PNS114 Ten Year Trends in High Cost Outpatient Pharmacy Claims Among Commercially Insured U.S. Population By Therapeutic Category and Date of Initial Approval

2021 ◽  
Vol 24 ◽  
pp. S193
Author(s):  
N. Shcherbakova ◽  
M. Hong ◽  
G. Tereso
Keyword(s):  
Pharmacy Claims ◽  
Therapeutic Category

scholarly journals Comparison of adherence between fixed and unfixed topical combination glaucoma therapies using Japanese healthcare/pharmacy claims database: a retrospective non-interventional cohort study

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Chikako Shirai ◽  
Nobushige Matsuoka ◽  
Toru Nakazawa
Keyword(s):  
Cohort Study ◽  
Real World ◽  
Fixed Combination ◽  
Japanese Patients ◽  
Eye Drops ◽  
Combination Therapies ◽  
Real World Data ◽  
Healthcare Database ◽  
Pharmacy Claims ◽  
Persistence Rate

Abstract Background Adherence to chronic therapies is crucial to prevent the progression of disease, such as glaucoma. However, only a limited number of studies have investigated them using real-world data in Japan. This study aimed to evaluate Japanese patients’ adherence to fixed- and unfixed-combination eye drops as a second-line therapy for glaucoma in real-world practice. Methods This retrospective, non-interventional cohort study utilized a commercially available Japanese healthcare database (MinaCare database). Medical/pharmacy claims data were collected from 2011 to 2016. The primary endpoint was adherence to medications, assessed by proportion of days covered (PDC) with medication during a 12-month post-index period. Meanwhile, the secondary endpoints included the persistence rate. Results A total of 738 patients were included in this study: 309 and 329 in the fixed- and unfixed-combination cohorts, respectively. Prostaglandin analog (PG)/β-blocker (BB) was most commonly claimed in 241/309 (78.0%) patients in the fixed-combination cohort. In the unfixed-combination cohort, PG and BB were claimed in 130/329 (39.5%) patients, whereas PG and α2-agonist were claimed in 87/329 (26.4%) patients. Patients were more adherent to the fixed-combination than the unfixed-combinations (mean PDCs [SD], 79.1% [32.1] vs. 62.2% [38.0]; P < 0.0001). The proportion of patients with good adherence (PDC ≥ 80%) was also higher in the fixed-combination cohort (69.6%) than in the unfixed-combination cohort (48.6%) (P < 0.0001). During the 12-month post-index period, the persistence rate was higher in the fixed-combination cohort than in the unfixed-combination cohort (47.6% [95% confidence intervals (CI): 41.9–53.0] vs. 24.9% [95% CI: 20.4–29.7], P < 0.0001). Conclusions Japanese patients with glaucoma preferred the fixed-combination therapies over the unfixed-combination therapies. Hence, fixed-combination therapies would contribute to the improvement of adherence.

Inappropriate outpatient antibiotic use in children insured by Kentucky Medicaid

2021 ◽  
pp. 1-7
Author(s):  
Bethany A. Wattles ◽  
Kahir S. Jawad ◽  
Yana Feygin ◽  
Maiying Kong ◽  
Navjyot K. Vidwan ◽  
...  
Keyword(s):  
Claims Data ◽  
Inappropriate Prescribing ◽  
Patient Characteristics ◽  
Antibiotic Use ◽  
Population Based ◽  
Antibiotic Prescribing ◽  
Cross Sectional ◽  
Inappropriate Use ◽  
Pharmacy Claims ◽  
Medicaid Children

Abstract Objective: To describe risk factors associated with inappropriate antibiotic prescribing to children. Design: Cross-sectional, retrospective analysis of antibiotic prescribing to children, using Kentucky Medicaid medical and pharmacy claims data, 2017. Participants: Population-based sample of pediatric Medicaid patients and providers. Methods: Antibiotic prescriptions were identified from pharmacy claims and used to describe patient and provider characteristics. Associated medical claims were identified and linked to assign diagnoses. An existing classification scheme was applied to determine appropriateness of antibiotic prescriptions. Results: Overall, 10,787 providers wrote 779,813 antibiotic prescriptions for 328,515 children insured by Kentucky Medicaid in 2017. Moreover, 154,546 (19.8%) of these antibiotic prescriptions were appropriate, 358,026 (45.9%) were potentially appropriate, 163,654 (21.0%) were inappropriate, and 103,587 (13.3%) were not associated with a diagnosis. Half of all providers wrote 12 prescriptions or less to Medicaid children. The following child characteristics were associated with inappropriate antibiotic prescribing: residence in a rural area (odds ratio [OR], 1.09; 95% confidence interval [CI], 1.07–1.1), having a visit with an inappropriate prescriber (OR, 4.15; 95% CI, 4.1–4.2), age 0–2 years (OR, 1.39; 95% CI, 1.37–1.41), and presence of a chronic condition (OR, 1.31; 95% CI, 1.28–1.33). Conclusions: Inappropriate antibiotic prescribing to Kentucky Medicaid children is common. Provider and patient characteristics associated with inappropriate prescribing differ from those associated with higher volume. Claims data are useful to describe inappropriate use and could be a valuable metric for provider feedback reports. Policies are needed to support analysis and dissemination of antibiotic prescribing reports and should include all provider types and geographic areas.

Trends in the utilisation of lipid-lowering medications in Australia: an analysis of national pharmacy claims data

2021 ◽  
pp. 100880
Author(s):  
Stella Talica ◽  
Clara Marquina Hernandez ◽  
Richard Ofori-Asenso ◽  
Danny Liew ◽  
Alice Owen ◽  
...  
Keyword(s):  
Claims Data ◽  
Lipid Lowering ◽  
Pharmacy Claims

Abstract 9: Alirocumab Prior Authorization Approval and Prescription Fill Rates Among Medicare Advantage Patients in a Large US Managed Care Plan

2018 ◽  
Vol 11 (suppl_1) ◽  
Author(s):  
Kelley C Dacus ◽  
Libby Horter ◽  
Jennifer Hayden ◽  
Raymond A Harvey ◽  
Stephen Thompson ◽  
...  
Keyword(s):  
Prescription Drug ◽  
Low Income ◽  
Care Plan ◽  
Atherosclerotic Cardiovascular Disease ◽  
Prior Authorization ◽  
Medicare Advantage ◽  
Pcsk9 Inhibitor ◽  
Prescription Claim ◽  
Pharmacy Claims ◽  
Dual Eligibility

Introduction: Alirocumab is a proprotein convertase subtilisin/ kexin type 9 (PCSK9) inhibitor approved as an adjunct to diet and maximally tolerated statin therapy for treatment of adults with heterozygous familial hypercholesterolemia (HeFH) or clinical atherosclerotic cardiovascular disease who require additional lowering of LDL-cholesterol. Barriers to possession, including therapy cost and cost-sharing implications, may contribute to low utilization of this therapy. Objective: To explore differences in demographic and clinical characteristics between patients with prior authorization (PA) approvals or denials for alirocumab as evidenced through filled alirocumab prescription claims. Methods: A retrospective claims-based database analysis of patients with a Medicare Advantage Prescription Drug (MAPD) plan was conducted to identify patients with evidence of a PA approval for alirocumab. Among the group of patients with a PA for alirocumab, the pharmacy claims database was searched for evidence of a corresponding prescription claim within 30 days following the first PA request (index date). The analysis was stratified by evidence of Federal low income subsidy (LIS) support, a program that provides extra assistance with prescription drug costs for eligible individuals whose income and resources are limited, and/ or dual eligibility (DE) status, eligible for Medicare and Medicaid, (LIS/DE) at index. Results: A total of 2,098 MAPD patients meeting study inclusion/exclusion criteria and with a PA for alirocumab were identified between March 1, 2016 and February 28, 2017. Non-LIS/DE patients comprised approximately 82% of the eligible population (n=1,730). There were several notable differences in baseline demographics between the non-LIS/DE vs. the LIS/DE cohorts with an approved PA claim, including Deyo-Charlson Comorbidity Index (2.2 vs. 3.0), prevalence of diabetes mellitus (39.2% vs. 54.7%), and prevalence of HeFH (11.8% vs. 15.6%). While the percentage of patients with an approved PA was similar between the LIS/DE and non-LIS/DE cohorts, 88.9% and 91.2%, respectively, substantially more patients in the LIS/DE cohort had evidence of alirocumab possession based on a paid claim (60.6%) vs. those in the non-LIS/DE cohort (17.3%). Conclusion: Although a high percentage of MAPD patients had evidence of an approved PA, there were notable differences in clinical and demographic characteristics between those with and without LIS/ DE status. Further, the proportion of patients with an approved PA and a paid prescription claim differed markedly amongst MAPD patients with and without LIS/DE status, suggesting further research is needed to understand potential barriers to obtaining PCSK9i therapy.

Abstract P212: Benchmark Analysis of Genetic Testing Practice Patterns in a Real-World Population of Patients Receiving Clopidogrel or Prasugrel Therapy

2011 ◽  
Vol 4 (suppl_2) ◽  
Author(s):  
Cynthia H Ewel ◽  
Barnabie C Agatep ◽  
Vivian Herrera ◽  
Nathan J Markward ◽  
Eric J Stanek ◽  
...  
Keyword(s):  
Genetic Testing ◽  
Real World ◽  
Cohort Analysis ◽  
Routine Practice ◽  
World Population ◽  
Provider Education ◽  
Stroke Event ◽  
Pharmacy Claims ◽  
Prescription Date ◽  
The Impact

BACKGROUND: Cytochrome P450 2C19 genotype has been shown to modify cardiovascular outcomes on clopidogrel therapy in patients post-acute coronary syndromes or percutaneous coronary interventions. Recent clopidogrel label changes have incorporated this information; however real-world application of genetic testing in patients receiving thienopyridine antiplatelet therapy is unknown. METHODS: A retrospective, integrated medical and pharmacy claims database, cohort analysis was conducted in patients with new clopidogrel or prasugrel prescriptions between 7/1/08-6/30/10, and continuous eligibility for 6 months pre- and 3 months post-initiation. Genetic testing was identified using CPT-4 codes present 1 month prior and 3 months post the index prescription date. Genetic testing incidence was calculated, and univariate comparisons of prescriber information, and patient demographic and clinical characteristics in cases tested vs not tested were performed. RESULTS: The analysis included 95,381 clopidogrel and 1,819 prasugrel patients. Genetic testing was recorded in 522 (0.6%) clopidogrel and 15 (0.8%) prasugrel patients, rendering the latter sample too small for detailed analysis. Clopidogrel patients receiving genetic testing (vs patients not tested) were a mean age of 58±13 yrs (68±13 yrs, p<0.001), 29% were ≥65 yrs old (61%, p<0.001), 56% were male (59%), 33% were Western US residents (18%, p<0.001), 35% were recently hospitalized for stroke (8%, p<0.001), and were less often prescribed clopidogrel by a cardiologist (22% vs 32%, p<0.001) and more often by a neurology specialist (8% vs 2%, p<0.001). The incidence of genetic testing did not vary over time. CONCLUSION: Although the FDA has provided numerous advisories that have lead to changes in clopidogrel provider information sheets, genetic testing is rarely employed in routine practice in patients prescribed clopidogrel or prasugrel therapy. Testing was biased toward younger clopidogrel patients with a recent stroke event, and non-cardiologist prescribers. While these data establish a national benchmark for future comparison, further exploration of barriers to testing, provider education and patient selection, and the impact of programmatic approaches to testing are warranted.

Generic Prescribing, Generic Substitution, and Therapeutic Substitution

PEDIATRICS ◽  
1987 ◽  
Vol 79 (5) ◽  
pp. 835-835
Author(s):  
Keyword(s):  
Health Care ◽  
Health Care Professionals ◽  
Generic Substitution ◽  
Drug Product ◽  
Therapeutic Substitution ◽  
General Acceptance ◽  
Conflicting Evidence ◽  
Therapeutic Category ◽  
Generic Prescribing ◽  
The Cost

Pressures generated by a constellation of professional consumer, legislative, and health care provider vider groups in this era of increasing health care costs have led to enactment of generic substitution laws in 50 states. The general acceptance of this concept, despite conflicting evidence that it has reduced the cost of prescription items to the consumer, has led to the concept of therapeutic substitution. Considerable confusion exists among health care professionals regarding the precise meaning of these concepts. Generic prescribing is the prescribing of a drug by a physician using the generic name. This leaves the choice of brand to the dispensing pharmacist. Generic substitution is a pharmacist-initiated act by which a different brand or an unbranded drug product is dispensed instead of a drug brand that was prescribed by the physician. This means substituting the same chemical entity in the same dosage form for one marketed by a different company. Therapeutic substitution is a pharmacist-initiated act by which a pharmaceutical or therapeutic alternate for the physician-prescribed drug is dispensed without consulting the physician. This denotes replacement of the prescribed drug with a chemically different drug within the same therapeutic category, eg, hydrochlorothiazide for furosemide; ranitidine for cimetidine; chloramphenicol for erythromycin. In 1976, the AAP Committee on Drugs published a commentary in Pediatrics (1976;57:275-277) on generic prescribing and concluded that "the lack of data on bioavailability and bioequivalence in children precludes blanket support of generic prescribing for infants and children." The Committee recently reviewed this issue and concluded that the situation has changed little during the past decade.

Abstract 275: Concomitant Statin Use With Ezetimibe Or Colesevelam For Treatment Of Hypercholesterolemia

2013 ◽  
Vol 6 (suppl_1) ◽  
Author(s):  
Xin Ye ◽  
Harold Bays ◽  
Philip Schwab
Keyword(s):  
Index Date ◽  
Claims Data ◽  
Study Objective ◽  
Factors Associated ◽  
Patient Demographics ◽  
Pharmacy Claims ◽  
Before And After ◽  
Charlson Comorbidity Score ◽  
Claims Data Analysis ◽  
Statin Use

OBJECTIVES: Ezetimibe or colesevelam are often used for treating hypercholesterolemia when statin therapy is insufficient or not well tolerated. Our study objective was to examine prevalence of concomitant statin use and associated factors among hypercholesterolemia patients newly treated with ezetimibe or colesevelam. METHODS: This analysis evaluated a large health plan’s Commercial and Medicare Advantage claims data from 1/1/08 to 7/31/12. The first ezetimibe (excluding fixed combination therapy of ezetimibe/simvastatin) or colesevelam prescription fill date during this period was identified as the index date. Patients were assigned to either ezetimibe or colesevelam cohort based on the index drug and were required to have ≥ 2 consecutive prescriptions for the index drug and have at least 6 months and 12 months continuous enrollment before and after the index date, respectively. Prevalence of concomitant statin use was identified based on pharmacy claims. Patient demographics and clinical characterisitics were explored to examine the factors associated with concomitant statin use using multivariate logistic regression. RESULTS: A total of 679 colesevelam and 1439 ezetimibe patients were included in this study. The concomitant use of statins was 24% among colesevelam and 50% among ezetimibe patients, respectively. After adjustment for patient demographics and comorbidities, ezetimibe patients were 3.2 times more likely than colesevelam patients to have concomitant statin use (OR= 3.168, 95% CI: 2.573, 3.900, P<0.001). Other significant factors associated with higher concomitant statin use include: male gender (OR= 1.296, 95%: 1.079, 1.558, P=0.006), presence of diabetes mellitus (OR=1.262, 95% CI: 1.035, 1.539, P=0.021) and higher Charlson comorbidity score (OR=1.114, 95% CI: 1.046, 1.187, P<0.001) CONCLUSIONS: In this claims data analysis, statins were administered along with ezetimibe more frequently than administered with colesevelam, which should be taken into account when evaluating effectiveness of ezetimibe vs. colesevelam in the real-world treatment of hypercholesterolemia.

Abstract 148: Association of Dosing Frequency on Medication Adherence in Patients with Non-Valvular Atrial Fibrillation

2013 ◽  
Vol 6 (suppl_1) ◽  
Author(s):  
Tanya Burton ◽  
Lauren J Lee ◽  
Ying Fan ◽  
Winghan Jacqueline Kwong
Keyword(s):  
Heart Failure ◽  
Atrial Fibrillation ◽  
Medication Adherence ◽  
Health Plan ◽  
Index Date ◽  
Improve Medication Adherence ◽  
Treatment Regimens ◽  
Pharmacy Claims ◽  
Comorbidity Burden ◽  
Dosing Frequency

Objective: Previous studies suggest that the complexity of a dosing regimen may affect medication adherence. We examined the association between dosing frequency and adherence for 2 concomitant medications commonly prescribed to patients with non-valvular atrial fibrillation (NVAF), metoprolol (MET) and carvedilol (CAR). Methods: A retrospective claims study from a large US commercial and Medicare Advantage health plan analyzed data of adults ( > 18 years) with 1 inpatient or 2 outpatient claims for NVAF between 1/1/2008 - 12/31/2010. Patients with > 2 pharmacy claims for MET or CAR were analyzed separately. Within MET and CAR samples, once-daily (QD) and twice-daily (BID) cohorts were defined by the dosing frequency on pharmacy claims. The index date was set as the date of the first MET or CAR claim. Patients were continuously enrolled in the health plan for 1 year before (pre-index) and 1 year after (post-index) the index date. MET patients were required to have > 1 pre-index claim for acute myocardial infarction, angina, heart failure, or hypertension; CAR patients were required to have ≥1 claim for heart failure or hypertension. Patients using both QD and BID formulations of the index medication were excluded. Adherence to the index medication was assessed by the proportion of days covered (PDC) during the post-index period. PDC between QD and BID patients was compared using logistic regression to adjust for demographic and pre-index clinical characteristics. The proportion of QD and BID patients who discontinued the index medication (defined by a gap > 30 days) during the post-index period was also compared. Results: The analysis included 11,621 MET patients (QD: 6,084; BID: 5,537) and 4,393 CAR patients (QD: 203; BID: 4,190). Mean (SD) age was 70 (12) years for MET and CAR patients; 59% of MET and 69% of CAR patients were male. Compared to patients with BID dosing, patients with QD dosing were on average younger, more likely to be male, and had a lower comorbidity burden. Fewer patients discontinued MET or CAR with QD than BID dosing (MET: 38% vs. 51%, p<0.001; CAR: 39% vs. 48%, p=0.009). The proportion of patients with PDC > 80% was greater for patients with QD than BID dosing (MET: 62% vs. 50%, p< 0.001; CAR: 63% vs. 53%, p=0.004). MET patients with BID dosing were less likely to achieve PDC > 80% than patients with QD dosing (adjusted OR: 0.66; 95% CI: 0.609-0.712). CAR patients with BID dosing were less likely to achieve PDC > 80% than patients with QD dosing (adjusted OR: 0.69; 95% CI: 0.508-0.934). Among MET and CAR patients, age <60 years was associated with lower adherence (p<0.001) while prior use of index medication was associated with higher adherence (p≤0.001) to the index medication. Conclusion: Medication adherence to MET and CAR was higher with QD than BID dosing. Quality initiatives that reduce the dosing frequency of treatment regimens may improve medication adherence among NVAF patients.

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