Abstract:
BACKGROUND:Medication therapy management (MTM) programs were first introduced as a result of the 2003 Medicare Prescription Drug Improvement and Modernization Act. Since then, the Centers for Medicare & Medicaid Services (CMS) have established minimum requirements for health plans to follow in establishing patient eligibility for enrollment in these programs. The eligibility criteria are based on projected annual Part D medication costs, number of chronic disease states, and number of chronic Part D covered medications. Patients meeting these criteria are automatically enrolled in an MTM program so must ask to be disenrolled from the program if they wish to not participate (opt-out). CMS rates the quality of health plans using the Five-Star Quality Rating System. Star ratings for various metrics are given to health plans based on a scale of 1 to 5 stars, with 5 stars being the highest quality rating that health plans can achieve. The "Medication Therapy Management Program Completion Rate for Comprehensive Medication Reviews (Part D)" was a display measure and is now a performance measure as of 2016. Consumers can view the star ratings and display measures for their health plans during the enrollment period, so these ratings can affect patient enrollments. Additionally, star ratings may also determine bonus payments awarded to health plans. To address the comprehensive medication review (CMR) measure, different outreach models are used by health plans and vendors to complete CMRs. Comparison of the effectiveness of these outreach models has not been sufficiently studied. OBJECTIVE:To compare the completion rate of CMRs by the University of Florida Medication Therapy Management Communication and Care Center (MTMCCC) for 3 models of patient outreach (cold calling, the initial offer and acceptance of a CMR from the health plan before contact by the MTMCCC, and scheduling of a CMR after mailing a welcome letter from the health plan) used for 3 different health plans. METHODS:This study is a retrospective chart analysis using data obtained from completed CMRs at the MTMCCC for health insurance beneficiaries enrolled in 3 different health plans. The CMR completion rate for 3 models of patient outreach used for 3 different health plans over the service period was compared. The CMR completion rate for this study was calculated using the number of completed CMRs and the total number of beneficiaries who were contacted at least once for the provision of a CMR for each respective model by the MTMCCC. The CMR completion rate calculated for this study is modified slightly from the CMS definition because of limitations in patient population assignment to the MTMCCC. RESULTS:The model in which patients were previously offered and subsequently completed a CMR from their health plans before contact by the MTMCCC had the highest CMR completion rate at 49.8%, compared with 40.5% and 23.8% for the other 2 outreach models. CONCLUSIONS:Offering patients a CMR, and subsequent completion, before provision of MTM services may increase CMR completion rate for health plans. DISCLOSURES:No outside funding supported this research. The University of Florida (UF) Medication Therapy Management Communication and Care Center (MTMCCC) receives grant funding from the Agency for Health Care Administration (AHCA) for services. Roane and Hardin are currently employed by UF as faculty with their practice sites at the UF MTMCCC. Salo is currently employed at UF as a clinical pharmacist with her practice site at the UF MTMCCC. Miller is currently employed as a transition of care clinical pharmacist at St. Joseph's Hospital in Tampa, Florida. The authors declare no potential conflicts of interest with respect to the research, authorship, and/or publication of this article. Miller and Roane were primary contributors to study concept and design, along with Salo and Hardin. Miller and Roane took the lead in data collection, assisted by Salo and Hardin, and data interpretation was performed by all the authors. The manuscript was written by all the authors and revised primarily by Roane and Miller, along with Salo and Hardin.
journal_name
J Manag Care Spec Pharmjournal_title
Journal of managed care & specialty pharmacyauthors
Miller DE,Roane TE,Salo JA,Hardin HCdoi
10.18553/jmcp.2016.22.7.796subject
Has Abstractpub_date
2016-07-01 00:00:00pages
796-800issue
7eissn
2376-0540issn
2376-1032journal_volume
22pub_type
杂志文章abstract::DISCLOSURES: Funding for the study referred to in this letter was contributed by Bayer Healthcare. Xia and Williamson are employees of Bayer Healthcare. Roth, Carlson, and Sullivan are consultants to Bayer Healthcare. Carlson also reports fees from Adaptive Biotechnologies, unrelated to the study. Roth reports consult...
journal_title:Journal of managed care & specialty pharmacy
pub_type: 信件
doi:10.18553/jmcp.2020.26.12.1617
更新日期:2020-12-01 00:00:00
abstract:BACKGROUND:Acromegaly is a chronic disorder characterized by excess growth hormone secretion and elevated insulin-like growth factor-1 levels most often caused by a pituitary adenoma. Clinical presentation of the disease includes coarsening of the facial features, soft-tissue swelling of the hands and feet, and overgro...
journal_title:Journal of managed care & specialty pharmacy
pub_type: 杂志文章
doi:10.18553/jmcp.2015.21.12.1106
更新日期:2015-12-01 00:00:00
abstract:BACKGROUND:Allergic rhinitis (AR) is a common condition that can be treated with a number of different therapies. Treatments such as intranasal antihistamines (INAs) and intranasal steroids (INSs) are widely used by AR patients. For some allergy sufferers, a combination of therapies, specifically an INA and an INS, is ...
journal_title:Journal of managed care & specialty pharmacy
pub_type: 杂志文章
doi:10.18553/jmcp.2016.22.12.1426
更新日期:2016-12-01 00:00:00
abstract:BACKGROUND:The management of schizophrenia, a chronic, multifaceted mental health condition, is associated with considerable health care resource utilization (HCRU) and costs. Current evidence indicates that a high-risk and costly prodromal period, during which patients are likely symptomatic, precedes diagnosis. Bette...
journal_title:Journal of managed care & specialty pharmacy
pub_type: 杂志文章
doi:10.18553/jmcp.2019.25.10.1102
更新日期:2019-10-01 00:00:00
abstract:BACKGROUND:Tisagenlecleucel was approved for the treatment of pediatric and young adult patients with relapsed/refractory (r/r) B-cell acute lymphoblastic leukemia (ALL) based on the pivotal ELIANA trial. OBJECTIVE:To comprehensively evaluate the total costs associated with tisagenlecleucel treatment, including costs ...
journal_title:Journal of managed care & specialty pharmacy
pub_type: 杂志文章
doi:10.18553/jmcp.2020.20052
更新日期:2020-08-01 00:00:00
abstract:BACKGROUND:Since multiple myeloma (MM) incurs a substantial economic burden in care management, more and more discussion has been generated in recent years about the costs of novel antimyeloma drugs and their associated value. Because of these costs, economic assessment that quantifies value of care over the long-term ...
journal_title:Journal of managed care & specialty pharmacy
pub_type: 杂志文章
doi:10.18553/jmcp.2017.23.8.831
更新日期:2017-08-01 00:00:00
abstract::A panel of experts drawn from neurology, psychiatry, geropsychiatry, geriatrics, and pharmacy representatives of 3 health plans convened in New York City on July 30, 2016, with the objective of sharing opinions, ideas, and information regarding the optimal management of Parkinson's disease psychosis (PDP). Three key p...
journal_title:Journal of managed care & specialty pharmacy
pub_type: 杂志文章,评审
doi:10.18553/jmcp.2017.23.6-b.s2
更新日期:2017-06-01 00:00:00
abstract:BACKGROUND:Previous research finds significant variation in spending and utilization across regions, with little evidence of differences in outcomes. While such findings have been interpreted as evidence that spending can be reduced without compromising patient outcomes, the link between spending variation and outcomes...
journal_title:Journal of managed care & specialty pharmacy
pub_type: 杂志文章
doi:10.18553/jmcp.2018.24.6.504
更新日期:2018-06-01 00:00:00
abstract:BACKGROUND:Natalizumab disease-modifying therapy for relapsing-remitting multiple sclerosis (MS) is efficacious in randomized controlled trials. Few studies have estimated the association between real-world natalizumab persistence behavior and relapse-related outcomes. OBJECTIVES:To (a) examine the impact of using nat...
journal_title:Journal of managed care & specialty pharmacy
pub_type: 杂志文章
doi:10.18553/jmcp.2015.21.3.210
更新日期:2015-03-01 00:00:00
abstract:BACKGROUND:Poor medication adherence is a predictor of poor health outcomes, especially in populations with chronic diseases. Although several self-reported measures of medication adherence exist, the scope of each is limited. OBJECTIVE:To identify barriers to medication adherence in order to facilitate effective del...
journal_title:Journal of managed care & specialty pharmacy
pub_type: 杂志文章
doi:10.18553/jmcp.2015.21.5.391
更新日期:2015-05-01 00:00:00
abstract:BACKGROUND:The functional impairment associated with migraine can cause physical, emotional, and economic ramifications that can affect occupational, academic, social, and family life. Understanding the relationship between headache-free days (HFDs) and the disease burden of migraine may help with decisions regarding t...
journal_title:Journal of managed care & specialty pharmacy
pub_type: 杂志文章
doi:10.18553/jmcp.2020.20103
更新日期:2020-10-01 00:00:00
abstract:BACKGROUND:Despite evidence showing the benefits of treatment intensification following an elevated hemoglobin A1c (A1c), clinical inertia, or failure to establish and/or escalate treatment to achieve treatment goals, is a concern among patients diagnosed with type 2 diabetes (T2DM). Clinical inertia may contribute to ...
journal_title:Journal of managed care & specialty pharmacy
pub_type: 杂志文章
doi:10.18553/jmcp.2019.25.3.304
更新日期:2019-03-01 00:00:00
abstract:BACKGROUND:Adjuvant trastuzumab treatment is administered to early stage breast cancer patients in physician office (POV) or hospital outpatient (HOP) settings. OBJECTIVE:To identify treatment patterns, utilization, and costs by site of care (POV vs. HOP) of patients with adjuvant treatment of breast cancer with trast...
journal_title:Journal of managed care & specialty pharmacy
pub_type: 杂志文章
doi:10.18553/jmcp.2014.20.5.485
更新日期:2014-05-01 00:00:00
abstract::Improving medication adherence has been identified as a crucial step towards improving health outcomes for patients with chronic disease and has provided the motivation for many changes in our health care system. Despite the volume of research done on this topic, however, we still lack important basic information abou...
journal_title:Journal of managed care & specialty pharmacy
pub_type: 杂志文章,评审
doi:10.18553/jmcp.2014.20.8.775
更新日期:2014-08-01 00:00:00
abstract:BACKGROUND:Prescription medication adherence is a known health-related barrier for elderly patients, leading to insufficient disease control and negative health outcomes. The Centers for Medicare & Medicaid Services (CMS) have placed significant emphasis on medication adherence, through the Part D star measures, revolv...
journal_title:Journal of managed care & specialty pharmacy
pub_type: 杂志文章
doi:10.18553/jmcp.2016.22.3.305
更新日期:2016-03-01 00:00:00
abstract::BACKGROUND: The economic burden of food allergy is large; however, costs specific to individuals with peanut allergy experiencing reactions to peanuts remain to be evaluated. As the prevalence of peanut allergy continues to increase in children, a better understanding of the cost of care is warranted. OBJECTIVE: To as...
journal_title:Journal of managed care & specialty pharmacy
pub_type: 杂志文章
doi:10.18553/jmcp.2021.20389
更新日期:2021-01-20 00:00:00
abstract:BACKGROUND:Adherence to treatment is correlated with treatment success in chronic myeloid leukemia (CML). CVS Specialty explored novel methods to improve adherence in this population to ensure optimal adherence and lower the risk of unsuccessful treatment. One novel program explored involved an interactive 2-way clinic...
journal_title:Journal of managed care & specialty pharmacy
pub_type: 杂志文章
doi:10.18553/jmcp.2019.25.11.1290
更新日期:2019-11-01 00:00:00
abstract:BACKGROUND:Despite multiple treatment options, the prognosis of pulmonary arterial hypertension (PAH) remains poor. PAH patients experience a high economic burden due to comorbidities, hospitalizations, and medication costs. Although combination therapy has been shown to reduce hospitalizations, the relationship betwee...
journal_title:Journal of managed care & specialty pharmacy
pub_type: 杂志文章
doi:10.18553/jmcp.2018.17391
更新日期:2018-08-01 00:00:00
abstract:BACKGROUND:Clinical trials impose exclusion criteria that may limit the generalizability of results. OBJECTIVES:To (a) determine the percentage of real-world patients who would qualify for psoriasis randomized controlled trials; (b) ascertain differences between moderate-to-severe psoriasis patients who would be eligi...
journal_title:Journal of managed care & specialty pharmacy
pub_type: 杂志文章
doi:10.18553/jmcp.2017.16367
更新日期:2017-03-01 00:00:00
abstract:BACKGROUND:In recent years, there have been a number of pharmacological innovations for Crohn's disease (CD), a difficult-to-treat condition, including new treatment philosophies (e.g., top-down therapy) and new therapeutic options in terms of the agent and the route of administration. Three anti-tumor necrosis factor ...
journal_title:Journal of managed care & specialty pharmacy
pub_type: 杂志文章
doi:10.18553/jmcp.2015.21.7.559
更新日期:2015-07-01 00:00:00
abstract::DISCLOSURES: No funding supported the writing of this commentary. The author has nothing to disclose. ...
journal_title:Journal of managed care & specialty pharmacy
pub_type: 杂志文章
doi:10.18553/jmcp.2020.26.12.1612a
更新日期:2020-12-01 00:00:00
abstract:BACKGROUND:The approval of new oral disease-modifying drugs (DMDs), such as fingolimod, dimethyl fumarate (DMF), and teriflunamide, has considerably expanded treatment options for relapsing forms of multiple sclerosis (MS). However, data describing the use of these agents in routine clinical practice are limited. OBJE...
journal_title:Journal of managed care & specialty pharmacy
pub_type: 杂志文章
doi:10.18553/jmcp.2019.25.1.113
更新日期:2019-01-01 00:00:00
abstract:BACKGROUND:Value-based insurance design attempts to align drug copayment tier with value rather than cost. Previous implementations of value-based insurance design have lowered copayments for drugs indicated for select "high value" conditions and have found modest improvements in medication adherence. However, these im...
journal_title:Journal of managed care & specialty pharmacy
pub_type: 杂志文章
doi:10.18553/jmcp.2015.21.4.269
更新日期:2015-04-01 00:00:00
abstract::The ever-vulnerable medication supply chain is being further strained by the COVID-19 pandemic. Pharmacists in all settings, including managed care, will need to prepare for a potential exacerbation of existing and new drug shortages in the midst of unprecedented crisis. We summarize the major issues, discuss potentia...
journal_title:Journal of managed care & specialty pharmacy
pub_type: 杂志文章
doi:10.18553/jmcp.2020.26.8.945
更新日期:2020-08-01 00:00:00
abstract:BACKGROUND:Immunoglobulin (Ig) is a costly blood product prescribed as immune replacement or modulation therapy to treat a wide spectrum of medical conditions. While the FDA has approved Ig for a limited number of indications, there are multiple off-label uses that have demonstrated proven clinical benefit or are curre...
journal_title:Journal of managed care & specialty pharmacy
pub_type: 杂志文章
doi:10.18553/jmcp.2014.20.4.357
更新日期:2014-04-01 00:00:00
abstract::The inclusion of pharmacists on care teams has been shown to improve clinical and economic health outcomes. However, a significant barrier to the widespread incorporation of pharmacists into care teams is the ability to financially support the salary of the pharmacist. A mechanism to improve the ability of pharmacists...
journal_title:Journal of managed care & specialty pharmacy
pub_type: 杂志文章
doi:10.18553/jmcp.2018.24.12.1273
更新日期:2018-12-01 00:00:00
abstract:BACKGROUND:Adherence to adjuvant endocrine therapy (AET) for estrogen receptor-positive breast cancer remains suboptimal, which suggests that women are not getting the full benefit of the treatment to reduce breast cancer recurrence and mortality. The majority of studies on adherence to AET focus on identifying factors...
journal_title:Journal of managed care & specialty pharmacy
pub_type: 杂志文章
doi:10.18553/jmcp.2016.22.8.969
更新日期:2016-08-01 00:00:00
abstract::BACKGROUND: Basal insulin is often recommended as the initial therapy for patients with type 2 diabetes who require insulin treatment. Adequate adherence is critical to diabetes management, yet suboptimal insulin adherence has been reported. Second-generation long-acting (SGLA) insulin has higher dosing flexibility an...
journal_title:Journal of managed care & specialty pharmacy
pub_type: 杂志文章
doi:10.18553/jmcp.2020.26.11.1434
更新日期:2020-11-01 00:00:00
abstract:BACKGROUND:Treatment patterns for metastatic colorectal cancer (mCRC) patients have changed considerably over the last decade with the introduction of new chemotherapies and targeted biologics. These treatments are often administered in various sequences with limited evidence regarding their cost-effectiveness. OBJECT...
journal_title:Journal of managed care & specialty pharmacy
pub_type: 杂志文章
doi:10.18553/jmcp.2017.23.1.64
更新日期:2017-01-01 00:00:00
abstract:BACKGROUND:Multiple sclerosis (MS) is a neurological degenerative chronic condition without cure. However, long-term disease-modifying therapies (DMTs) help reduce the severity of MS symptoms. Adherence to DMTs is key to their success. Several studies have analyzed what makes patients adherent to their DMTs. As new DMT...
journal_title:Journal of managed care & specialty pharmacy
pub_type: 杂志文章
doi:10.18553/jmcp.2016.22.12.1394
更新日期:2016-12-01 00:00:00