Drug Utilization Review & Cost Reduction Strategies. Esther Liu, PharmD, MSIA, CGP Clinical Pharmacist Outcome Resources
|
|
- Janice Shelton
- 5 years ago
- Views:
Transcription
1 Drug Utilization Review & Cost Reduction Strategies Esther Liu, PharmD, MSIA, CGP Clinical Pharmacist Outcome Resources
2 Goals and Objectives Define Drug Utilization Reviews Interpret various performance indicators such as Benchmarking Data Conduct Cost-Effective Analysis Perform Cost Reduction Strategies
3 Drug Utilization Review (DUR) Definition - an authorized, structured, ongoing review of prescribing, dispensing and use of medications against predetermined criteria that results in changes to drug therapy DUR is classified in three categories: Prospective - evaluation of a patient's drug therapy before medication is dispensed Concurrent - ongoing monitoring of drug therapy during the course of treatment Retrospective - review of drug therapy after the patient has received the medication
4 Drug Utilization Review (DUR) Common terms: Drug Use Evaluation (DUE) Medication Use Evaluation (MUE) Used by American Society of Health System Pharmacist (ASHP) Medication use Management Pharmaceutical Utilization Management Used by National Committee for Quality Assurance (NCQA)
5 Drug Utilization Review (DUR) Why is it important? Mandated by the Government agencies NCQA, CMS, Medicaid Ensure appropriate, safe and effective use of drugs Identify opportunities to lower the overall cost of care Evaluate the benefit of intervention in enhancing therapeutic and economic outcomes
6 Drug Utilization Review (DUR) How is DUR done? Population Level (CMS, Medicaid, Public Health) Retrospective Organization Level (PBM, Hospice Administrators) Retrospective and Concurrent Patient level (Individual Clinicians) Prospective and Concurrent
7 Questions?
8 Tools for DUR Performance Indicators Benchmarking Cost-Effective Analysis (CEA)
9 Performance Indicators DUR is usually done against a set of Predetermined criteria These criteria are called Performance Indicators The indicators can be Patient s historical record Population s average Gold practice standards
10 Performance Indicators - Examples Performance Indicators Individual Level Criteria Population Level Criteria Drug Interactions Warfarin and Cipro # of patients on with Cipro with no Warfarin dose change Duplicate Therapy Advair and Symbicort # of patients with both Advair and Symbicort, Cost of the duplicated Therapy High Dose Alert >400mg Tramadol per day Avg Qty of Tramadol 50mg prescribed for a facility is > 8 per day High Cost Alert Use of Dexilant # of Dexilant Rxs for the facility Bowel Regimen for Chronic Opioid Use No Bowel Regimen while on long acting opioid % patient not on bowel regimen when receiving long acting opioids
11 Benchmarking Benchmarking a process of comparison between the performance characteristics of separate, often competing organizations intended to enable each participant to improve its own performance in the marketplace Usually done at a population level Example: CMS benchmark study Outcome Resources benchmarking data
12 Benchmarking Data - Example Outcome Resources Benchmarks: Cost per patient per day Cost per prescription Prescriptions per patient % cost on opioids, antipsychotics, PPI
13 Cost- Effective Analysis (CEA) Often used in Scientific Research It can get sophisticated! You may have been using it everyday! Esther s definition The cost comparison to achieve the same effect Example: Walmart vs. Baby R Us Methadone vs. Oxycontin
14 Questions?
15 Cost Reduction Strategies Who cares? Government Scientist/Researcher Healthcare administrators PBM/payers Individual clinicians Goal: Reduce cost while enhancing patient care and outcomes
16 Cost Reduction Strategy #1 Patient Medication Profile Directed Review the complete medication profile, diagnosis, allergy information Identify drug interactions, duplication in therapy, appropriateness of dosing and indications Required by Hospice s Condition of Participation (CoPs) Goal: Reduce cost in duplicated therapy and medications without indication Reduce cost in managing complications resulted from drug interactions, etc Reduce cost in violation to CoPs
17 Example Patient A Terminal Diagnosis: End Stage Lung Cancer Medications: Medications Direction Monthly Price ProAir (albuterol) Q4h PRN $20 DuoNeb (albuterol/ipratropium) QID and PRN $131 Advair (fluticasone/salmeterol) BID $325 Flovent (fluticasone) BID PRN $202 Prednisone 10mg daily $10 Total Cost before review $688 Saved >$500 after review for duplication!
18 Cost Reduction Strategy #2 Performance indicator directed Review summary of medication utilization data against benchmarking data or clinical gold standards Use the appropriate benchmarking data for comparison Evaluate how well your hospice is in comparison to the rest of the hospice industry Focus efforts on indicators that are significantly different from the benchmarking data Goal: Identify problem area Direct improvement plans
19 Example Hospice A Hospice A spent 25% on opioids, when its administrator wants to find out how well they are doing, what should they compare this to? A. 45% Opioid spend in neighboring Hospice B B. 28% Opioid spend at Outcome Resources (national PBM for hospice only) C. 10% Opioid spend at Humana (national PBM for Medicare Part D and Commercial business) D. 12% Opioid spend for seniors >65 years old from a published research article done in US
20 Cost Reduction Strategy #3 Cost-Effectiveness Directed Review medications used within the same class or for the same indication Observe prescribing pattern Goals: Help reduce cost with minimum impact on care quality Evaluate medication substitute/conversion programs Support formulary decisions
21 Example Opioids Rx Counts Cost Oxycontin Morphine ER Fentanyl Methadone Oxycontin 80mg q12h $900 Morphine ER 100mg q12h $350 Fentanyl 100mcg q72h $450 Methadone 10mg q12h $15
22 Questions
23 Practice Case #1 Hospice Data See handouts
24 Practice Case #2 Patient Profile See handouts
25 Summary DUR can improve quality of care and reduce cost DUR should be done routinely by clinicians together with administrators Benchmarking data can be use to identify direction of improvement Cost reduction strategies should not only focus on cost but also clinical outcomes Let the numbers take you to opportunities! Get the clinicians involved!
26 References 1. American Society of Health-System Pharmacists. ASHP guidelines on Medication- Use Evaluation, published Vol.53: National Committee for Quality Assurance. NCQA Health Plan Accreditation, Available at 3. Academy of Managed Care Pharmacy. Drug Utilization Review. Approved by AMCP Board of Directors November Navarro, Robert. Chapter 8: Drug Utilization Review Strategies. Managed Care Pharmacy Practice, published pp Kay, Jay. Health Care Benchmarking. Medical Bulletin. Vol.12 No.2 February U.S.Congress.H.R.1, Medicare Prescription Drug Improvement and Modernization Act of 2003, Public Law , 108 th Congress. Published December 2003.
Curbing 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 informationNavigating the Road to Efficient Medication Use
Navigating the Road to Efficient Medication Use Molly R. Sinert, RPh, PharmD Clinical Pharmacist HospiScript Services LLC a Catamaran Rx Company October 28, 2013 Objectives Describe the components of the
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 informationFollow-up to Previous Reviews
21 January 2016 1 Follow-up to Previous Reviews Patients Receiving > 1 Long-Acting Opioid Multiple Dosage Forms of Aripiprazole Prescribed Concomitantly Multiple Dosage Forms of Oral Paliperidone Prescribed
More informationA 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 informationAmy Larrick Chavez-Valdez, Director, Medicare Drug Benefit and C & D Data Group
DEPARTMENT OF HEALTH & HUMAN SERVICES Centers for Medicare & Medicaid Services 7500 Security Boulevard Baltimore, Maryland 21244-1850 CENTER FOR MEDICARE TO: FROM: SUBJECT: All Part D Sponsors Amy Larrick
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 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 informationA 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 informationMedications 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 informationStark County Safety Council Presentation: Opioid & Anti-Anxiety Medication Use Among Ohio s Injured Workers
Stark County Safety Council Presentation: Opioid & Anti-Anxiety Medication Use Among Ohio s Injured Workers June 11, 2015 John Hanna, R.Ph. BWC, Pharmacy Director 6/24/2015 BWC Pharmacy Program Overview
More informationA 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 informationUSE OF OPIODS AT HIGHER DOSES IN PERSONS WITHOUT CANCER: MORPHINE EQUIVALENT DOSE EDIT
BACKGROUND: USE OF OPIODS AT HIGHER DOSES IN PERSONS WITHOUT CANCER: MORPHINE EQUIVALENT DOSE EDIT Approximately 10% of patients who are prescribed opioids and seek care from multiple doctors, are prescribed
More informationManaged Care Pushes for Safer Opioid Oversight
Page 1 of 6 Clinical AUGUST 11, 2017 Managed Care Pushes for Safer Opioid Oversight High-risk pain Rx eyed Denver Health systems haven t escaped the nation s ongoing opioid crisis, as evidenced by surging
More informationAn Evaluation of the DoD Transdermal Fentanyl Pharmacy Edit. LTC Stacia Spridgen, MSC, USA Director, DoD Pharmacoeconomic Center
An Evaluation of the DoD Transdermal Fentanyl Pharmacy Edit LTC Stacia Spridgen, MSC, USA Director, DoD Pharmacoeconomic Center 1 TRICARE Eligible Beneficiaries Monthly Average, FY08 Retirees & Family
More informationOpioid epidemic and PEHP
Opioid epidemic and PEHP Agenda Overview of opioid crisis Utah perspective PEHP: clinical interventions Impact of interventions Why are we here? In the 1990s, the medical establishment came to believe
More informationApril 26, New Mexico Board of Pharmacy Prescription Monitoring Program (PMP) New Mexico Board of Pharmacy Prescription Monitoring Program (PMP)
New Mexico Board of Pharmacy Prescription Monitoring Program (PMP) New Mexico Nurse Practitioner Council New Mexico Board of Pharmacy Prescription Monitoring Program (PMP) Peter Ryba, PharmD PMP Director
More informationDo not open the test booklet prior to being told to do so.
Last Name: Pharmacy 4054 Pharmacy Law Exam II Do not open the test booklet prior to being told to do so. I, the undersigned student, agree to do my best on the exam and that I have only used resources
More information1. A patient receives the wrong drug (ex. verified Amox 875 drug dispensed should have been Augmentin 875)
July 12, 2018 Topic: Errors and Omissions Medications errors are made everyday. It is the job of the Pharmacist to prevent these errors from occurring. The right drug to the right patient at the right
More informationHospice High Dollar Medications and Possible Alternatives
Hospice High Dollar Medications and Possible Alternatives Ly M. Dang, PharmD LDang@HospicePharmacySolutions.com Director of Pharmacy Operations Hospice Pharmacy Solutions Topics of Discussion Hospice Coverage
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 informationPrescription Drug Monitoring Program (PDMP)
Prescription Drug Monitoring Program (PDMP) District of Columbia Information contained in this presentation is accurate as of September 2017 Meet the Speaker Tadessa Harper-Nichols Program Specialist Pharmaceutical
More informationThe Wisconsin Prescription Drug Monitoring Program
The Wisconsin Prescription Drug Monitoring Program DHS 2018 WI Opioid Forum April 12, 2018 Learning Objectives 1. How the WI epdmp supports healthcare professionals in making informed prescribing, dispensing
More informationMedicare Part D Opioid Policies for 2019 Information for Patients
CENTERS FOR MEDICARE & MEDICAID SERVICES Medicare Part D Opioid Policies for 2019 Information for Patients Introduction Prescription opioid pain medications like oxycodone (OxyContin ), hydrocodone (Vicodin
More informationThe Wisconsin Prescription Drug Monitoring Program. WI PDMP Timeline. PDMP Overview. What is a PDMP? PDMPs Across the Nation. Wisconsin.
The Wisconsin Prescription Drug Monitoring Program Wisconsin Nurses Association Jail Health Care Conference May 21, 2018 WI PDMP Timeline PDMP Overview January 2013 WI PDMP operational April 2017 WI epdmp
More informationSTEP THERAPY IN MEDICARE PART D
STEP THERAPY IN MEDICARE PART D Sarkis Kavarian, PharmD Candidate 15 Preceptor Dr. Craig Stern Pro Pharma Pharmaceutical Consultants, Inc. May 1 st, 2015 Objectives Why is this important? Medicare Part
More informationMedicare Part D Prescription Opioid Policies for 2019 Information for Pharmacists
CENTERS FOR MEDICARE & MEDICAID SERVICES Medicare Part D Prescription Opioid Policies for 2019 Information for Pharmacists Background Opioid medications are effective at treating certain types of pain,
More informationA Bill Regular Session, 2015 SENATE BILL 717
Stricken language would be deleted from and underlined language would be added to present law. 0 State of Arkansas 0th General Assembly As Engrossed: S// H// A Bill Regular Session, SENATE BILL By: Senator
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 informationChronic Pain Pharmacist role in the clinic
Chronic Pain Pharmacist role in the clinic WSPA Annual Meeting 2015 Alvin Goo, PharmD Clinical Associate Professor University of Washington Schools of Pharmacy and Family Medicine Speakers Declaration
More informationMedi Cal Managed Care. Melissa Lamer, PharmD, BCPP July 31 st, 2014
Pharmacy Benefit Carve Outs in Medi Cal Managed Care Melissa Lamer, PharmD, BCPP July 31 st, 2014 2 The Behavioral Health Carve Out Services Carved Out to the County Starting 1/1/2014 Medi Cal plans now
More informationMedicaid and the Opioid Crisis
Medicaid and the Opioid Crisis Erica Floyd Thomas Bureau Chief of Medicaid Policy Agency for Health Care Administration Presented to: Medical Care Advisory Committee March 20, 2018 1 Florida Medicaid Covers
More informationIdaho DUR Board Meeting Minutes
Date: July 16, 2015 Time: 9am-1:30pm Idaho DUR Board Meeting Minutes Location: Idaho Medicaid, 3232 Elder Street, Boise, Idaho, Conference Room D-West Moderator: Mark Turner, M.D. Committee Member Present:
More informationChallenges for U.S. Attorneys Offices (USAO) in Opioid Cases
Challenges for U.S. Attorneys Offices (USAO) in Opioid Cases Overview On August 2, 2017, U.S. Attorney General Jeff Sessions announced a pilot program whereby a new federal data analysis program is being
More informationAddressing Challenges Together, One Rock at a Time
Addressing Challenges Together, One Rock at a Time PAMELA SCHWEITZER, PHARM.D., BCACP ASSISTANT SURGEON GENERAL REAR ADMIRAL (RADM), U.S. PUBLIC HEALTH SERVICE E-MAIL: PAMELA.SCHWEITZER@CMS.HHS.GOV @USPHSPHARMACY
More informationBackground. CMS finalized new policies for Medicare drug plans to follow starting on January 1,2019.
Background CMS finalized new policies for Medicare drug plans to follow starting on January 1,2019. These policies involve further partnershipwith providers and prescription drug plans. Providers are in
More informationDose equivalent of fentanyl patch to oxycontin
Dose equivalent of fentanyl patch to oxycontin 10-3-2018 Detailed dosage guidelines and administration information for OxyContin (oxycodone hydrochloride). Includes dose adjustments, warnings and precautions.
More informationSee Important Reminder at the end of this policy for important regulatory and legal information.
Clinical Policy: Reference Number: HIM.PA.139 Effective Date: 12.01.17 Last Review Date: 02.18 Line of Business: Health Insurance Marketplace Revision Log See Important Reminder at the end of this policy
More informationDuquesne University Mylan School of Pharmacy
Duquesne University Mylan School of Pharmacy Course Title: Pharmacy in Long Term Care Academic Semester: Fall 2016 Course Number: PHPR 466 Credits: 3 Prerequisites: None Course Hours: Tuesday 6-9 pm Please
More information15mg oxycodone is equivalent to how much morphine
15mg oxycodone is equivalent to how much morphine The Borg System is 100 % 15mg oxycodone is equivalent to how much morphine nursing home activity director cover letter 15 mg oxycodone equal to how much
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 informationWelcome - we will begin the webinar shortly Please read the participation tips below:
Welcome - we will begin the webinar shortly Please read the participation tips below: All guest phones have been muted: Background noises, conversations, white noise etc., can be disruptive to a webinar.
More informationOpioid Addiction Statistics
May 2017 Opioid Addiction Statistics Definitions Heroin Epidemic - As pill mills close, prescribing is becoming tighter, demand among younger users rise, and dealer s profits rise, addicts are turning
More informationArkansas Department of Health
Arkansas Department of Health 4815 West Markham Street Little Rock, Arkansas 72205-3867 Telephone (501) 661-2000 Governor Mike Beebe Nathaniel Smith, MD, MPH, Interim Director and State Health Officer
More informationPRESCRIBING GUIDELINES
Ohio Department of Health RESPONSE TO OHIO S PRESCRIPTION DRUG OVERDOSE EPIDEMIC: PRESCRIBING GUIDELINES MIPA CONFERENCE PREVENTING INJURY: FROM RESEARCH TO PRACTICE TO PEOPLE SEPTEMBER 30, 2013 Christy
More informationPrescription Monitoring Program (PMP)
06/15/2018 FACT SHEET Implementation of Enacted Prescribing Limits and Requirements and Relevant Opioid Prescribing Laws and Rules Background: The 2016 law (Chapter 488) makes five major changes to opioid
More informationPrescription Drug Importation: Can it Help America's Seniors? Safety of Imported Medications: I-SaveRx Case Study
Prescription Drug Importation: Can it Help America's Seniors? Safety of Imported Medications: I-SaveRx Case Study Presented By: Scott McKibbin Special Advocate For Prescription Drugs State Of Illinois
More informationPharmacy Medical Necessity Guidelines: Opioid Analgesics
Pharmacy Medical Necessity Guidelines: Effective: January 1, 2019 Prior Authorization Required Type of Review Care Management Not Covered Type of Review Clinical Review Pharmacy (RX) or Medical (MED) Benefit
More informationA nation in pain: Focus on Medicaid
DATA INSIGHTS A nation in pain: Focus on Medicaid Opioid pain medications have become one of the most controversial classes of prescription therapy. While they provide great benefits in controlling both
More informationPrescription Drug Monitoring Program
California Department of Justice Prescription Drug Monitoring Program May, 2016 Health and Safety Code section 11165. (a) To assist health care practitioners in their efforts to ensure appropriate prescribing,
More informationFollow-up to Previous Reviews. Multiple Dosage Forms of Aripiprazole Prescribed Concomitantly
15 October 2015 1 Follow-up to Previous Reviews Multiple Dosage Forms of Aripiprazole Prescribed Concomitantly 2 Multiple Dosage Forms of Aripiprazole Prescribed Concomitantly Usual maximum FDA approved
More informationQuestions and answers about HCA s opioid clinical policy for Apple Health (Medicaid)
Questions and answers about HCA s opioid clinical policy for Apple Health (Medicaid) This Q&A covers questions the Health Care Authority (HCA) received during webinars about the opioid clinical policy
More informationRisk Evaluation And Mitigation Strategies:
Risk Evaluation And Mitigation Strategies: The Experts Answer Questions from Health-System Pharmacists A midday symposium about the risk evaluation and mitigation strategies (REMS) required by the Food
More informationDEPARTMENT OF HEALTH & HUMAN SERVICES Food and Drug Apini$r$iy -tq 5-f
DEPARTMENT OF HEALTH & HUMAN SERVICES Food and Drug Apini$r$iy -tq 5-f J Dallas District 4040 North Central Expressway Dallas, Texas 75204-3145 Ref: 2004-DAL-WL-03 WARNING LETTER CERTIFIED MAIL RETURN
More informationNew Mexico Board of Pharmacy Prescription Monitoring Program (PMP)
New Mexico Board of Pharmacy Prescription Monitoring Program (PMP) PDMP West Regional Meeting PMP Collaboration with the NM Department of Health April 26, 2018 New Mexico Board of Pharmacy Prescription
More informationAddressing Prescription Drug Abuse. Allan Coukell Senior Director, Drugs and Medical Devices The Pew Charitable Trust
Addressing Prescription Drug Abuse Allan Coukell Senior Director, Drugs and Medical Devices The Pew Charitable Trust Outline 1. Prescription Drug Monitoring Programs 2. Federal policy landscape including
More informationMedicines Optimisation Strategy
Clinical Reducing Dosing Errors with Opioid Medicines (Controlled Drug SOP): Document Control Summary Status: Version: Author/Owner/Title: Approved by: Ratified: Related Trust Strategy and/or Strategic
More informationAn Integrated Healthcare System s Approach to Chronic Pain
An Integrated Healthcare System s Approach to Chronic Pain Presbyterian Health Plan (PHP) Charles Baumgart M.D., Chief Medical Officer Louanne Cunico PharmD, Pharmacy Director September 20, 2011 Medical
More informationMaine s Response to the Opiate Crisis. Christopher Pezzullo, DO State Health Officer Maine DHHS Maine CDC November 12, 2016
Maine s Response to the Opiate Crisis Christopher Pezzullo, DO State Health Officer Maine DHHS Maine CDC November 12, 2016 Required Disclosure Text Font typically Times New Roman at least 20 point Try
More informationTaos Alive. Improving a Community in Pain By Julie Martinez CPS
Taos Alive Improving a Community in Pain By Julie Martinez CPS About Taos County About Taos Alive Community Based Coalition 12 Sectors (Youth, Parents, Business, Media, Schools, Youth Serving Organizations,
More informationFighting the Good Fight: How to Convert Opioids Just Right!
Fighting the Good Fight: How to Convert Opioids Just Right! Tanya J. Uritsky, PharmD, BCPS, CPE Clinical Pharmacy Specialist - Pain Medication Stewardship Hospital of the University of Pennsylvania - Philadelphia,
More informationManaging Narcotics on Workers Comp Claims. Presented By: Craig S. Stern, PharmD, MBA President Pro Pharma Pharmaceutical Consultants, Inc.
Managing Narcotics on Workers Comp Claims Presented By: Craig S. Stern, PharmD, MBA President Pro Pharma Pharmaceutical Consultants, Inc. October 21, 2014 Outline Rationale Scope list drug list Recommended
More informationOpioid Analgesic Treatment Worksheet
Opioid Analgesic Treatment Worksheet Aetna Better Health of Louisiana Fax: 1 844 699 2889 www.aetnabetterhealth.com/louisiana/providers/pharmacy LA Legacy Fee for Service (FFS) Medicaid Fax: 1 866 797
More informationSee Important Reminder at the end of this policy for important regulatory and legal information.
Clinical Policy: Transmucosal Immediate Release Fentanyl Products Reference Number: CP.HNMC.211 Effective Date: 11.16.16 Last Review Date: 11.17 Line of Business: Medicaid Medi-Cal Revision Log See Important
More information9/30/15. Learning Objectives. Conflict of Interest. Learning Objectives. Need For Balance. Public Health Issue
Strategies for Safe Opioid Prescribing: Re-Calibrating the Pendulum Swing Traci White, PharmD, PhC Assistant Professor, UNM College of Pharmacy Pharmacist Clinician, Mesilla Valley Hospice tmwhite@nmsu.edu
More informationStrategies for Safe Opioid Prescribing: Re-Calibrating the Pendulum Swing
Strategies for Safe Opioid Prescribing: Re-Calibrating the Pendulum Swing Traci White, PharmD, PhC Assistant Professor, UNM College of Pharmacy Pharmacist Clinician, Mesilla Valley Hospice tmwhite@nmsu.edu
More informationPrescription Drug Monitoring Program Update. Rebecca R. Poston, BPharm., MHL Program Manager August 26, 2017
Prescription Drug Monitoring Program Update Rebecca R. Poston, BPharm., MHL Program Manager August 26, 2017 Objectives Brief historical overview of opioids Review of PDMP information Discuss ideas from
More informationNWCDC 2018 Pharmacy Analytics in Workers Comp
NWCDC 2018 Pharmacy Analytics in Workers Comp Cliff Belliveau VP Business Intelligence What is Visual Analytics? Transforming data into insights that tell a story 2 A little history Jacquard loom Punch
More informationSt. Francis Primary Care Downtown Patient Name Date of Birth SSN: Home Phone Work Mobile Address City State Zip Code Gender: M/F Race Marital Status: S M D W Hispanic or Non-Hispanic Emergency Contact
More informationShining a Light on MEDs Understanding morphine equivalent dose
Shining a Light on MEDs Understanding morphine equivalent dose In the workers compensation industry, 60.2 percent of claimants utilize opioid analgesics for the treatment of pain caused by a workplace
More informationOverview of FDA Oversight and Enforcement on Drug Compounding
Overview of FDA Oversight and Enforcement on Drug Compounding Ruey Ju, Pharm.D., J.D. Senior Advisor for Compounding Compliance and Enforcement (Acting) Center for Drug Evaluation and Research Today s
More informationAppendix 1. University of Minnesota Amplatz Children s Hospital Opioid Weaning Guideline
Appendix 1. University of Minnesota Amplatz Children s Hospital Opioid Weaning Guideline 1. Pharmacist to order Narcotic Withdrawal Scores QH X 4 hours, then per table below: Narcotic Withdrawal Score
More informationOpioid Harm Reduction
Opioid Harm Reduction Lucas G. Hill, PharmD Clinical Assistant Professor, The University of Texas at Austin College of Pharmacy Clinical Pharmacist, CommUnityCare FQHCs Director, Operation Naloxone Mark
More informationSee Important Reminder at the end of this policy for important regulatory and legal information.
Clinical Policy: Opioid Analgesics Reference Number: HIM.PA.139 Effective Date: 12.01.17 Last Review Date: 11.17 Line of Business: Health Insurance Marketplace Revision Log See Important Reminder at the
More informationIdaho DUR Board Meeting Minutes. Committee Member Present: David Agler, M.D., Dawn Berheim, Pharm.D., Perry Brown, M.D., Matthew Hyde, Pharm.D.
Idaho DUR Board Meeting Minutes Date: January 25, 2018 Time: 9am-12:00pm Location: Idaho Medicaid, 3232 Elder Street, Boise, Idaho, Conference Room D-West Moderator: David Agler, M.D. Committee Member
More informationDrug Use Evaluation: Short Acting Opioids (SAO)
Drug Use Evaluation: Short Acting Opioids (SAO) Summary Short acting opioid analgesics are one of the most prescribed (top 10) and highest cost (top 20) medication classes for the Oregon Fee For Service
More informationSafe, effective, affordable drug choices: online tool for payers and patients.
Executive summary: Rising healthcare costs and greater access to medical information drive patients to seek options for their drug therapy. The MedAlternatives database by Gold Standard/Elsevier empowers
More informationOpioid Management Program May 2018
Opioid Management Program May 2018 What Is the Opioid Management Program? This program is based on guidelines developed by the U.S. Centers for Disease Control and Prevention (CDC). It consists of daily
More informationInnovative Opportunities for Pharmacists in the Evolving World of Healthcare
Innovative Opportunities for Pharmacists in the Evolving World of Healthcare Christina Pornprasert, PharmD Population Health Clinical Pharmacist Hartford Healthcare Integrated Care Partners Assistant Clinical
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 informationTools for Targeting High Risk Patients in Your Practice. Statement of Disclosure
Tools for Targeting High Risk Patients in Your Practice Joseph Vande Griend, PharmD, BCPS, CGP Assistant Professor, University of Colorado Departments of Clinical Pharmacy and Family Medicine Skaggs School
More informationThe Opioid Epidemic: The State of the State
JOINT LEGISLATIVE COMMITTEE ON HEALTH AND HUMAN SERVICES The Opioid Epidemic: The State of the State Dr. Mandy Cohen, Dr. Susan Kansagra Department of Health and Human Services Nov. 14, 2017 3 PEOPLE DIE
More information11/11/2015. MVAs Suicide Firearms Homicide. Where Can I Find A Copy of the PDMP Law? Why Was the Law Established? Why Was the Law Established?
Where Can I Find A Copy of the PDMP Law? Alabama Uniform Controlled Substances Act Code of Alabama 1975 20-2- (Article 10) -210 through 220 and Rules 420-7-2-.11 through.13 1 Why Was the Law Established?
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 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 informationNew Guidelines for Prescribing Opioids
New Guidelines for Prescribing Opioids Keeping Your Claimants Safe Presented by: Dr. Mitch Freeman, Pharm.D. Chief Clinical Officer, Pharmacy Solutions Agenda The Opioid Challenge Today How We Got Here
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 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 informationGeneral Providers. Tamper-Resistant Prescription Requirements
September 2008 Provider Bulletin Number 8138 General Providers Tamper-Resistant Prescription Requirements Effective with processing dates on and after October 1, 2008, written prescriptions for Kansas
More informationSee 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 informationHEADED FOR HEDIS AND REACHING FOR THE STARS: THE PHARMACIST S ROLE IN POPULATION HEALTH MANAGEMENT
HEADED FOR HEDIS AND REACHING FOR THE STARS: THE PHARMACIST S ROLE IN POPULATION HEALTH MANAGEMENT Desola Davis, PharmD, BCPS, BCACP Dalia Zall, PharmD 1 Copyright 2017 Kaiser Foundation Health Plan, Inc.
More informationProposed Changes to Existing Measure for HEDIS : Use of Opioids at High Dosage (UOD)
Proposed Changes to Existing Measure for HEDIS 1 2020: Use of Opioids at High Dosage (UOD) NCQA seeks comments on proposed revisions to the Use of Opioids at High Dosage HEDIS measure. The current measure
More informationTo Cover or Not To Cover? A Review of Medication Coverage Guidelines. Dr. Sherita D. Castille, Pharm D Clinical Pharmacist. Agenda.
To Cover or t To Cover? A Review of Medication Coverage Guidelines Dr. Sherita D. Castille, Pharm D Clinical Pharmacist Agenda 2 Overview Define key Medicare terms Determine relatedness to terminal prognosis
More informationNarcotics Monitoring System (NMS) Update
Narcotics Monitoring System (NMS) Update DISCLOSURE OF COMMERCIAL SUPPORT This program has received no financial or in-kind support. Potential for conflict(s) of interest: None Faculty/Presenter Disclosure
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 informationTechnician Training Tutorial: Safety Considerations with Opioids
(Page 1 of 5) Technician Training Tutorial: Safety Considerations with Opioids Opioids as a drug class are considered to be high-alert drugs. This class includes codeine, methadone, oxycodone, etc. When
More informationArkansas Prescription Monitoring Program
Arkansas Prescription Monitoring Program ONE YEAR UPDATE Scott Pace, Pharm.D., Esq. Special Thanks Thanks to Denise Robertson at the Arkansas Department of Health for supplying the PMP data for this presentation
More informationMorphine er to oxycontin conversion
Morphine er to oxycontin conversion The Borg System is 100 % Morphine er to oxycontin conversion 17-4-2011 Conversion dose from Oxycontin 40mg 3x a day to morphine sulfate 15 mg?. Oxycontin vs morphine
More informationUnderstanding the Value of Generic Drugs
Understanding the Value of Generic Drugs Generic drugs can help you get the most out of your health care budget. 05.02.306.1 (8/05) Many people believe that when something costs more, it must be of higher
More informationNEW MEXICO DEPARTMENT OF HEALTH Administrative Manual ADMINISTRATION
Chapter NEW MEXICO DEPARTMENT OF HEALTH Administrative Manual ADMINISTRATION EFFECTIVE: Policy REVISED: 4/13/9 draft NALOXONE DISTRIBUTION POLICY I. PURPOSE: This New Mexico Department of Health (NMDOH)
More information