Overview of a Hepatitis C Medication Monitoring Program in a State Medicaid Program

This presentation outlines a successful hepatitis C medication monitoring program instituted by Clinical Pharmacy Services for MassHealth, the Massachusetts Medicaid program. The program used outreach and education strategies to communicate with prescribers about regimens that were the most effective in treating the virus and containing costs. Member adherence to the regimen was monitored and hepatitis C cure rates were tracked through the program

Impact of Lumacaftor/Ivacaftor on Pulmonary Exacerbation Rates in Members with Cystic Fibrosis in a Medicaid Population

This poster gives an overview of pulmonary exacerbation rates pre- and post-initiation of Lumacaftor/Ivacaftor (LUM/IVA) in Massachusetts\u27 Medicaid program. Pulmonary disease is one of the leading causes of morbidity and mortality among patients with cystic fibrosis. LUM/IVA has been effective in improving pulmonary outcomes in two observational studies, but before this study, there had been no published data evaluating real-world outcomes for Medicaid patients receiving this therapy. This poster on the impact of a drug for patients with cystic fibrosis was shared during the 2018 Academy of Managed Care Pharmacy Managed Care & Specialty Pharmacy Annual Meeting and awarded a gold ribbon. The poster abstracts were evaluated on relevance, originality, quality, bias and clarity. Only 20 percent of submitted abstracts were honored with awards

Implementation of a Pediatric Behavioral Health Medication Safety Initiative in a State Medicaid Program

The poster will address concerns about an increase in the use of behavioral medications in children and the need to manage prescribing practices to ensure appropriate use of the drugs. Presented at the American Drug Utilization Review Society 2015 Conference

Evaluation of Progesterone Agent Utilization and Birth Outcomes in a State Medicaid Plan

An analysis of medication adherence and birth outcomes among members receiving progesterone for the prevention of preterm birth in a state Medicaid program. Data is also used to evaluate the association between member characteristics and medication adherence and birth outcomes as well as whether there was a change in the cost of care

Effectiveness of Ledipasvir/Sofosbuvir and Predictors of Treatment Failure in Members with Hepatitis C Genotype 1: A Retrospective Cohort Study in a Medicaid Population

An evaluation of the effectiveness of HCV genotype 1 treatment with Harvoni® (ledipasvir/sofosbuvir) as measured by a sustained virological response (SVR) of 12 weeks in the MassHealth fee-for-service and Primary Care Clinician plan population. The analysis concluded that treatment was associated with a a high rate of SVR12, which means that Hepatitis C is not detected in the blood after 12 weeks

Impact of a Pilot Outreach Program upon Provider Awareness and Prescribing of a Concerning Opioid Combination Regimen

This pilot program was developed in response to a drug utilization review within a large Medicaid population that revealed some hazardous practices. Co-prescribing of opioids with benzodiazepines, gabapentin, and other stimulants occurred in more than 500 members, putting them at risk for additive central nervous system depression, misuse, abuse, and death from overdose. The poster presentation outlines the objectives, methods, and results of a telephonic outreach program that addressed these safety concerns. It captures prescriber awareness of the presence and risks of potentially deadly medication combinations among members in their care, with some intriguing results. Our experts provide health plans with framework and support to address the opioid epidemic head on with robust opioid medication management programs, evidence-based clinical guidelines, and prescriber outreach. Our interdisciplinary team’s innovative approach helps health plans decrease inappropriate opioid usage and while ensuring members maintain access to appropriate pain management. This presentation was given at the American Drug Utilization Review Society (ADURS) conference February 22-24, 2018 in Scottsdale, Arizona

Evaluating the Impact of Interventions by a Multidisciplinary Pediatric Behavioral Health Medication Initiative Workgroup on Medication Prescribing Trends in a Medicaid Population

In 2011, the U.S. Government Accountability Office (GAO) reported foster and non-foster children in the MassHealth, Massachusetts Medicaid program, exhibited the highest rate of behavioral health medication (BHM) utilization, with 49.3% of all Medicaid children being prescribed a psychotropic medication, and 39.1% of children in foster care prescribed these medications. The MassHealth Pharmacy Program, which is managed by UMass Medical School, implemented a PBHMI Workgroup in November 2014 with the collaboration of the Department of Children and Families and the Department of Mental Health. The workgroup proactively requires prior authorization (PA) for specific medications or combinations of BHMs prescribed to members less than 18 years of age. Interventions include telephonic prescriber outreach by a child/adolescent psychiatrist to discuss opportunities for regimen simplification, drug interactions or toxicity, and to encourage evidence-based practices. An analysis of the workgroup suggests a peer-to-peer outreach program is associated with increased awareness and implementation of evidence based medicine in a pediatric population treated with behavioral health medications

Impact of Ivacaftor on Medication Use, Hospital and Outpatient Provider Visits and Associated Costs in a Medicaid Population

BACKGROUND: Ivacaftor is the first Food and Drug Administration-approved medication to treat an underlying genetic defect in patients with cystic fibrosis (CF). With an approximate annual cost of $300,000 per patient, ivacaftor may have a profound financial impact on health systems, even when utilized by a small population. Clinical data has demonstrated that treatment with ivacaftor may reduce pulmonary exacerbations (PE) and associated hospitalizations. As a result, patients receiving ivacaftor may need less outpatient care and fewer medications to treat CF complications. Evaluating the impact of ivacaftor therapy on medication utilization, PEs and hospital/outpatient visits can aid formulary decision makers in its effective management. OBJECTIVES: The primary objective is to examine the effects of ivacaftor on patients’ overall medication regimen and associated costs within a Medicaid population. The secondary objective is to examine its effect on the rates of PEs and hospital/outpatient visits. METHODS: Pharmacy and medical claims data for Medicaid members ≥ six years of age was collected for six months before and after the first reported pharmacy claim of ivacaftor. Data included: total number of unique claims, days supply, dose, and total cost for each medication, number of short-term antibiotic and/or steroid courses, outpatient provider visits, hospitalizations, ER visits and corresponding diagnosis codes. Diagnosis codes and short-term antibiotic and/or steroid courses were reviewed to determine if a PE may have occurred. RESULTS: Ivacaftor treatment did not decrease the utilization of medications used to treat patients with CF and resulted in increased pharmacy expenditures for other medications. However, a 65% reduction in PEs as well as a reduction in hospitalizations/ER visits was observed in members receiving ivacaftor. CONCLUSIONS: This study found that while ivacaftor treatment may not decrease total medication utilization or associated costs, it may decrease the number of PEs and associated hospitalizations in patients with CF

An Eye to a Kill: Using Predatory Bacteria to Control Gram-Negative Pathogens Associated with Ocular Infections

Ocular infections are a leading cause of vision loss. It has been previously suggested that predatory prokaryotes might be used as live antibiotics to control infections. In this study, Pseudomonas aeruginosa and Serratia marcescens ocular isolates were exposed to the predatory bacteria Micavibrio aeruginosavorus and Bdellovibrio bacteriovorus. All tested S. marcescens isolates were susceptible to predation by B. bacteriovorus strains 109J and HD100. Seven of the 10 P. aeruginosa isolates were susceptible to predation by B. bacteriovorus 109J with 80% being attacked by M. aeruginosavorus. All of the 19 tested isolates were found to be sensitive to at least one predator. To further investigate the effect of the predators on eukaryotic cells, human corneal-limbal epithelial (HCLE) cells were exposed to high concentrations of the predators. Cytotoxicity assays demonstrated that predatory bacteria do not damage ocular surface cells in vitro whereas the P. aeruginosa used as a positive control was highly toxic. Furthermore, no increase in the production of the proinflammatory cytokines IL-8 and TNF-alpha was measured in HCLE cells after exposure to the predators. Finally, injection of high concentration of predatory bacteria into the hemocoel of Galleria mellonella, an established model system used to study microbial pathogenesis, did not result in any measurable negative effect to the host. Our results suggest that predatory bacteria could be considered in the near future as a safe topical bio-control agent to treat ocular infections. © 2013 Shanks et al

Fine-mapping analysis including over 254,000 East Asian and European descendants identifies 136 putative colorectal cancer susceptibility genes

Genome-wide association studies (GWAS) have identified more than 200 common genetic variants independently associated with colorectal cancer (CRC) risk, but the causal variants and target genes are mostly unknown. We sought to fine-map all known CRC risk loci using GWAS data from 100,204 cases and 154,587 controls of East Asian and European ancestry. Our stepwise conditional analyses revealed 238 independent association signals of CRC risk, each with a set of credible causal variants (CCVs), of which 28 signals had a single CCV. Our cis-eQTL/mQTL and colocalization analyses using colorectal tissue-specific transcriptome and methylome data separately from 1299 and 321 individuals, along with functional genomic investigation, uncovered 136 putative CRC susceptibility genes, including 56 genes not previously reported. Analyses of single-cell RNA-seq data from colorectal tissues revealed 17 putative CRC susceptibility genes with distinct expression patterns in specific cell types. Analyses of whole exome sequencing data provided additional support for several target genes identified in this study as CRC susceptibility genes. Enrichment analyses of the 136 genes uncover pathways not previously linked to CRC risk. Our study substantially expanded association signals for CRC and provided additional insight into the biological mechanisms underlying CRC development