Catherine I. Starner

Effect of a retrospective drug utilization review on potentially inappropriate prescribing in the elderly

BACKGROUND Use of potentially inappropriate medications or drugs to be avoided in the elderly (DAE) continues to be widespread. Although the literature suggests DAE are associated with negative health outcomes, educational interventions have had a positive impact on inappropriate prescribing. OBJECTIVES The objectives of this study were to identify those members aged > or =65 years participating in a Medicare Part D Blue Cross and Blue Shield (BCBS) benefit plan who were receiving medications that may be inappropriate for use in older adults and, through a retrospective drug utilization review (RetroDUR), to notify their prcscribers of the possible safety concerns with continued use. METHODS The analysis used retrospective administrative pharmacy claims data from 3 Medicare Part D BCBS plans across 4 states. Plan members aged > or =65 years who had a claim for > or =1 DAE during a 30-day review period (August 15, 2007-September 14, 2007) with a minimum supply of 7 days of medication were identified. The National Committee for Quality Assurance 2007 Healthcare Effectiveness Data and Information Set measures for Medicare were used to determine DAE. A packet of information was mailed to prescribers identifying patients who had a claim for > or =1 DAE. Members were then assessed for the presence of a drug in the same drug class 6 months after the initial analysis. RESULTS Of a possible 328,000 eligible members, 16,973 (5.2%) had a claim for > or =1 DAE during the 30-day review period. A total of 7963 intervention prescriber letters were mailed, affecting 13,198 members with 14,267 DAE claims. The final analyzable intervention cohort consisted of 10,364 members with 11,062 DAE claims. Overall, 5403 claims (48.8%) for DAE were defined as discontinued after 6 months. The most common DAE in the study were estrogens, propoxyphene, muscle relaxants, anticholinergics, antihistamines, and nitrofurantoin, accounting for 9682 claims (87.5%). At the 6-month follow-up, reductions in claims for each of the top 6 drug/drug classes ranged from 31.3% to 66.7%. As a class, the anticholinergics had the highest rate of discontinuation. CONCLUSIONS The DAE RetroDUR was associated with a possible reduction in the use of potentially inappropriate prescription medications in these older adults. Further research, using a control population, is needed to show the impact on health care utilization and costs, adverse drug events, and health care and quality-of-life outcomes.

Erlotinib and patterns of pharmacogenomic (PGx) testing.

182 Background: Erlotinib is an oral oncology drug that costs approximately

Erlotinib patterns of use and out-of-pocket (OOP) expenses.

5,000 per month. Both the NCCN Guidelines (since March 2011) and ASCO (since April 2011) recommend PGx testing for tumor epidermal growth factor receptor (EGFR) mutation in patients with advanced non-small cell lung cancer prior to erlotinib use in the first line setting. Insight into early utilization patterns of PGx testing is crucial as new reimbursement methods, care models and evidence-based clinical pathways are developed. METHODS Using integrated medical and pharmaceutical data from four Blue Cross Blue Shield plans, we retrospectively identified members who received erlotinib between 01/2011 and 06/2011 and identified the date of the first erlotinib claim (index date). A new erlotinib user was defined as having no erlotinib claims filed in the prior 180 days. Among members who received erlotinib, medical claims were queried for the presence of ICD-9 codes for malignant neoplasm of trachea, bronchus and lung and for any current procedure terminology (CPT) code indicating PGx testing and other chemotherapy in the prior 24-month period and 1-month post the index date. Total paid amounts from all PGx test codes were obtained. The closest PGx testing date to the index date was used to calculate days between PGx testing and index date. Further analyses examining lines of therapy, monthly patterns of erlotinib usage and PGx testing pre- and post-guidelines recommendations, as well as a description of differences in utilized PGx CPT codes per individual patient, were performed. RESULTS Among 3,357,936 members insured, 125 (40 per million) received erlotinib, and 102 (81.6%) of those patients had a lung cancer diagnosis. Sixty (48%) were new erlotinib users, and 47 had a diagnosis of lung cancer. Of these, 36 (76.5%) had a PGx CPT code claim. The time between the PGx test and erlotinib start ranged from 4 days to 22 months. A total of

Rosiglitazone and Pioglitazone Utilization from January 2007 Through May 2008 Associated With Five Risk-Warning Events

30,391 was spent on all PGx testing with an average of

Association of Prescription Abandonment with Cost Share for High-Cost Specialty Pharmacy Medications

844 per member tested. CONCLUSIONS In a privately insured cohort of members who newly initiated erlotinib for lung cancer, 23.5% had no prior PGx testing. There is an opportunity for consensus guidelines, care management programs and a single PGx CPT code to possibly reduce variation regarding PGx testing patterns.

Health plan utilization and costs of specialty drugs within 4 chronic conditions.

126 Background: Erlotinib is an oral oncology drug FDA-approved for advanced pancreatic and non-small cell lung cancers. Data on its patterns of use, pharmacy dispensing, and patients OOP are scarce. METHODS Using integrated medical and pharmaceutical data from 4 Blue Cross Blue Shield plans, we retrospectively identified individuals who received erlotinib between 01/2011 and 06/2011. Their claims were further queried for neoplasm ICD9 codes. A new user was defined as having no erlotinib claims filed in the prior 180 days. All new users were followed for 180 days or until their death/disenrollment (censor date). Excess erlotinib tablets were calculated for individuals with a censor date. The cost of unused tablets was estimated considering the standard 30-day, as well as a hypothetical 15-day drug supply. A gap of 45 days without erlotinib, during the follow-up, was defined as non-persistent to erlotinib therapy. The OOP costs were recorded from their first erlotinib claim. RESULTS Among 3,357,936 members insured, 125 (40 per million) received erlotinib in the period; 102 members (81.6%) had a lung cancer diagnosis, 18 (14.4%) pancreatic cancer, and 5 (4%) had cancers where erlotinib use is not evidence-based; 31 (24.8%) had a total cumulative supply of less than 30 days suggesting one fill and then discontinuation; 60 patients (48%) were new users in the period, 47 with lung cancer and 12 with pancreatic cancer. Among new users, 27 (45%) died or disenrolled; 18 (30%) of these patients had 211 unused tablets, which amounted to

Specialty Drug Coupons Lower Out-Of-Pocket Costs And May Improve Adherence At The Risk Of Increasing Premiums

35,237 or

Generic drug discount programs: are prescriptions being submitted for pharmacy benefit adjudication?

587 per new user. With a hypothetical 15-day drug supply, there would be 45 unused tablets, totaling

Pharmacy students' views of managed care pharmacy and PBMS: should there be more exposure to managed care in the pharmacy curriculum?

7,515 or

Rosiglitazone Prior Authorization Safety Policy: A Cohort Study

125 per new user. Among the 60 new users, individual OOP on their first claim was <