Wendy Clary Nash, PharmD BCPS CPG FASCP. Neil Medical Group Sept 30, 2014

Transcription

1 Wendy Clary Nash, PharmD BCPS CPG FASCP Neil Medical Group Sept 30, 2014

2 Do you feel like You re in a daze? A healthcare craze? A medication maze?

3 Quack, Quack If it walks like a duck, talks like a duck and looks like a duck. It must be skilled nursing.

4 Quack, Quack No it s assisted living

5 emr vs ehr emr is a digital version of paper chart

6 emr vs ehr

7 emr vs ehr The EHR represents the ability to easily share medical information among stakeholders and to have a patient s information follow him or her through the various modalities of care engaged by that individual. EHRs are designed to be accessed by all people involved in the patients care including the patients themselves. Indeed, that is an explicit expectation in the Stage 1 definition of meaningful use of EHRs. HIMSS Analytics

8 emr vs ehr

9 emr vs ehr Jan 2011 Yesterday I spent 10 minutes filling out information on 5 sheets of paper before I could be seen by a dermatologist for the first time. It s the same information I ve filled out on similar forms every time I go to see a doctor. While I welcome EMRs and EHRs, how and when will they make it possible for me to see a new doctor without having to fill out the paperwork? Is there going to be some way I can give them a password to access my information online?

10 emr vs ehr July 2014 Does anyone know.. Can/should therapist s psychotherapy notes be included in an EHR?

11 Well now aren t you special? Specialty Drug & Specialty Pharmacies Unfortunately how they are defined depends on who is doing the defining, as there is no established or standardized definition for either.

12 Well now aren t you special? CMS defines drugs that cost more that $600 per month as specialty drugs. Some prescription drug plans use a $1200 per month threshold.

13 Well now aren t you special? URAC states Specialty Drugs usually require: special handling administration unique inventory management a high level of patient monitoring more intense support than conventional therapies.

14 Well now aren t you special?

15 Well now aren t you special? Specialty drugs are used in the following diseases: Multiple Sclerosis Rheumatoid Arthritis Anemia Cystic Fibrosis Hemophilia Hepatitis C Diseases requiring Human growth factors Psoriasis Neutropenia

16 Well now aren t you special? Examples of Specialty Drugs Aranesp Humira Remicade Arixtra Lovenox Revatio Avenox Lupron Sabril Cayston NPlate Sensipar Enbrel Octreotide Tikosyn Epivir Procrit Xenazine Femara Pulmozyme Xolair Forteo Reclast Zemplar

17 Well now aren t you special? Concerns specific to assisted living: Logistics and inventory Limited distribution (*You may see Neil Pharmacy print behind a drug entry on the MAR-Must obtain from specialty pharmacy) Prior authorization not uncommon Problematic medications

18 Well now aren t you special? May not have ALF friendly packaging Gaps in care Fragmentation, usually the specialty pharmacy is only concerned about one drug Comfort care or simplification of therapy unknown to specialty pharmacy

19 Bye bye Donuts.

20 Bye bye Donuts.

21

22 Let s do the numbers A report from the Department of Health and Human Services in 2002 Mean total drug mentions per month: 7.5 per assisted living resident Percent of beneficiaries on scheduled drugs: 98.2% in assisted living facilities Mean scheduled drug mentions per month: 6.9 per assisted living resident U.S. Department of Health and Human Services. Medication Use by Medicare Beneficiaries Living in Nursing Homes and Assisted Living Facilities ; June 2002.

23 Let s do the numbers Facility #1 Facility #2 Facility #3 Facility #4 Facility #5 Facility #6 Ave # Scheduled meds Ave # PRNs % on 9 or more meds

24 One Flu over the Cuckoo s Nest

25 One Flu over the Cuckoo s Nest Formula changes every year Best guess of epidemiologists Intranasal traditional trivalent (three strain) inactivated influenza vaccine quadrivalent (four strain) inactivated influenza vaccine high dose trivalent (three strain) inactivated influenza vaccine

26 Moving on UP Controlled Substance Schedules CI: no currently accepted medical use and a high potential for abuse; examples-- heroin, LSD, marijuana CII: high potential for abuse with use potentially leading to severe psychological or physical dependence; examples-- cocaine, morphine, fentanyl, oxycodone, methylphenidate CIII: moderate to low potential for physical & psychological dependence; examples--tylenol with codeine, anabolic steroids, testosterone CIV: low potential for abuse and low risk of dependence; examples Xanax, Ativan, Ambien CV: lower potential for abuse than Schedule IV and consist of preparations containing limited quantities of certain narcotics; examples, Robitussin AC, Lomotil, Lyrica

27 Moving on UP Vicodin, Norco (Hydrocodone/Acetaminophen) is to be moved from CIV to CII effective October 6, 2014 This eliminates a clinician s ability to prescribe up to a 6 month of the drugs or to simply call in a prescription. A written prescription for each fill will be mandatory.

28 Moving on UP Ultram (tramadol) was moved from nonscheduled to CIV effective August 18, 2014

29 What do you mean you don t have this! Shortages may affect drug therapy compromise or delay medical procedures result in medication errors Examples: o Vitamin B12 o Doxycycline o Atorvastatin (generic Lipitor) o Methylphenidate (generic Ritalin) o PPD

30 What do you mean you don t have this!

31 escripts

32 More complexity EBM: Evidence based medicine EBG: Evidence based guidelines CPG: clinical practice guidelines Protocol driven, care pathways, algorithms Best Practices REMS

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34 Mother, May I? PA: prior authorization: an administrative tool normally used by a health plan or PBM that requires the prescriber to receive pre-approval for prescribing a drug in order for the drug to qualify for coverage under the terms of the pharmacy benefit plan. SA: service authorization Step Therapy: designed to encourage the use of therapeutically equivalent, lower-cost medications (first line therapy) before stepping up to more expensive therapy (second line therapy) Examples: PPIs, NSAIDs, antidepressants, antihypertensives. TI: Therapeutic Interchange: also referred to as switch or conversion programs, encourage the use of either formulary or preferred drugs by switching from one agent to another that is less expensive for the payor. Examples: ERT, statins, antihistamines, PPIs. TS: Therapeutic substitution DUR: Drug utilization review: comprehensive review of patients prescription and medication data before, during and after dispensing to ensure appropriate medicaiton decision making and positive patient outcomes and the intervention can occur at the point of sale or point of dispensing, including e-prescribing.

35 You are not alone..

36 Medication Maze SCARCH Sept 2014 References: rce=hp&biw=1040&bih=622&q=specialty+drugs&oq=specialty+drugs&gs_l=img. 3..0l j0j4j5-1j ac.1.12.img.7NtnTvDCn0c#safe=active&hl=en&site=imghp&tb m=isch&sa=1&q=co+pay+tiers&oq=co+pay+tiers&gs_l=img c.1.12.img.LNe3vuOGiho&bav=on.2,or.r_qf.&bv m=bv ,d.ewu&fp=121b3911c886bc77&biw=1040&bih=579&facrc=_&im grc=yuwp0wsqtyxtmm%3a%3bkdlsdskuxjodmm%3bhttp%253a%252f%25 2Fwww.mymedicarematters.org%252Fimages%252FcopayGraphic.gif%3Bhttp% 253A%252F%252Fwww.mymedicarematters.org%252FPrescriptionDrugs%252F Steps%252Fstep4.php%3B442%3B221 U.S. Department of Health and Human Services. Medication Use by Medicare Beneficiaries Living in Nursing Homes and Assisted Living Facilities ; June