Tips for Evolving Medicaid Pharmacy Benefits Management (PBM) Programs. June 5, 2015
|
|
- Jeffrey Jacobs
- 5 years ago
- Views:
Transcription
1 Tips for Evolving Medicaid Pharmacy Benefits Management (PBM) Programs 1 June 5, 2015
2 Introductions Mark Steck Pharm.D Independent Consultant, MAXIMUS John J.P. Crouse Vice President, MAXIMUS Market Lead DecisionPoint for Pharmacy Benefits Management 2
3 Agenda Introductions Changes in the Medicaid Population Increasing Drug Costs Changing Technology Prescription Drug Abuse Strategies for States 3
4 Changes in Medicaid Populations The Medicaid population is growing and changing Total Medicaid & CHIP enrollment has grown by 19% since 2013 to over nearly 70 million people This is through both expansion and woodwork affect Fiscal 2011 data (the most current data available) Disabled 15% Elderly 9% Adults - 27% Children - 48% 4
5 Changes in Medicaid Populations States that have expanded Medicaid have brought new populations to the Program Childless Adult populations have brought with them a number of special cases that Medicaid had not traditionally dealt with in large numbers Hepatitis C, HIV\AIDS, Tuberculosis Some cancers Drug spend that was part of public health is now paid for by the Medicaid program 5
6 Changes in Medicaid Populations States have moved many enrollees to Medicaid Managed Care plans Nationally, nearly 75% of the Medicaid population now receives their medical services, and their prescription drug benefit, through a Managed Care Organization (MCO) Each MCO is free to manage their PBM program as they wish, within some limits percent of people covered by Medicaid now in some kind of managed care 6
7 Increasing Drug Costs Data and Trends Utilization Nationwide Part D Medicaid 1. Lipid Regulators 2. Antidepressants 3. Narcotic Analgesics 4. Beta Blockers 5. ACE Inhibitors 6. Antidiabetics 7. Respiratory Agents 11. Tranquilizers 12. Thyroid Preps 13. Calcium Antagonists 14. Antirheumatics 15. Hormonal Contraceptives 16. Angiotensin II Blockers 17. Penicillins 1. Lipid Regulators 2. ACE Inhibitors 3. Calcium Channel Blockers 4. Beta Blockers 5. Proton Pump Inhibitors 6. Thyroid Preps 7. Angiotensin II Blockers 1. Antipsychotics 2. CNS Stimulants 3. Narcotic Analgesics 4. Anticonvulsants 5. Diabetic Agents 6. Anxiolytic / Hypnotics 8. Anti Ulcerants 18. Macrolides 8. Narcotic Analgesics CDC Diuretics 19. Vitamins/Minerals 9. Antidepressants 10. Seizure Disorder Agents 20. Hypnotic / Sedatives 10. Seizure Disorders IMS 2015 CBO
8 Increasing Drug Costs Miscellaneous Information $300 Billion in U.S. Spending Drugs as a Percent of Healthcare Spend Nationally % Medicaid 5% Costs Spiked in % largest increase since 2003 Dispensing rates for generic drugs are similar across Medicaid FFS and Medicare Part D Drug costs are lower in Medicaid FFS than in Medicare Part D because of CMS rebates Average Cost of Drugs for Top 50 Therapeutic Classes (70% of Drug Spend) for 30 Day Supply Part D: $50 Medicaid FFS: $37 CMS Rebate Brand Drugs 23.1% Generics (and other limited categories) 13.0% Specialty Drugs in Medicaid: 2% of the Utilization / 32% of the Spend Generic Drugs: Top Ten Therapeutic Classes Rose Over 400% in
9 Increasing Drug Costs Specialty Pharmacy 9
10 Increasing Drug Costs Specialty Pharmacy RANKED BY 2014 PMPY SPEND Trend Therapeutic Class PMPY Util. Unit Cost Total 1 Inflammatory Conditions $ % 15.7% 24.3% 2 Multiple Sclerosis $ % 9.7% 12.9% 3 Oncology $ % 11.7% 20.7% 4 Hepatitis C $ % 666.6% 742.6% 5 HIV $ % 10.3% 14.8% 6 Misc. Specialty Conditions $ % 8.2% 35.6% 7 Growth Deficiency $ % 7.5% 6.6% 8 Hemophilia $ % 17.6% 16.9% 9 Pulmonary Arterial HTN $ % 6.2% 13.8% 10 Transplant $ % -3.1% -2.3% TOTAL Specialty $ % 25.2% 30.9% *Am J Health-Syst Pharm. 2014; 71:e
11 Increasing Drug Costs Specialty Pharmacy Specialty Drug Sampling Afatinib (Gilotrif )* Dabrafenib (Tafinlar)* Ibrutinib (Imbruvica)* Drugs Approved in 2013 / 2014 Drug Indication Cost Obinutuzumab (Gazyva)* Trametinib (Mekinist)* First-line metastatic non-small cell lung cancer with an EGFR mutation Unresectable or metastatic melanoma with BRAF V600E mutation Pts. with mantle cell lymphoma who have received at least 1 prior therapy Previously untreated chronic lymphocytic leukemia (with chlorambucil) Unresectable or metastatic melanoma with BRAF V600E mutation 11 $6,300/mo $8,600/mo $12,500/mo $12,400/mo $9,800/mo Opdivo PD-1 inhibitor $143,000/yr Sovaldi Hep-C $84K- $168K/tx Kalydeco Cystic Fibrosis $300,000/yr *Am J Health-Syst Pharm. 2014; 71:e6-23
12 Increasing Generic Drug Costs Almost 80% of all prescriptions dispensed as generics Cost 7,000-8,000% increases over a couple months Reasons Excuses Consolidation Raw material shortages Production run interruptions Q&A and compliance issues Bottom line: competition, it has always driven generic pricing Cost increases dramatic, but equally problematic is the velocity of the increases Impact on pharmacies Timeliness of pricing Purchase price versus reimbursement rate Access Issue (patients sent away from pharmacies) 12
13 Changing Technology PBM technology is fairly mature eprescribing is now pervasive and electronically transmitted prescriptions now account for roughly half of all prescriptions The next significant technology change that is emerging in the market is Electronic Prior Authorization (epa) epa has the potential to substantially change the workflow for filling prescriptions for non-preferred drugs Implementing epa allows PBMs to receive Prior Authorization requests generated within the prescribers Electronic Health Records (EHR) systems. 13
14 Prescription Drug Abuse Prescription drug abuse is a national problem that touches Medicaid program as well as all public and private health systems. Drug overdose is now the leading cause of death in some states surpassing motor vehicle accidents Medicaid programs are addressing the issue through utilization and fraud management and participation in State Prescription Drug Monitoring Programs (PDMP) 14
15 Strategies for States The Changing Role of the PBM in Medicaid Historically Through the Late 1990s: Fiscal Intermediary Role Claims Processing Rebate Processing OBRA 90 RetroDUR Early 2000s: Management of the Actual Benefit Care Management Initiatives Preferred Drug List Now Environmental Shift Changing Role Modularized MMIS Increased Managed Care Enrollment New Medical Approaches New Challenges Extension of State Medicaid Pharmacy Departments Emphasis on Program Performance Evaluation (Across FFS & MCO) Increased Need for Enhanced Analytics 15
16 Strategies for States Specialty Pharmacy Cost justifies individual and sub-population strategy Approach includes: Case identification Educational resources access and outreach through a Treatment Information Center Distribution management System edits/monitoring Compliance and Clinical Value Monitoring Provider contracting Limited network reduced reimbursement rate 1915(b)(4) Supplemental rebates (more efficient access greater profit opportunity) 16
17 Strategies for States Generic Drugs Access Improve/eliminate timing issue, access will improve Wholesaler contracting Agree to inventory levels Agree to price increase restraints Agree to restricted contracting Direct purchasing Supplemental rebates Direct purchasing Issue with limited access by providers Tipping point and mutual interest Administration analytics, monitoring, contracting 17
18 Strategies for States Statewide PDL / SR Preferred Drug List (Formulary) Currently MCOs Have Their Own Formularies Creates Difficulties and Administrative Challenges to Enforce Consistency and Compliance Statewide PDL Increases Rebates, Decreases Issues with Consistency Supplemental Rebates Based on PDL Above and Beyond CMS Rebates Individual MCO Formularies Fragment Buying Power (i.e., Lower Rebates) 1-2% vs 7%-8% Push Back MCOs Commercial PBMs Manufacturers 18
19 Questions Discussion 19
20 Thank You! To view the recording of this webinar and others, please visit: 20
MArch The 2014 Drug Trend Report Highlights
MArch 2015 The 2014 Drug Report Highlights Highest Increase in U.S. Drug Spend Over Past Decade In 2014, the pharmacy landscape underwent a seismic change, and the budgetary impact to healthcare payers
More informationMagellan Rx. A smarter approach to pharmacy benefits management
Magellan Rx A smarter approach to pharmacy benefits management Presented by: Cheri Caruso, VP of Sales, Magellan Rx Management Bryce Canfield, VP, Client Development, GoodRx A unique vision of care We
More informationApril 2o14. The 2013 Drug Trend Report Highlights
April 2o14 The 2013 Drug Trend Report Highlights Express Scripts Reports Lowest Specialty Drug Trend Since 2007 In 2013, spending on prescription drugs increased 5.4% after several years of slower-paced
More informationIdaho DUR Board Meeting Minutes
Idaho DUR Board Meeting Minutes Date: July 20, 2017 Time: 9am-12:30pm Location: Holiday Inn Boise Airport 2970 West Elder Street, Boise, Idaho, 83705 Moderator: David Agler, M.D. Committee Member Present:
More informationPrescription Drugs North Carolina Policies. Carol Steckel, MPH Medicaid Director
Prescription Drugs North Carolina Policies Carol Steckel, MPH Medicaid Director March 19, 2013 Pharmacy Services Optional service provided each year to about 1.5 million beneficiaries by 2,200 pharmacy
More informationTexas Vendor Drug Program. Formulary Drug Index File Layout. Layout effective: Jul. 2, 2018 Document update: Oct. 1, 2018
Texas Vendor Drug Program Formulary Drug Index File Layout Layout effective: Jul. 2, 2018 Document update: Oct. 1, 2018 The Vendor Drug Program provides a weekly update of resource data available for download
More informationMedication trends shaping workers compensation. A 2018 update of the prevailing industry influences impacting pharmacy outcomes
Medication trends shaping workers compensation A 2018 update of the prevailing industry influences impacting pharmacy outcomes This page intentionally left blank Trends impacting workers compensation pharmacy
More informationLegislative & Regulatory Update Brad Young, RxPlus Government Affairs
Legislative & Regulatory Update 2018 Brad Young, RxPlus Government Affairs Disclosures Brad Young reports no actual or potential conflicts of interest associated with this presentation. 2 Learning Objectives
More informationMedicaid Perspective
Prescription Opioid Fraud and Abuse: Medicaid Perspective Presenter: Gary P. Gilmore, B.S., R.Ph. Director, Analysis & Reporting Office of Clinical Affairs Deputy Director, Pharmacy Program Objectives:
More informationTexas Vendor Drug Program. Formulary Delimited File Layout. April 26, 2017
Texas Vendor Drug Program Formulary Delimited File Layout April 26, 2017 The Vendor Drug Program provides a weekly update of resource data available for download from txvendordrug.com/resources/downloads.
More information2017 Drug Trend Report Commercial Medicare Medicaid Exchanges
2017 Drug Trend Report Commercial Medicare Medicaid Exchanges Leading the way for patients and plans Our clients place a great deal of trust in Express Scripts. They ask us to care for their plan members
More informationMarket Distortions from the 340B Drug Pricing Program
Market Distortions from the 340B Drug Pricing Program Adam J. Fein, Ph.D. www.drugchannels.net @DrugChannels The opinions and views expressed in this presentation are those of the author and may not reflect
More informationMedicaid in South Carolina. South Carolina Medicaid in /19/2018. > FY 2017 Appropriation: $7.2 billion > Full benefit Membership: 1.
Medicaid in South Carolina > FY 2017 Appropriation: $7.2 billion > Full benefit Membership: 1.04 million South Carolina Medicaid in 2018 Bryan Amick SC Chapter, American Academy of Pediatrics 2018 CATCH
More informationRisk Classification Modeling to Combat Opioid Abuse
Risk Classification Modeling to Combat Opioid Abuse Improve Data Sharing to Identify High-Risk Prescribers of Opioids Christopher Sterling Chief Statistician NCI, Inc. www.nciinc.com 11730 Plaza America
More informationIdaho DUR Board Meeting Minutes
Idaho DUR Board Meeting Minutes Date: October 16, 2014 Time: 9am-2pm Location: Idaho Medicaid, 3232 Elder Street, Boise, Idaho, Conference Room D-West Moderator: Mark Turner, M.D. Committee Member Present:
More informationThe Un-Special World of Specialty Medications
The Un-Special World of Specialty Medications Manpreet Chahal, PharmD, PhD Oncology Pharmacist, Medical Oncology Associates, Spokane WA Adjunct Clinical Instructor, WSU College of Pharmacy mschahal@wsu.edu
More informationTHE GROWTH OF SPECIALTY PHARMACY
UnitedHealth Center for Health Reform & Modernization THE GROWTH OF SPECIALTY PHARMACY Current trends and future opportunities Issue Brief April 2014 Summary Innovative specialty drugs are providing important
More informationNote: Mandatory measures are those measures that are a requirement of accreditation and must be reported to URAC on an annual basis.
COMMUNITY PHARMACY V1.1 MANDATORY S Note: Mandatory measures are those measures that are a requirement of accreditation and must be reported to URAC on an annual basis. # NAME DESCRIPTION NUMERATOR DENOMINATOR
More information9/25/15. Pharmacy Quality Measures: Financial Support. Learning Objectives. Speaker Disclosure. Access to Preferred Networks and Clinical Performance
Pharmacy Quality Measures: Action Steps for Improvement Financial Support Financial support was provided for this activity through an unrestricted grant from Health Mart Systems, Inc. Christine Jacobson
More informationEvaluation of Specialty Pharmacy in an Integrated Health-System
Evaluation of Specialty Pharmacy in an Integrated Health-System Emma Chermely, PharmD, BCACP Alyssa McCann, PharmD, BCACP *The presenters have no conflicts of interest to disclose. Objectives Introduce
More informationChapter 6: Healthcare Expenditures for Persons with CKD
Chapter 6: Healthcare Expenditures for Persons with CKD In this 2017 Annual Data Report (ADR), we introduce information from the Optum Clinformatics DataMart for persons with Medicare Advantage and commercial
More informationOpioid Use and Misuse: History, Trends, And The Oregon Opioid Initiative
Opioid Use and Misuse: History, Trends, And The Oregon Opioid Initiative John W. McIlveen, Ph.D., LMHC, State Opioid Treatment Authority, Oregon Health Authority, Addictions and Mental Health Division
More informationDrug Prior Authorization Form Opdivo (nivolumab)
This document contains both information and form fields. To read information, use the Down Arrow from a form field. Drug Prior Authorization Form The purpose of this form is to obtain information required
More informationStatement Of. The National Association of Chain Drug Stores. For. U.S. Senate Committee on Finance. Hearing on:
Statement Of The National Association of Chain Drug Stores For U.S. Senate Committee on Finance Hearing on: 10:00 a.m. National Association of Chain Drug Stores (NACDS) 1776 Wilson Blvd., Suite 200 Arlington,
More informationManaging Opioid Overutilization Challenges
One Source. Lower Cost. Better Care. Managing Opioid Overutilization Challenges A LOOK AT REDUCING OPIOID OVERUTILIZATION BY 36 PERCENT Copyright 2017 MedImpact Healthcare Systems, Inc. All rights reserved.
More informationSession 169 L, Quantifying Excess Specialty Drug Risk. Moderator: Patrick Gallagher, FSA, FCAS. Presenters: Robert Bachler, FSA, FCAS, MAAA
Session 169 L, Quantifying Excess Specialty Drug Risk Moderator: Patrick Gallagher, FSA, FCAS Presenters: Patrick Gallagher, FSA, FCAS Robert Bachler, FSA, FCAS, MAAA SOA Antitrust Disclaimer SOA Presentation
More information2017 Drug Trends Series
2017 Drug Trends Series Part 1 Evaluating the traditional view Retail and mail-order prescriptions Published April 2018 1 2017 Drug Trends Series Traditional View First Script A year of important progress
More informationThe Risky Business of Claims-Only Risk Adjustments
The Risky Business of Claims-Only Risk Adjustments August 3 rd & 4 th, 2016 Presented by: Kim Browning Executive Vice President Vince Bryant Vice President of Business Development Agenda 2 Plan Selection
More informationPBMs: Impact on Cost and Quality of Pharmaceutical Care in the U.S.
Speaker Brian K. Solow, MD, FAAFP Optum Life Sciences Irvine, CA, USA PBMs: Impact on Cost and Quality of Pharmaceutical Care in the U.S. Brian K. Solow, MD, FAAFP Chief Medical Officer, Optum Life Sciences
More informationInnovative Ways to Fund Harm Reduction Services New Mexico
Innovative Ways to Fund Harm Reduction Services New Mexico Laine M. Snow, MSW HIV Service Program Manager New Mexico Department of Health History and Importance of Harm Reduction New Mexico Sero-prevalence
More informationCost of Mental Health Care
Section 4 Cost of Mental Health Care Per capita mental health spending for Americans with a mental health diagnosis has increased among children, peaking in. For adults, the spending has been more stable.
More information2017 URAC PHARMACY BENEFIT MANAGEMENT PERFORMANCE MEASUREMENT: AGGREGATE SUMMARY PERFORMANCE REPORT
2017 URAC PHARMACY BENEFIT MANAGEMENT PERFORMANCE MEASUREMENT: AGGREGATE SUMMARY PERFORMANCE REPORT December 2017 Table of Contents Executive Summary... 1 Pharmacy Benefit Management Organization Characteristics...
More informationusing analytics to identify and strategically manage patient opioid abuse
using analytics to identify and strategically manage patient opioid abuse Philip Finocchiaro, MD, FACP Senior Medical Director, Quality and Clinical Outcomes Verscend Olivia Mapplethorpe Senior Client
More information2125 Rayburn House Office Building 2125 Rayburn House Office Building Washington, DC Washington, DC 20515
The Honorable Greg Walden Chairman Ranking Member 2125 Rayburn House Office Building 2125 Rayburn House Office Building Washington, DC 20515 Washington, DC 20515 Chairman Ranking Member Subcommittee on
More informationHow to Conduct an Effective Medication Therapy Management Session in the Community Pharmacy
How to Conduct an Effective Medication Therapy Management Session in the Community Pharmacy Presented by: Dale Christensen, University of North Carolina Susmita Chavala, Humana Ed Staffa, Community MTM
More informationEvaluation of a Medicaid Psychotropic Drug Management Program in Utah
Evaluation of a Medicaid Psychotropic Drug Management Program in Utah Dominick Esposito James M. Verdier 2008 SAMHSA/CMS Invitational Conference on Medicaid and Mental Health Service/Substance Abuse Treatment
More informationRestrictions to HCV Treatment in State Medicaid Programs
Center for Health Law and Policy Innovation of Harvard Law School Restrictions to HCV Treatment in State Medicaid Programs Acknowledgements: We are in the midst of merging/comparing data with other analysts
More informationTexas Vendor Drug Program. Pharmacy Provider Procedure Manual. Vitamin and Mineral Products. Effective Date. November 2017
Texas Vendor Drug Program Pharmacy Provider Procedure Manual Vitamin and Mineral Products Effective Date November 2017 The Pharmacy Provider Procedure Manual (PPPM) is available online at txvendordrug.com/about/policy/manual.
More informationClinical Therapeutic Intelligence Report: Year in Review
Clinical Therapeutic Intelligence Report: Year in Review Last year marked a productive year for oncology drug research and development with ten new oncology drugs coming to market two of which were granted
More information2016 Drug Trends Series
Drug Trends Series Part 3: Assessing opioids and compounds Published August 2017 1 Drug Trends Series Opioids & Compounds First Script Introduction As with the first two editions in Coventry s Drug Trends
More informationNote: Mandatory measures are those measures that are a requirement of accreditation and must be reported to URAC on an annual basis.
Note: Mandatory measures are those measures that are a requirement of accreditation and must be reported to URAC on an annual basis. DESCRIPTION NUMERATOR DENOMINATOR DM2012-12 Portion of Days Covered
More informationMedication Therapy Management: Improving Health and Saving Money
Medication Therapy Management: Improving Health and Saving Money Ed Staffa, RPh Vice President, Pharmacy Mirixa Corporation estaffa@mirixa.com July 23, 2008 MTM At A Glance The U.S. health care system
More informationChairwoman Bono Mack, Vice-Chairwoman Blackburn, Ranking Member Butterfield and
United States House of Representatives Committee on Energy and Commerce Subcommittee on Commerce, Manufacturing and Trade Hearing on Chairwoman Bono Mack, Vice-Chairwoman Blackburn, Ranking Member Butterfield
More informationIllinois Prescription Monitoring Program. Sarah Pointer, Pharm D. Clinical Director of the Illinois Prescription Monitoring Program
Illinois Prescription Monitoring Program Sarah Pointer, Pharm D. Clinical Director of the Illinois Prescription Monitoring Program Agenda Provide an overview of the Illinois Prescription Monitoring Program
More informationChanges to the Eighth Edition
Pharmacy Practice and the Law, Eighth Edition Includes Navigate 2 Advantage Access By Richard R. Abood, BS Pharm, JD-Professor Emeritus Pharmacy Practice, Thomas J. Long School of Pharmacy and Health Sciences,
More informationThe University of Mississippi School of Pharmacy
LONG TERM PERSISTENCE WITH ACEI/ARB THERAPY AFTER ACUTE MYOCARDIAL INFARCTION: AN ANALYSIS OF THE 2006-2007 MEDICARE 5% NATIONAL SAMPLE DATA Lokhandwala T. MS, Yang Y. PhD, Thumula V. MS, Bentley J.P.
More informationKentucky Department for Medicaid Services. Drug Review Options
Kentucky Department for Medicaid Services Drug Review Options The following chart lists the agenda items scheduled and the options submitted for review at the November 21, 2013 meeting of the Pharmacy
More informationCoding for Care: Using Data Analytics for Risk Adjustment. March 2, 2016 Clive Fields, MD, President, Village Family Practice
Coding for Care: Using Data Analytics for Risk Adjustment March 2, 2016 Clive Fields, MD, President, Village Family Practice Conflict of Interest Clive Fields, MD, has no real or apparent conflicts of
More informationE-Prescribing, EPCS & PDMP: An Update
E-Prescribing, EPCS & PDMP: An Update Melissa A. Kotrys, MPH Chief Executive Officer July 27, 2018 Arizona Health-e Connection is now Health Current Arizona s primary resource for health information technology
More informationThe Prescription Drug Overdose Epidemic
The Prescription Drug Overdose Epidemic Rita Noonan, PhD National Center for Injury Prevention and Control Centers for Disease Control and Prevention National Center for Injury Prevention and Control Division
More informationMassachusetts Department of Developmental Services Medication Review
University of Massachusetts Medical School escholarship@umms Commonwealth Medicine Publications Commonwealth Medicine 8-7-2012 Massachusetts Department of Developmental Services Medication Review Alexandra
More informationDeconstructing the RADV: The Past, Present, and Future of RADV
Deconstructing the RADV: The Past, Present, and Future of RADV May 24, 2016 Presented by: Kim Browning, CHRS, PMP, CHC Executive Vice President Agenda 2 PY 2007 What We ve Learned PY 2011 Expectations
More informationExecutive Summary. Classes Under Review: Analysis:
Outcome Report on MHQAC Edits Classes Under Review: Analysis: Atypical Antipsychotics, SSRIs, SNRIs, Antianxietals, Hypnotics, and Drugs to Treat ADD/ADHD Utilization and Cost Trends: Pre and Post Implementation
More informationStatement Of. The National Association of Chain Drug Stores. For. U.S. House of Representatives Committee on the Budget.
Statement Of The National Association of Chain Drug Stores For U.S. House of Representatives Committee on the Budget Hearing on: 2:00 p.m. 210 Cannon House Office Building National Association of Chain
More informationSubmitted to the House Energy and Commerce Committee. Federal Efforts to Combat the Opioid Crisis
STATEMENT FOR THE RECORD Submitted to the House Energy and Commerce Committee Federal Efforts to Combat the Opioid Crisis October 25, 2017 America s Health Insurance Plans 601 Pennsylvania Avenue, NW Suite
More informationTri-County Region Opioid Trends Clackamas, Multnomah, and Washington, Oregon. Executive Summary
Tri-County Region Opioid Trends Clackamas, Multnomah, and Washington, Oregon 2016 Executive Summary 20.8 million people in the United States have a substance use disorder (not limited to opioids), equivalent
More informationMassachusetts Department of Developmental Services. Medication Review
Massachusetts Department of Developmental Services Medication Review NASDDDS Reinventing Quality August 7, 2012 Alixe Bonardi 1, Gail Grossman 2 Emily Lauer 1 1 University of Massachusetts Medical School
More informationMEASURE STEWARD Pharmacy Quality Alliance (PQA) D ATA SOURCE Enrollment; U R A C DOMAIN Engagement & Experience of Care
MANDATORY S Note: Mandatory measures are those measures that are a requirement of accreditation and must be reported to URAC on an annual basis. DM2012-12 DTM2015-01 Portion of Days Covered (PDC) Adherence
More informationSummary of Related Documentation Pennsylvania House Bill 1846 of 2014
Summary of Related Documentation Pennsylvania House Bill 1846 of 2014 15 November 2018 Department of Labor & Industry BWC-Administrative Division 1171 S. Cameron St. Harrisburg PA 17104-2501 Essential
More informationPrescription for Disaster: Impact of Drugs in our Society
Prescription for Disaster: Impact of Drugs in our Society What you can do about the epidemic of drug abuse in our communities 1 Florida Poison Information Center-Tampa 10/26/2012 Cynthia R. Lewis-Younger,
More informationIdaho DUR Board Meeting Minutes
Idaho DUR Board Meeting Minutes Date: January 21, 2016 Time: 9am-1:30pm Location: Idaho Medicaid, 3232 Elder Street, Boise, Idaho, Conference Room D-West Moderator: Mark Turner, M.D. Committee Members
More informationImproving Mental Health Care: A Case Study
Improving Mental Health Care: A Case Study Why Improve Mental Health Care? Because the prevalence and costs of mental health problems are increasing in America despite the high prescribing of psychotropic
More informationKeytruda. Keytruda (pembrolizumab) Description
Federal Employee Program 1310 G Street, N.W. Washington, D.C. 20005 202.942.1000 Fax 202.942.1125 5.21.50 Subject: Keytruda Page: 1 of 5 Last Review Date: June 24, 2016 Keytruda Description Keytruda (pembrolizumab)
More informationFriend or Foe? Review of the Regulations & Benefits: Risk Profiles of the Benzodiazepines
Friend or Foe? Review of the Regulations & Benefits: Risk Profiles of the Benzodiazepines Program Learning Objectives At the conclusion of the activity, participants should be able to: Have a basic understanding
More informationToday s Presenters. Pills, Providers, and Problems: How to Investigate Drug Diversion in Long-Term Care
Pills, Providers, and Problems: How to Investigate Drug Diversion in Long-Term Care 203 - Monday, April 16, 2018 Today s Presenters Ben Purser Former F.B.I. Special Agent Donna Thiel ProviderTrust Chief
More informationThe Louis de la Parte Florida Mental Health Institute
Data Brief December 2003 Mary Rose Murrin, M.A. Kelley Dhont, M.S. David Thornton, M.A. The Louis de la Parte Florida Mental Health Institute Children s Psychotropic Medication Use by Age and Diagnostic
More informationWebinar Series: Diabetes Epidemic & Action Report (DEAR) for Washington State - How We Are Doing and How We Can Improve.
Webinar Series: Diabetes Epidemic & Action Report (DEAR) for Washington State - How We Are Doing and How We Can Improve April 22, 2015 Qualis Health A leading national population health management organization
More informationUSING MTM TO IMPROVE STAR RATINGS : CASE STUDIES
USING MTM TO IMPROVE STAR RATINGS : CASE STUDIES Sept 13, 2015 Amanda Applegate, PharmD, BCACP Disclosures Nothing to disclose Learning Objectives Describe how MTM can improve star ratings Discuss strategies
More informationCost-Motivated Treatment Changes in Commercial Claims:
Cost-Motivated Treatment Changes in Commercial Claims: Implications for Non- Medical Switching August 2017 THE MORAN COMPANY 1 Cost-Motivated Treatment Changes in Commercial Claims: Implications for Non-Medical
More informationUp to $402,000. Insight HIV. Drug Class. 1.2 million people in the United States were living with HIV at the end of 2011 (most recent data).
HIV Background, new developments, key strategies Drug Class Insight INTRODUCTION Human Immunodeficiency Virus (HIV) is the virus that can lead to Acquired Immunodeficiency Syndrome, or AIDS. No safe and
More informationAbout the PCTB Examination Assisting the Pharmacist in Serving Patients p. 1 Filling the Medication Order p. 3 Receiving the Medication Order p.
Preface p. ix About the PCTB Examination p. xii Assisting the Pharmacist in Serving Patients p. 1 Filling the Medication Order p. 3 Receiving the Medication Order p. 4 The Retail Medication Order p. 6
More informationCyber Liability and Crime Update
Cyber Liability and Crime Update Cyber Liability Probability of a Data Breach 2 3 Cyber Liability Challenges Carriers are not as forthcoming with sharing data as we would like to see Large uptick in ransomware
More informationRe: Docket No. FDA-2009-N-0294 Regulation of Tobacco Products; Request for Comments
VIA Electronic Submission to http://www.regulations.gov September 29, 2009 Division of Dockets Management (HFA-305) Food and Drug Administration 5630 Fishers Lane, rm. 1061 Rockville, MD 20852 Re: Docket
More informationImplementing Pain and Opioid Management Guidelines in Primary Care Practice
Implementing Pain and Opioid Management Guidelines in Primary Care Practice Objectives 1. What is the issue? 2. Why use a dedicated dissemination & implementation process? a. Historical perspective Cooperative
More informationUpdate to HMO Drug Formulary Tier Definitions. February 8, 2018
Update to HMO Drug Formulary Tier Definitions February 8, 2018 Agenda 1 Overview of Current Drug Tiers 2 Proposed Drug Tiers for 2019 3 Impact to SFHSS and SFHSS Members 4 How the Drug Formulary Works
More informationModule 6: Substance Use
Module 6: Substance Use Part 1: Overview of Substance Abuse I am Martha Romney and I am presenting on substance abuse. This module focuses on the healthy people 2020 objective to reduce substance abuse
More informationMarket Potential for MDX Alcobra Investor Breakfast July 15, 2014
Market Potential for MDX Alcobra Investor Breakfast July 15, 2014 Forward Looking Statement This presentation includes statements that are, or may be deemed, forward-looking statements. In some cases,
More informationMedication trends shaping workers compensation. A 2018 mid-year review of the prevailing industry influences impacting pharmacy outcomes
Medication trends shaping workers compensation A 2018 mid-year review of the prevailing industry influences impacting pharmacy outcomes OPTUM WORKERS COMPENSATION DATA SET Analysis of our data, the industry
More informationSanofi Press Breakfast on Behavioral Science. Friday 22 September 2017
Sanofi Press Breakfast on Behavioral Science Friday 22 September 2017 Agenda WHY UNDERSTANDING BEHAVIORS CAN UNLOCK CARE SUCCESS 8.45-9.00 Welcome coffee 9.00 Kick-off 9.00-9.10 Introduction by Alexandra
More informationIssues for Part D Compliance
HCCA- MEDICARE PRESCRIPTION DRUG PART D COMPLIANCE CONFERENCE Issues for Part D Compliance Craig Miner, RPh, JD Division of Drug Plan Policy Babette S. Edgar, Pharm.D., MBA Division of Finance and Operations
More information05/01/2014. Medicare has 4 parts A: Hospital coverage National Training Program. Session Objectives. The Basics. B: Outpatient medical coverage
2015 National Training Program Medicare Prescription Drug Coverage Parts A, B and D Session Objectives This session should help you Differentiate when/under what scenarios drugs are covered under the various
More informationPharmacy Trends and Management Opportunities. Kerry Bendel, R.Ph. Director of Pharmacy Medica
Pharmacy Trends and Management Opportunities Kerry Bendel, R.Ph. Director of Pharmacy Medica September 14, 20 1 Agenda Pharmacy Trend Experience Trend Drivers and Management Opportunities Call to Action
More informationCurbing Prescription Drug Abuse in Medicaid
Curbing Prescription Drug Abuse in Medicaid Joint Legislative Health Care Oversight Committee October 12, 2010 Dr. Lisa Weeks, BSPharm, PharmD Pharmacy and Ancillary Services Division of Medical Assistance
More informationQIOs: Partners for Quality Improvement Under the Medicare Drug Benefit
QIOs: Partners for Quality Improvement Under the Medicare Drug Benefit Presentation to The 2 nd Annual National Medicare Prescription Drug Congress David Schulke Executive Vice President The American Health
More informationDrug Formulary Update, October 2013
Drug Formulary Update, October 2013 Updates to the HealthPartners Drug Formularies are listed below. Updates for the Commercial Drug Formularies and the Minnesota Health Care Programs (Medicaid and Minnesota
More informationHOPE Agenda. Heroin, Opioid Prevention & Education WISCONSIN STATE REPRESENTATIVE JOHN NYGREN ASSEMBLY DISTRICT 89
HOPE Agenda Heroin, Opioid Prevention & Education WISCONSIN STATE REPRESENTATIVE JOHN NYGREN ASSEMBLY DISTRICT 89 In compliance with CMA regulation, I attest that I have no conflicts of interest associated
More informationOutpatient use of Atypical Antipsychotic Agents in the Pediatric Population Years
Outpatient use of Atypical Antipsychotic Agents in the Pediatric Population Years 2004-2008 Laura Governale, Pharm.D., MBA Team Leader, Drug Utilization Data Analyst Hina Mehta, Pharm.D. Drug Utilization
More informationHow Mail-Servi. Prepared for
How Mail-Servi ice Pharmacies Will Save $46.6 Billion Over the Next Decade and the Cost of Proposed Restrictions Prepared for February 2012 Table of Contents I. Executive Summary... 3 Major Findings on
More informationPHARMACY BENEFITS MANAGER SELECTION FAQ FOR PRODUCERS
PHARMACY BENEFITS MANAGER SELECTION FAQ FOR PRODUCERS For Producer Audience Only - Please Do Not Distribute Regence has selected Prime Therapeutics as the Pharmacy benefits manager for its health plans.
More informationKeytruda. Keytruda (pembrolizumab) Description
Federal Employee Program 1310 G Street, N.W. Washington, D.C. 20005 202.942.1000 Fax 202.942.1125 5.21.50 Subject: Keytruda Page: 1 of 6 Last Review Date: September 15, 2017 Keytruda Description Keytruda
More informationCONFRONTING THE OPIOID EPIDEMIC. e-book: Introducing OptumRx Opioid Risk Management
CONFRONTING THE OPIOID EPIDEMIC 2 0 1 8 OPIOID ABUSE IS A CRISIS IN THE U.S. OptumRx Opioid Risk Management attacks this complex, deeply embedded problem with a comprehensive approach featuring five interrelated
More information29 August 2016 Page 1 of 7. How does the NHS board decide which new medicines to make available for patients?
NHS Greater Glasgow and Clyde: New Medicines Decisions In Scotland, a newly licensed medicine is routinely available for use in an NHS board only after it has been: accepted for use in the NHSScotland
More informationUnderstanding Hierarchical Condition Categories (HCC)
Understanding Hierarchical Condition Categories (HCC) How hierarchical condition category coding will impact your practice and how you can use these codes to increase quality, improve the patient experience,
More informationATS 2013 International Conference May Philadelphia Pennsylvania
American Journal of Respiratory and Critical Care Medicine American Journal of Respiratory Cell and Molecular Biology Proceedings of the American Thoracic Society STEPHEN C. CRANE, PhD, MPH Executive Director
More informationMedicare Advantage Outreach and Education Bulletin
Medicare Advantage Outreach and Education Bulletin Blue Cross and Blue Shield of Georgia Prescription Drug Monitoring Programs Prescription drug abuse and diversion are acute problems in the area of pain
More informationCalifornia Workers Compensation Prescription Drug Utilization & Payment Distributions, : Part 1
California Workers Compensation Prescription Drug Utilization & Payment Distributions, 2009-2018: Part 1 Bob Young and Steve Hayes Background Over the past two decades, public policymakers in California
More informationManaged Care Trends in Statin Usage GARY R. BAZALO, MS, MBA
PHARMACY UTILIZATION Managed Care Trends in Statin Usage GARY R. BAZALO, MS, MBA ABSTRACT Purpose HMG-CoA reductase inhibitors ( statins ) have become the drug class of choice for the treatment of hyperlipidemia.
More informationMinimizing Rx Opioid Fraud and Abuse While Maintaining Appropriate Access for Patients In Need. Best Practices for Rx Payers
Minimizing Rx Opioid Fraud and Abuse While Maintaining Appropriate Access for Patients In Need Best Practices for Rx Payers William J. Mahon The MAHON Consulting Group LLC THCI Program on Opioid Risk Management
More information