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ABSTRACT: To determine the impact on insulin acquisition cost of a pharmacy program to convert insulin utilization from multidose vials to pen-delivery systems for long-term care residents covered by Medicare Part A, and managed care plans.
Retrospective cost comparison.
Long-term care facilities.
Residents covered by Medicare Part A and managed care plans.
Policy to replace insulin vials with pen devices, effective July 2009.
Mean insulin cost-per-patient day (total insulin purchases divided by patient admission days) and pen utilization (pen purchases as a percent of total insulin purchases).
Insulin purchase data covered 2,405 admissions in 75 facilities over the 12-month period ending June 2010. Pen device purchases increased from less than 1% to almost 35% of total insulin purchases over the study period during which insulin cost per patient-day declined from $10.29 to $4.08. For Medicare Part A patients with admissions of 30 days or fewer, the most frequent visit type, mean cost per patient-day decreased from $13.73 to $9.19 as pen purchases increased from less than 1% to about 32%. For these same patients, mean cost per patient-day for admissions using only pen devices was $7.04, compared with $11.79 for admissions using only vials (P < 0.001). Significant differences in mean cost per patient-day were also found for residents covered by managed care and for longer admissions.
Total insulin costs can be reduced through higher utilization of pen devices by patients in long-term care facilities.
The Consultant pharmacist: the journal of the American Society of Consultant Pharmacists 06/2012; 27(6):411-20.
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ABSTRACT: To evaluate the impact of the final Centers for Medicare & Medicaid Services' (CMS) "short-fill" rule regarding the appropriate dispensing of prescription drugs in long-term care facilities.
A prospective study to determine rates of unconsumed medication and the net-cost impact on Medicare Part D prescription drug plans based on the proposed and final CMS rule and other scenarios under consideration by CMS. Setting: Four hundred twenty-five long-term care facilities in six states.
Residents covered by Medicare Part D. Main Outcome Measures: Rates of unconsumed medication, average dispensing fees, potential reduction in unconsumed medication, incremental fills, incremental dispensing fees, net cost or savings to Medicare Part D plans, and percentage increase in fills.
Total estimates of the cost of unconsumed medication charged to Medicare Part D plans for residents in long-term care facilities are $87 million for brand products and $39 million for generics annually. Based on current dispensing fees, it is likely that implementation of the final rule will result in incremental costs to CMS plans in the range of $30 million annually. The number of Medicare Part D prescription fills will increase by about 20%. A seven-day fill requirement on brand products would raise incremental costs to more than $150 million annually, and inclusion of generic products in a seven-day fill requirement would result in incremental costs in the range of $850 million annually.
The final CMS rule on short-fills is unlikely to result in savings to Medicare Part D plans. Shorter fill times and inclusion of generic products would significantly raise costs to these plans.
The Consultant pharmacist: the journal of the American Society of Consultant Pharmacists 04/2012; 27(4):269-73.
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The Consultant pharmacist: the journal of the American Society of Consultant Pharmacists 09/2011; 26(9):647-56.
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ABSTRACT: Insulin pump users discard unused medication and infusion sets according to labeling and manufacturer's instructions. The stability labeling for insulin aspart (rDNA origin] (Novolog) was increased from two days to six. The associated savings was modeled from the perspective of a hypothetical one-million member health plan and the total United States population.
The discarded insulin volume and the number of infusion sets used under a two-day stability scenario versus six were modeled.
A mix of insulin pumps of various reservoir capacities with a range of daily insulin dosages was used. Average daily insulin dose was 65 units ranging from 10 to 150 units. Costs of discarded insulin aspart [rDNA origin] were calculated using WAC (Average Wholesale Price minus 16.67%). The cost of pump supplies was computed for the two-day scenario assuming a complete infusion set change, including reservoirs, every two days. Under the six-day scenario complete infusion sets were discarded every six days while cannulas at the insertion site were changed midway between complete changes. AWP of least expensive supplies was used to compute their costs.
For the hypothetical health plan (1,182 pump users) the annual reduction in discarded insulin volume between scenarios was 19.8 million units. The corresponding cost reduction for the plan due to drug and supply savings was $3.4 million. From the U.S. population perspective, savings of over $1 billion were estimated.
Using insulin that is stable for six days in pump reservoirs can yield substantial savings to health plans and other payers, including patients.
Managed care (Langhorne, Pa.) 05/2011; 20(5):42-7.
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ABSTRACT: The objective of this study is to examine the financial impact of a prior authorization (PA) intervention for pregabalin in a commercially insured US population via an economic model.
An Excel-based model was developed to simulate 2 hypothetical scenarios for health plans: one with a PA on pregabalin, and another without a PA. In the PA scenario, a variable percentage of pregabalin prescriptions were assumed to be approved and dispensed, the remainder being denied or a substitute product dispensed (branded or generic alternatives). In the "no PA" scenario, all pregabalin prescriptions were assumed to be filled. The market shares of these products, including pregabalin, were based on secondary prescription data. The model calculated the total drug acquisition cost and cost of PA administration in each scenario for a cohort of 1000 patients over a 1-year period. Patients switching to pregabalin following denial were accounted for in the model. Sensitivity analyses were carried out varying the PA approval rates and prescription share of pregabalin and limiting the range of substituted products.
The pregabalin prescribing rate was set to 10.3% in both the PA and "no PA" scenarios, with a denial rate of 50% in the PA scenario, consistent with the IMS prescription volume. The calculated drug acquisition cost for the PA scenario was $885,564 compared with $888,822 for the "no PA" scenario, a difference of 0.4%, after factoring in the cost of PA administration. The calculated PA administration cost was $4121. Eliminating the PA administration cost results in a cost for the PA scenario of $881,443, 0.8% below the "no PA" scenario. Lowering the pregabalin PA approval rate from 50% to 10% decreased the costs of the PA scenario to $879,660, 1.0% lower than the "no PA" scenario. Raising the pregabalin market share to 20% in the "no PA" scenario increased the costs of that scenario to $902,714, 1.9% higher than the PA scenario. Limiting the substituted products for denied pregabalin prescriptions in the PA scenario to the 2 most common products, valproate sodium and gabapentin (both generics), lowered the cost of the PA scenario to $875.412, 1.5% below the "no PA" scenario cost. With half of the denied pregabalin patients switching to pregabalin during the course of the year, the cost of the PA scenario increased to $892,550, 0.4% higher than the "no PA" scenario.
Potential savings due to PA protocols on pregabalin are low, in the 1% to 2% range across a variety of scenarios, because of the relatively low pregabalin market share (about 10%) in typical health plans and the absence of a significant difference in cost for the most commonly substituted products. Patients who switch to pregabalin after an initial denial will further reduce savings to health plans.
The American journal of managed care 05/2010; 16(5 Suppl):S154-9. · 2.46 Impact Factor
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ABSTRACT: The purpose of this study was to corroborate an earlier study that explored the relationship between a health plan's Health Plan Employer Data and Information Set (HEDIS) score for glycolated hemoglobin (HbA1c) control in diabetes patients and its utilization of insulin and oral diabetes products. Prescription volumes were tracked for four categories of diabetes drug therapy: analog insulin, human insulin, single-source brand oral products, and multisource generic oral products, for calendar years 2005 and 2006. The prescription shares of each of the four drug categories for each health plan were matched to the health plan's HEDIS measurements of HbA1c control for each year. Univariate and multivariate regression analysis was performed between the health plan's HbA1c -based HEDIS score and its prescription share of each drug category. A favorable and statistically significant (p < 0.01) relationship was found between plan HbA1c HEDIS score and plan prescription share of analog insulin in both 2005 and 2006. The correlation between HEDIS scores and human insulin was not statistically significant. Unfavorable relationships were found between HEDIS scores and both the single-source brand (statistically significant) and the multisource generic oral category prescription shares (not significant). These results corroborate the relationships found in our earlier study, although a cause and effect relationship cannot be confirmed.
Managed care (Langhorne, Pa.) 02/2009; 18(2):40-4.
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ABSTRACT: This study sought to determine the correlation between a health plan's Health Plan Employer Data and Information Set (HEDIS) score for glycated hemoglobin (HbA1c) control in patients with diabetes and its utilization of analog insulin, human insulin, and oral drug therapy as determined by the share of prescriptions of each therapy. Prescription volumes were tracked for four categories of diabetes drug therapy: (1) analog insulin, (2) human insulin, (3) single-source brand oral products, and (4) multisource generic oral products, for the three months ending January 2005 and January 2006 and matched to the 2004 and 2005 HEDIS scores. A correlation analysis conducted between the HbA1c-based HEDIS score and the prescription share of each drug category found a favorable and statistically significant (P < .0001) correlation between plan HbA1c HEDIS score and plan prescription share of analog insulin in both 2004 and 2005. The correlation between HEDIS scores and human insulin was not statistically significant. Unfavorable correlations were found between HEDIS scores and both the single-source brand and the multisource generic oral category prescription shares, although these correlations were found to be significant only for the single-source products in 2005.
Managed care interface 11/2007; 20(10):14-7.
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Gary Bazalo
Managed care interface 02/2005; Suppl:10-1.
