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

Contrasting Pressure Effects in Sr2VFeAsO3 and Sr2ScFePO3

We report the resistivity measurements under pressure of two Fe-based superconductors with a thick perovskite oxide layer, Sr2VFeAsO3 and Sr2ScFePO3. The superconducting transition temperature Tc of Sr2VFeAsO3 markedly increases with increasing pressure. Its onset value, which was Tc{onset}=36.4 K at ambient pressure, increases to Tc{onset}=46.0 K at ~4 GPa, ensuring the potential of the "21113" system as a high-Tc material. However, the superconductivity of Sr2ScFePO3 is strongly suppressed under pressure. The Tc{onset} of ~16 K decreases to ~5 K at ~4 GPa, and the zero-resistance state is almost lost. We discuss the factor that induces this contrasting pressure effect.Comment: 5 pages, 4 figures, to be published in J. Phys. Soc. Jpn. No.12 (2009

Hydrostatic pressure effects on superconducting transition of nanostructured niobium highly strained by high-pressure torsion

We study the effects of hydrostatic pressure (HP) compression on the superconducting transition of severely strained Nb samples, whose grain sizes are reduced to the submicrometer level. Engineered granularity by high-pressure torsion (HPT) treatment changes the strength of coupling between submicrometer-scale grains and introduces lattice strain. We attempt to utilize the initially accumulated shear strain in the starting material for increasing the superconducting transition temperature Tc under HP compression. The HP effects on non-strained Nb have already been investigated in the pressure regime over 100 GPa by Struzhkin et al. [Phys. Rev. Lett. 79, 4262 (1997)], and Tc reportedly exhibited an increase from 9.2 to 9.9 K at approximately 10 GPa. (1) Slightly strained Nb in the HPT treatment exhibits the increase in Tc under HP due to the strengthening of the intergrain coupling, so the pressure scale of the pressure response observed by Struzhkin et al. is reduced to approximately one-seventh at the maximum. (2) Prominently strained Nb in the HPT treatment exhibits the increase in Tc under HP due to a reduction in structural symmetry at the unit-cell level: In a Nb sample subjected to HPT (6 GPa, 10 revolutions), Tc exceeds 9.9 K at approximately 2 GPa. According to our first-principle calculations, the reduction in the structural symmetry affords an increase in the density of states at the Fermi energy, thereby yielding a prominent increase in Tc at low pressures

Anomalous Pressure Dependence of the Superconducting Transition Temperature in FeSe1-x Studied by DC Magnetic Measurements

The pressure dependence of superconducting transition temperature $T_{\rm c}$ has been investigated through the DC magnetic measurements for FeSe$_{0.8}$ and FeSe$_{1.0}$. For both samples, with increasing pressure $P$, the $T_{\rm c}$$-$$P$ curve exhibits a two-step increase, showing a local maximum of $\sim$11 K at $P$$\sim$1.0 GPa and a rapid increase with an extremely large pressure coefficient for $P$$>$1.5 GPa. $T_{\rm c}$ saturates at $\sim$25 K (21 K) in FeSe$_{1.0}$ (FeSe$_{0.8}$) for $P$$>$3 GPa. A rapid decrease in superconducting volume fraction is observed with an increase in $T_{\rm c}$ above 1.5 GPa, suggesting the presence of electronic inhomogeneity.Comment: 4 pages, 4 figures, to appear in J. Phys. Soc. Jpn, 78 (2009), No.

11\text{}^{11}B-NMR Study of SmB6SmB_6 under Pressure

We present first experimental results of $\text{}^{11}$B-NMR of SmB_6 under applied pressure. From measurement of nuclear spin-lattice relaxation time $(T_1)$ we find that with applied pressure the value of activation gap $E_{g}$ is decreasing. This decrease is larger than in case of other experimental techniques. We suppose that the enhancement of $1//T_1$ in temperature range 20-100 K with applied pressure reflects not only a suppression of hybridization gap, but also changes in spin correlations

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

OBJECTIVES: Progesterone (hydroxyprogesterone caproate injection and vaginal progesterone) has been shown to reduce preterm birth (PTB) rates by a third among pregnant women at high risk. The purpose of this analysis is to report birth outcomes and medication adherence among Massachusetts Medicaid (MassHealth) members receiving progesterone, evaluate the association between member characteristics and birth outcomes and medication adherence, and compare cost of care with a prior preterm pregnancy. METHODS: This retrospective cohort study used medical claims, pharmacy claims, and prior authorization (PA) request data for MassHealth members who had a PA submitted for progesterone between January 1, 2011, and March 31, 2015. Members were excluded due to breaks in coverage, progesterone was not indicated for prevention of PTB, and if current gestational week or date of delivery was unavailable. MAIN RESULTS: A total of 418 members were screened for inclusion of whom 190 met criteria and 169 filled progesterone. Mean age was 29.2 years (SD = 5.23), and clinical comorbidities were identified in 90.5% of members. Consistent with clinical trials on progesterone effectiveness, 62.1% of members had a term delivery (37 wks of gestation). Among members with prior gestational age at delivery available, the average difference in gestational age between pregnancies was 8.25 weeks (SD = 6.11). In addition, 66.3% of members were adherent to progesterone based on proportion of days covered (PDC) of 0.8 or higher. The overall mean PDC was 0.79 (SD = 0.26). CONCLUSION: Despite similar birth outcomes in clinical trials and national trends, medication adherence is low in this state Medicaid program. Therefore, members may benefit from adherence support

The Effect of a Federal Controlled Substance Act Schedule Change on Hydrocodone Combination Products Claims in a Medicaid Population

BACKGROUND: In 2012, hydrocodone combination products (HCPs) were the most prescribed medications in the United States. Under the Controlled Substance Act of 1970, hydrocodone alone was classified as a Schedule II drug, while HCPs were classified as Schedule III, indicating a lower risk for abuse and misuse. However, according to a Drug Enforcement Agency analysis, the addition of nonopioids has not been shown to diminish abuse potential of hydrocodone. In response to concerns for drug abuse and overdose, the Drug Enforcement Agency rescheduled HCPs to Schedule II in October 2014, with the intent of limiting overprescribing and increasing awareness of their abuse potential. However, it is unknown whether this has affected the overall claims for HCPs in a Medicaid population. OBJECTIVES: To (a) compare the trend in HCP prescription claims with select non-HCP (opioid and nonopioid) analgesic claims before and after the HCP schedule change in the Massachusetts Medicaid fee-for-service/Primary Care Clinician plan population and (b) identify if there was a change in HCP new start member and claim characteristics before and after the HCP schedule change. METHODS: This quasi-experimental, retrospective study used enrollment and pharmacy claims data to evaluate all members in the study population 1 year before and after the HCP schedule change. The number of claims for HCPs and select non-HCP analgesics was reported as the monthly rate per total population, and an interrupted time series analysis compared the change in the monthly rate of claims across groups. Members with 1 or more pharmacy claims for a new HCP prescription during a 5-month period before or after the HCP schedule change were analyzed to determine member demographics (age, gender, and number of claims) and claim characteristics (average daily dose, average quantity per claim, and days supply). RESULTS: The rate of HCP claims increased before and decreased after the HCP schedule change. Controlling for the trend during the period before the HCP schedule change, the rate of HCP claims per 1,000 members per month decreased at a greater rate than non-HCP analgesics in the period after the HCP schedule change (P \u3c 0.001). The percentage of HCP claims for new start members decreased after the HCP schedule change (44.9% vs. 34.1% of all HCP claims pre- to post-schedule change; P \u3c 0.001). In the group of new starts, there was not a significant difference in the average daily dose (26.3 mg vs. 26.4 mg; P = 0.69), while there was a decrease in average number of tablets dispensed per claim (from 37.1 to 20.3 tablets; P \u3c 0.001) and an increase in the percentage of claims for a shorter days supply (from 57.7% to 81.6%; P \u3c 0.001). CONCLUSIONS: The findings of this study suggest that the HCP schedule change may have contributed to the decrease in claims for HCPs in a Medicaid population. After the HCP schedule change, there was a trend towards decreased HCP use among new starts. DISCLOSURES: No outside funding supported this study. The authors have nothing to disclose. Study concept and design were contributed by all authors except for Arnold and Clements. Tran, Arnold, and Clements took the lead in data collection, along with Peristere, and data interpretation was performed by all the authors, except Arnold. The manuscript was written primarily by Tran, along with Lavitas, Stevens, and Greenwood, and revised by all the authors except Arnold and Peristere. A poster of this research project was presented at the Academy of Managed Care Pharmacy\u27s 2016 Annual Meeting in San Francisco, California, April 2016