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

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

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

AMCP Partnership Forum: Navigating Innovations in Diabetes Care

New developments that provide opportunities to enhance cost-effective diabetes care include advances in the pharmacologic treatment of diabetes, new drug delivery devices, innovations in patient management strategies, contracting strategies that incentivize effective interventions, and mobile health technologies. Payers must carefully consider the utility of these advances when making coverage decisions and designing benefits. To engage national stakeholders in a discussion about how to utilize innovations in diabetes care to optimize patient outcomes, the Academy of Managed Care Pharmacy organized the Partnership Forum on Navigating Innovations in Diabetes Care in Arlington, Virginia, on July 19-20, 2016. The forum explored current trends and advances in diabetes treatments and engaged in discussions about how organizations can leverage these emerging options to develop strategies that improve coordination of care and patient outcomes, while managing limited health resources. Additionally, stakeholders were tasked with identifying gaps in evidence that hinder decision making around novel therapies and other advances that are of direct relevance to managed care organizations

Overview of Comprehensive Hepatitis C Virus Medication Management in a State Medicaid Program

BACKGROUND: Breakthrough direct-acting antivirals set a new standard in the management of hepatitis C virus (HCV) with regard to cure rates and improved tolerability; however, the health care system is challenged by the cost of these medications. OBJECTIVE: To describe the effect of a comprehensive HCV medication management program on optimized regimen use, prior authorization (PA) modifications, and medication cost avoidance in a state Medicaid program. METHODS: This program consists of a 2-tiered prescriber outreach: (1) regimen outreach to promote optimized regimen selection and (2) refill outreach to support medication adherence. PA criteria were developed to identify optimized regimens, taking into account member- and virus-specific factors as well as cost. Prescriber outreach was conducted to recommend the use of an optimized regimen as applicable. Successful regimen outreach was defined as the number of members for whom a recommendation was accepted. A refill report identified members without a subsequent paid HCV medication claim within 25 days of the previous claim and outreach to the prescriber\u27s office was performed. The outcome measure for refill outreach was the number and type of PA modifications made secondary to outreach (closure or extension). Cost avoidance was calculated for members who completed treatment with an optimized regimen. Return on investment (ROI) was calculated for the program. RESULTS: Between December 18, 2013, and January 31, 2015, 911 members had PA requests approved for simeprevir, sofosbuvir, or ledipasvir/ sofosbuvir. Of these members, 223 (24.5%) met the criteria for regimen outreach. Pharmacist interventions to treat with an optimized regimen were accepted for 135 members (60.5%). Following implementation of prescriber outreach to promote refills, between March 10, 2014, and January 31, 2015, offices were informed of an upcoming refill for 515 members. As a result of outreach, 19.6% of members had a subsequent PA modification. Sixty-nine approved PAs (for 68 members) were closed after correspondence with the prescriber, and 33 approved PAs (for 33 members) were extended. The total projected cost avoidance was $3,770,097. The comprehensive HCV medication management program demonstrated an ROI of$10.28 for every $1 spent. CONCLUSIONS: A comprehensive HCV medication management program can help contain costs while ensuring that members have access to most clinically appropriate regimens