12/14/2017 CLASS: MEDICATION COVERAGE POLICY PHARMACY AND THERAPEUTICS ADVISORY COMMITTEE POLICY: Asthma/COPD P&T DATE 12/14/2017 CLASS: LOB: Respiratory Disorders Medi-Cal REVIEW HISTORY (MONTH/YEAR) 12/17,12/16, 5/15,

More information

First to Market or 505 (b)2 CMC Considerations IPAC-RS/UF Orlando Inhalation Conference Orlando, Florida

First to Market or 505 (b)2 CMC Considerations IPAC-RS/UF Orlando Inhalation Conference Orlando, Florida First to Market or 505 (b)2 CMC Considerations IPAC-RS/UF Orlando Inhalation Conference Orlando, Florida Prasad Peri, Ph.D., Branch Chief, ONDQA, FDA March 19, 2014 1 Topics for discussion Introduction

More information

COPD Update: Focus on Intensifying LABA, LAMA and ICS Therapy

COPD Update: Focus on Intensifying LABA, LAMA and ICS Therapy Update: Focus on Intensifying LABA, LAMA and ICS Therapy B.C. Provincial Academic Detailing Service February 2017 Background In Canada, approximately 20 inhaled medications are approved to treat Chronic

More information

Inhaled bronchodilators relax constricted airways and treat the noisy part of asthma: coughing, wheezing, choking and shortness of breath.

Inhaled bronchodilators relax constricted airways and treat the noisy part of asthma: coughing, wheezing, choking and shortness of breath. Inhaled bronchodilators relax constricted airways and treat the noisy part of asthma: coughing, wheezing, choking and shortness of breath. AccuNeb inhalation 0.021% solution: 0.63mg/3mL 3-4 times solution

More information

Correct Use of Inhaler Devices

Correct Use of Inhaler Devices PL Detail-Document #300206 This PL Detail-Document gives subscribers additional insight related to the Recommendations published in PHARMACIST S LETTER / PRESCRIBER S LETTER February 2014 Correct Use of

More information

Using Inhaled Corticosteroids as Needed for Asthma: giving patients relief or leaving them breathless?

Using Inhaled Corticosteroids as Needed for Asthma: giving patients relief or leaving them breathless? Using Inhaled Corticosteroids as Needed for Asthma: giving patients relief or leaving them breathless? Lindsay Thomas, Pharm.D. PGY2 Ambulatory Care Resident Department of Pharmacotherapy and Pharmacy

More information

Wirral COPD Prescribing Guidelines

Wirral COPD Prescribing Guidelines Wirral COPD Prescribing Guidelines (To be read in conjunction with the Wirral COPD Supplementary Information) STEP 1: Assess symptoms COPD Assessment Test (CAT) [Link for CAT-test Online] is a patient-completed

More information

Balanced information for better care. Helping patients with COPD breathe easier

Balanced information for better care. Helping patients with COPD breathe easier Balanced information for better care Helping patients with COPD breathe easier COPD is the third-leading cause of death in the U.S., following cancer and heart disease 1 FIGURE 1. Women now have a higher

More information

NHS Dumfries & Galloway Triple therapy in COPD patients over 16 years

NHS Dumfries & Galloway Triple therapy in COPD patients over 16 years Title of Project: NHS Dumfries & Galloway Triple therapy in COPD patients over 16 years 1 Reason for the review Respiratory prescribing is long term and can be costly. Appropriate choice and use of inhaled

More information

CHRONIC OBSTRUCTIVE PULMONARY DISEASE (COPD) TREATMENT GUIDELINES

CHRONIC OBSTRUCTIVE PULMONARY DISEASE (COPD) TREATMENT GUIDELINES CHRONIC OBSTRUCTIVE PULMONARY DISEASE (COPD) TREATMENT GUIDELINES Document Description Document Type Service Application Version Guidelines All healthcare professionals(hcps) caring for patients with asthma

More information

Chronic Obstructive Pulmonary Disease

Chronic Obstructive Pulmonary Disease Quality Department Guidelines for Clinical Care Ambulatory COPD Guideline Team Team Leader Davoren A Chick, MD General Medicine Team Members Paul J Grant, MD General Medicine R Van Harrison, PhD Learning

More information

Global Strategy for the Diagnosis, Management and Prevention of COPD 2016 Clinical Practice Guideline. MedStar Health

Global Strategy for the Diagnosis, Management and Prevention of COPD 2016 Clinical Practice Guideline. MedStar Health Global Strategy f the Diagnosis, Management and Prevention of COPD 2016 Clinical Practice Guideline MedStar Health These guidelines are provided to assist physicians and other clinicians in making decisions

More information

Question I was one of the first dry power devices available in the US Flovent, Serevent and Advair are all available in this device

Question I was one of the first dry power devices available in the US Flovent, Serevent and Advair are all available in this device What Device am I Class Side Effects History Potpourri Monitoring Tools 10 10 10 10 10 20 20 20 20 20 30 30 30 30 30 40 40 40 40 40 50 50 50 50 50 WHAT KIND OF DEVICE AM I? I was one of the first dry power

More information

A Patient s Guide to Aerosol Medication Delivery

A Patient s Guide to Aerosol Medication Delivery A Patient s Guide to Aerosol Medication Delivery 3rd Edition Prepared by: Tim Op t Holt, EdD, RRT, AE-C, FAARC Kimberly Wiles, RRT, CPFT Ellen Becker, PhD, RRT, RRT-NPS, RPFT, AE-C, FAARC Edited by: Timothy

More information

End Stage COPD Guidance Document

End Stage COPD Guidance Document End Stage COPD Guidance Document Suggested Guidelines for the Determination of Hospice Eligibility A patient with severe chronic pulmonary disease that meets the following criteria may be eligible for

More information

Chronic obstructive pulmonary disease (COPD) is a condition characterized by

Chronic obstructive pulmonary disease (COPD) is a condition characterized by PUBLISHING STAFF SPECIAL REPORT: COPD EDITOR-IN-CHIEF Troy Trygstad, PharmD, PhD, MBA EDITORIAL EDITORIAL DIRECTOR Kirk McKay DIGITAL MANAGING EDITOR Colleen Hall SENIOR EDITOR Melissa Lauro SENIOR EDITOR

More information

See Important Reminder at the end of this policy for important regulatory and legal information.

See Important Reminder at the end of this policy for important regulatory and legal information. Clinical Policy: (Fasenra) Reference Number: CP.PHAR.## Effective Date: 01.16.18 Last Review Date: 05.18 Line of Business: Commercial, Medicaid Revision Log See Important Reminder at the end of this policy

More information

COPD Robert Schilz DO, PhD Pulmonary, Critical Care and Sleep Medicine University Hospitals Case Medical Center

COPD Robert Schilz DO, PhD Pulmonary, Critical Care and Sleep Medicine University Hospitals Case Medical Center COPD 2018 GOLD 2017 Report Global Initiative for Chronic Obstructive Lung D isease COPYRIGHTED MATERIAL- DO NOT COPY OR DISTRIBUTE GLOBAL STRATEGY FOR THE DIAGNOSIS, MANAGEMENT, AND PREVENTION OF CHRONIC

More information

Three s Company - The role of triple therapy in chronic obstructive pulmonary disease (COPD)

Three s Company - The role of triple therapy in chronic obstructive pulmonary disease (COPD) Three s Company - The role of triple therapy in chronic obstructive pulmonary disease (COPD) Zahava Picado, PharmD PGY1 Pharmacy Practice Resident Central Texas Veterans Healthcare System Temple, TX October

More information

Adjustment of Inhaled Controller Therapy of Asthma in the Yellow Zone, Based on the Inhaler Product Used in the Green Zone Age 16 Years and Older

Adjustment of Inhaled Controller Therapy of Asthma in the Yellow Zone, Based on the Inhaler Product Used in the Green Zone Age 16 Years and Older Adjustment of Inhaled Controller Therapy of Asthma in the Yellow Zone, Based on the Inhaler Product Used in the Green Zone Age 16 Years and Older The Canadian Thoracic Society and other international asthma

More information

See Important Reminder at the end of this policy for important regulatory and legal information.

See Important Reminder at the end of this policy for important regulatory and legal information. Clinical Policy: Indacaterol/Glycopyrrolate (Utibron Neohaler) Reference Number: CP.PMN.147 Effective Date: 10.01.18 Last Review Date: 07.13.18 Line of Business: Oregon Health Plan Revision Log See Important

More information

Individualizing and Optimizing Asthma Care. CFW 2018 Friday, April 13, 9:45 11:15 am Renaissance Austin Hotel in Austin, Texas

Individualizing and Optimizing Asthma Care. CFW 2018 Friday, April 13, 9:45 11:15 am Renaissance Austin Hotel in Austin, Texas Individualizing and Optimizing Asthma Care CFW 2018 Friday, April 13, 9:45 11:15 am Renaissance Austin Hotel in Austin, Texas Speaker Disclosure Dr. Hawkins has disclosed that he has no actual or potential

More information

Pulmonary Medication Toolkit: Is yours up to date?

Pulmonary Medication Toolkit: Is yours up to date? Pulmonary Medication Toolkit: Is yours up to date? Michelle Schymik, PharmD, BCPS Pharmacist for Deaconess Health System Overview Assuming basic knowledge of pulmonary diseases FEEL FREE TO ASK ME ANY

More information

Common Drug Review Pharmacoeconomic Review Report

Common Drug Review Pharmacoeconomic Review Report Common Drug Review Pharmacoeconomic Review Report January 2018 Drug umeclidinium bromide (Incruse Ellipta) Indication Listing request Dosage form(s) Manufacturer Indicated for long-term, once daily maintenance

More information

Key features and changes to these four components of asthma care include:

Key features and changes to these four components of asthma care include: Guidelines for the Diagnosis and Management of Asthma in Adults Clinical Practice Guideline MedStar Health These guidelines are provided to assist physicians and other clinicians in making decisions regarding

More information

2017 GOLD Report. Is it worth its weight in GOLD??? CSHP-NB Fall Education Day September 30, 2017

2017 GOLD Report. Is it worth its weight in GOLD??? CSHP-NB Fall Education Day September 30, 2017 2017 GOLD Report Is it worth its weight in GOLD??? CSHP-NB Fall Education Day September 30, 2017 Lauren Munro; BSc(Pharm) Amanda Burns; BSc(Pharm) Pharmacy Residents The Moncton Hospital Objectives Explain

More information

See Important Reminder at the end of this policy for important regulatory and legal information.

See Important Reminder at the end of this policy for important regulatory and legal information. Clinical Policy: Reference Number: CP.PMN.69 Effective Date: 11/15 Last Review Date: 08/17 Line of Business: Medicaid Revision Log See Important Reminder at the end of this policy for important regulatory

More information

April 10 th, Bond Street, Toronto ON, M5B 1W8

April 10 th, Bond Street, Toronto ON, M5B 1W8 Comprehensive Research Plan: Inhaled long-acting muscarinic antagonists (LAMAs; long-acting anticholinergics) for the treatment of chronic obstructive pulmonary disease (COPD) April 10 th, 2014 30 Bond

More information

Michelle Zeidler, MD, MS

Michelle Zeidler, MD, MS 7/1/18 Chronic Obstructive Pulmonary Disease: Optimizing Outpatient Care & Reducing Exacerbations Michelle Zeidler, MD, MS Professor of Medicine, Pulmonary, Critical Care Medicine & Sleep Medicine, VA

More information

Algorithm for the use of inhaled therapies in COPD

Algorithm for the use of inhaled therapies in COPD Berkshire West Integrated Care System Representing Berkshire West Clinical Commisioning Group Royal Berkshire NHS Foundation Trust Berkshire Healthcare NHS Foundation Trust Berkshire West Primary Care

More information

Algorithm for the use of inhaled therapies in COPD Version 2 May 2017

Algorithm for the use of inhaled therapies in COPD Version 2 May 2017 Algorithm for the use of inhaled therapies in COPD This document has been revised by the Berkshire West Respiratory Network to support clinicians in selecting the most appropriate, cost effective treatments

More information

II: Moderate Worsening airflow limitations Dyspnea on exertion, cough, and sputum production; patient usually seeks medical

II: Moderate Worsening airflow limitations Dyspnea on exertion, cough, and sputum production; patient usually seeks medical Table 3.1. Classification of COPD Severity Stage Pulmonary Function Test Findings Symptoms I: Mild Mild airflow limitations +/ Chronic cough and sputum production; patient unaware of abnormal FEV 1 80%

More information

COPD. Understanding. An educational health series from National Jewish Health IN THIS ISSUE. What is COPD? 2. How is COPD Managed?

COPD. Understanding. An educational health series from National Jewish Health IN THIS ISSUE. What is COPD? 2. How is COPD Managed? Understanding COPD The Mount Sinai National Jewish Health Respiratory Institute was formed by the nation s leading respiratory hospital National Jewish Health, based in Denver, and top ranked academic

More information

FDCs for CO PD: From Famine to a Feast of Therapeutic Choices

FDCs for CO PD: From Famine to a Feast of Therapeutic Choices FDCs for CO PD: From Famine to a Feast of Therapeutic Choices LAURA RUNKEL, PhD Associate Director, CNS, AutoImmune/Inflammation, Ophthalmology Historically, there have been few therapies developed for

More information

Incorporating Newer Therapies and Strategies to Improve COPD Outcomes: A Practical Guide for Pharmacists. Learning Objectives.

Incorporating Newer Therapies and Strategies to Improve COPD Outcomes: A Practical Guide for Pharmacists. Learning Objectives. Incorporating Newer Therapies and Strategies to Improve COPD Outcomes: A Practical Guide for Pharmacists Learning Objectives Identify the risk factors for COPD and the clinical features that differentiate

More information

Improving Outcomes in COPD. Improving Outcomes in COPD 4/4/2018

Improving Outcomes in COPD. Improving Outcomes in COPD 4/4/2018 Updates 2018 Neil MacIntyre MD Duke University Durham NC. Barnes PJ. N Engl J Med. 2000;343:269-80. 1 COPD spectrum Proximal predominant (large airways) mucus gland hypertrophy (cough/sputum) reduced respiraty

More information

APPENDIX 1 Printable point-of-care tables Asthma Action Plan Yellow Zone Formulation Table Region: Europe

APPENDIX 1 Printable point-of-care tables Asthma Action Plan Yellow Zone Formulation Table Region: Europe APPENDIX 1 Printable point-of-care tables Asthma Action Plan Yellow Zone Formulation Table Region: Europe Instructions: Print on 8.5 x14 (216 x 279 mm) paper (Legal size) Medication in Green Zone Change

More information

Commissioner for the Department for Medicaid Services Selections for Preferred Products

Commissioner for the Department for Medicaid Services Selections for Preferred Products Commissioner for the Department for Medicaid Services Selections for Preferred Products This is a summary of the final Preferred Drug List (PDL) selections made by the Commissioner for the Department for

More information

Reference Guide for Caring for Pediatric Patients with Asthma

Reference Guide for Caring for Pediatric Patients with Asthma Reference Guide for Caring for Pediatric Patients with Asthma Co-Chair: Nancy Cantey Banasiak, DNP, PPCNP-BC, APRN Co-Chair: Deborah Hickman, DNP, APRN-CNP, CPNP-PC, NNP-BC Asthma and Allergy SIG Members

More information

Medications for Managing COPD in Hospice Patients. Jim Joyner, PharmD, CGP Director of Clinical Operations Outcome Resources

Medications for Managing COPD in Hospice Patients. Jim Joyner, PharmD, CGP Director of Clinical Operations Outcome Resources Medications for Managing COPD in Hospice Patients Jim Joyner, PharmD, CGP Director of Clinical Operations Outcome Resources Goal of medications in COPD Decrease symptoms and/or complications Reduce frequency

More information

Take My Breath Away: COPD Update. Jason Henderson D.O. Warren Clinic Pulmonary & Critical Care

Take My Breath Away: COPD Update. Jason Henderson D.O. Warren Clinic Pulmonary & Critical Care Take My Breath Away: Update Jason Henderson D.O. Warren Clinic Pulmonary & Critical Care Objectives 1. Recognize clinical signs and symptoms associated with chronic bronchitis and emphysema. 2. Describe

More information

I have no conflicts of interest or financial relationships to disclose!

I have no conflicts of interest or financial relationships to disclose! I have no conflicts of interest or financial relationships to disclose! Timothy R. Hudd BS, PharmD, RPh, AE-C Associate Professor of Pharmacy Practice MCPHS University Boston, MA Clinical Pharmacist Primary

More information

Pharmacy Medical Policy Asthma and Chronic Obstructive Pulmonary Disease Medication Management

Pharmacy Medical Policy Asthma and Chronic Obstructive Pulmonary Disease Medication Management Pharmacy Medical Policy Asthma and Chronic Obstructive Pulmonary Disease Medication Management Table of Contents Policy: Commercial Information Pertaining to All Policies Endnotes Policy: Medicare References

More information

University System of Georgia Prior Authorization, Step Therapy and Quantity Limit List (Updated 1/1/2016)

University System of Georgia Prior Authorization, Step Therapy and Quantity Limit List (Updated 1/1/2016) University System of Georgia, Step Therapy and Quantity Limit List (Updated 1/1/2016) (PA) Your doctor will need to obtain a prior authorization for the drugs listed below, before your prescription drug

More information

Provider Respiratory Inservice

Provider Respiratory Inservice Provider Respiratory Inservice 2 Welcome Opening Remarks We will cover: Definition of Asthma & COPD Evidence based guidelines for diagnosis, evaluation, and management of asthma Evidence based guidelines

More information

primer on inhalers and nebulizers

primer on inhalers and nebulizers CREDIT: 2.0 Continuing Education EARN CE CREDIT FOR THIS ACTIVITY AT WWW.DRUGTOPICS.COM AN ONGOING CE PROGRAM OF THE UNIVERSITY OF CONNECTICUT SCHOOL OF PHARMACY AND DRUG TOPICS educational objectives

More information

See Important Reminder at the end of this policy for important regulatory and legal information.

See Important Reminder at the end of this policy for important regulatory and legal information. Clinical Policy: (Nucala) Reference Number: CP.PHAR.200 Effective Date: 04.01.16 Last Review Date: 02.18 Line of Business: Commercial, Medicaid Coding Implications Revision Log See Important Reminder at

More information

DOD PHARMACY AND THERAPEUTICS COMMITTEE RECOMMENDATIONS INFORMATION FOR THE UNIFORM FORMULARY BENEFICIARY ADVISORY PANEL

DOD PHARMACY AND THERAPEUTICS COMMITTEE RECOMMENDATIONS INFORMATION FOR THE UNIFORM FORMULARY BENEFICIARY ADVISORY PANEL DOD PHARMACY AND THERAPEUTICS COMMITTEE RECOMMENDATIONS INFORMATION FOR THE UNIFORM FORMULARY BENEFICIARY ADVISORY PANEL I. Uniform Formulary Review Process Under 10 U.S.C. 1074g, as implemented by 32

More information

Three better than 1 or 2?

Three better than 1 or 2? Three better than 1 or 2? DISCLOSURE Pam McLean-Veysey, Team Leader Drug Evaluation Unit DEU funded by the Drug Evaluation Alliance of NS. (DEANS). DEU prepares Drug Evaluation Reports for the Atlantic

More information

Guide to Inhaled Treatment Choices

Guide to Inhaled Treatment Choices Guide to Inhaled Treatment Choices Note: this is guidance only, it is important to consider which device is best suited to the patient. This may NOT be the first line choice (but should be on the joint

More information

A Breath of Fresh Air? An update of novel inhalers used for the treatment of asthma and COPD

A Breath of Fresh Air? An update of novel inhalers used for the treatment of asthma and COPD A Breath of Fresh Air? An update of novel inhalers used for the treatment of asthma and COPD Chris Federico PharmD, BCACP RIPF Kimberly McDonough Spring Seminar May 4, 2016 Disclosure I have no actual

More information

Guide to Inhaled Treatment Choices

Guide to Inhaled Treatment Choices Guide to Inhaled Treatment Choices Note: this is guidance only, it is important to consider which device is best suited to the patient. This may NOT be the first line choice (but should be on the joint

More information

Disclosure. Case. Objectives. Case Continued. Inhalers. Asthma: A GINA Update to the NAEPP 2007 Guidelines 1/20/2015

Disclosure. Case. Objectives. Case Continued. Inhalers. Asthma: A GINA Update to the NAEPP 2007 Guidelines 1/20/2015 Disclosure Asthma: A GINA Update to the NAEPP 2007 Guidelines Robert (RC) Hellinga, Pharm.D. PGY 1 Pharmacy Resident Wolfson Children s Hospital/Baptist Health I do not have a vested interest in or affiliation

More information

If you require this document in another format such as Braille, large print, audio or another language please contact the Trusts Communications Team

If you require this document in another format such as Braille, large print, audio or another language please contact the Trusts Communications Team MANAGEMENT OF CHRONIC OBSTRUCTIVE PULMONARY DISEASE (COPD) IN ADULTS Summary statement: How does the document support patient care? Staff/stakeholders involved in development: Job titles only Division:

More information

MANAGING ASTHMA. Nancy Davis, RRT, AE-C

MANAGING ASTHMA. Nancy Davis, RRT, AE-C MANAGING ASTHMA Nancy Davis, RRT, AE-C What is asthma? Asthma is a chronic respiratory disease characterized by episodes or attacks of inflammation and narrowing of small airways in response to asthma

More information

CHRONIC OBSTRUCTIVE PULMONARY DISEASE

CHRONIC OBSTRUCTIVE PULMONARY DISEASE CHRONIC OBSTRUCTIVE PULMONARY DISEASE INCIDENCE UP TO 380,000 PEOPLE IN IRELAND HSE FIGURES 110,000 DIAGNOSED AND 200,000 UNDIAGNOSED. AFFECTS MORE MEN THAN WOMEN BUT RATES ARE RISING 1500 DEATHS PER YEAR

More information

The Latest Medications A Pharmacological Update for RTs

The Latest Medications A Pharmacological Update for RTs The Latest Medications A Pharmacological Update for RTs Douglas S. Gardenhire, EdD, RRT-NPS, FAARC Associate Professor and Chairman Department of Respiratory Therapy Georgia State University Objectives

More information

Journal of the COPD Foundation

Journal of the COPD Foundation 38 Umeclidinium-Vilanterol for COPD Exacerbations Chronic Obstructive Pulmonary Diseases: Journal of the COPD Foundation Original Research Effectiveness of Umeclidinium-Vilanterol for Protocolized Management

More information