Rochelle Henderson

Geographic Variation in Receipt of Psychotherapy in Children Receiving Attention-Deficit/Hyperactivity Disorder Medications

Antibiotics were prescribed during 60% of pharyngitis visits for children (Table). Narrow-spectrum penicillins accounted for 61% of antibiotics prescribed. During the 14-year study period,narrow-spectrumpenicillinprescribingdecreasedfrom65% (95% CI, 57%-72%) of antibiotics in 1997 to 1998 to 52% (95% CI, 44%-60%) in 2009 to 2010 (P = .08), while macrolides increased (P < .01) (Figure). Macrolides and first-generation cephalosporins (second-line antibiotics for GAS pharyngitis) and second-/thirdgeneration cephalosporins and amoxicillin-clavulanate (not recommended)accountedfor21%and18%ofantibioticsprescribed, respectively.

Early Marketplace Enrollees Were Older And Used More Medication Than Later Enrollees; Marketplaces Pooled Risk

Little is known about the health status of the 7.3 million Americans who enrolled in insurance plans through the Marketplaces established by the Affordable Care Act in 2014. Medication use may provide an early indicator of the health needs and access to care among Marketplace enrollees. We used data from January-September 2014 on more than one million Marketplace enrollees from Express Scripts, the largest pharmacy benefit management company in the United States. We compared the characteristics and medication use between early and late Marketplace enrollees and between all Marketplace enrollees and enrollees with employer-sponsored insurance. Among Marketplace enrollees, we found that those who enrolled earlier (October 2013-February 2014) were older and used more medication than later enrollees. Marketplace enrollees, as a whole, had lower average drug spending and were less likely to use most medication classes than the employer-sponsored comparison group. However, Marketplace enrollees were more likely to use medicines for hepatitis C and particularly for HIV.

Medication Nonadherence Among Medicare Beneficiaries with Comorbid Chronic Conditions: Influence of Pharmacy Dispensing Channel

BACKGROUND Taking medications as prescribed is imperative for their effectiveness. In populations such as Medicare, where two thirds of Medicare beneficiaries have at least 2 or more chronic conditions requiring treatment with medications and account for more than 90% of Medicare health care spend, examining ways to improve medication adherence in patients with comorbidities is warranted. OBJECTIVE To examine the association of pharmacy dispensing channel (home delivery or retail pharmacy) with medication adherence for Medicare patients taking medications with comorbid conditions of diabetes, hypertension, and high blood cholesterol (3 of the top 5 most prevalent conditions), while controlling for various confounders. METHODS A retrospective analysis was conducted using de-identified pharmacy claims data from a large national pharmacy benefits manager between October 2010 and December 2012. Continuously eligible Medicare Part D patients (Medicare Advantage Prescription Drug plan and Prescription Drug Plan only) aged 65 years or older who had an antidiabetic, antihypertensive, and antihyperlipidemic prescription claim between October and December 2010 were identified and analyzed over a 2-year period. Multivariate logistic regression was used to evaluate the association between dispensing channel (DC) and medication adherence in calendar year (CY) 2012 controlling for prior adherence behavior (adherence in CY2011), differences in demographics, low-income subsidy status, days supply, disease burden, and drug-use pattern. Patients with a proportion of days covered (PDC) of at least 80% for each of the 3 conditions were considered to be adherent, and patients with PDC less than 80% for each of the 3 conditions were considered to be nonadherent. Patients were assigned to a DC depending on where they filled at least 66.7% of their prescriptions for each of the 3 conditions, and the rest were assigned to a mixed channel group. RESULTS The final analytical sample consisted of 40,632 patients. The adjusted odds of adherence for patients using home delivery were 1.59 (95% CI = 1.40-1.80) higher compared with patients using retail channels to obtain their prescriptions. CONCLUSIONS Medicare Part D patients taking medications for comorbid conditions who used home delivery had a greater likelihood (adjusted) of adherence than patients who filled their antidiabetic, antihypertensive, and antihyperlipidemic prescriptions using retail channels. Managed care stakeholders looking to make informed decisions in a cost-constrained environment to assess, implement, and promote solutions that improve health outcomes should consider the use of home delivery of prescriptions to improve adherence for Medicare Part D patients with comorbid conditions. DISCLOSURES Funding for this study was provided internally by Express Scripts Holding Company. Iyengar, LeFrancois, Henderson, and Rabbitt are employees of Express Scripts. Study concept and design were created by Iyengar and LeFrancois. Iyengar was responsible for acquisition of data, statistical analysis, and interpretation of data. The manuscript was written by Iyengar and LeFrancois and revised by all the authors.

Poster 350: Predictors of Falls in Inpatient Rehabilitation

low back pain (n 1), hip pain (n 2), or foot pain (n 3). Interventions: Clinical examination, imaging, kinematic/ gait analysis of running, high speed filming, functional kinetic chain screening, customized physical therapy, shoe fitting/orthoses. Main Outcome Measures: Pain-musculoskeletal discomfort, return to running. Results: Patients underwent a comprehensive examination to identify the pain-generating source and the static/dynamic muscle weakness. Imaging identified whether soft tissue or bony injury was involved. Three-dimensional kinematic analysis identified aberrations to lower limb joint angular motion and joint torques. Gait and foot pressure patterns provided information about the transfer of the body weight over the feet. The study of the running motion provided data of muscle weakness and imbalance. Anthropometrics were useful in planning for corrective orthoses. Collectively, the integrative testing revealed several common pain types: patellofemoral, hip ligament, facet joint/lumbar, and foot metatarsal. Kinematic study and high speed filming identified that muscle strength deficiencies translated into suboptimal running mechanics from the thorax to the foot. Low core, hip flexor, hip adductor, and low foot strength generally contributed to alterations in knee motion and excessive foot pronation or supination. Targeted strengthening, corrective shoe fitting or orthoses were used to normalize running mechanics and gait. This comprehensive approach was used successfully to restore running performance in this group. Conclusions: This integrated model can be used for the systematic approach to treatment of running injuries and the expansion of the current state of knowledge of running rehabilitation outcomes.

The Effect of Florida Medicaid’s State-Mandated Formulary Provision on Prescription Drug Use and Health Plan Costs in a Medicaid Managed Care Plan

BACKGROUND Formulary or preferred drug list (PDL) management is an effective strategy to ensure clinically efficient prescription drug management by managed care organizations (MCOs). Medicaid MCOs participating in Floridas Medicaid program were required to use a state-mandated PDL between May and August 2014. OBJECTIVE To examine differences in prescription drug use and plan costs between a single Florida Medicaid managed care (MMC) health plan that implemented a state-mandated PDL policy on July 1, 2014, and a comparable MMC health plan in another state without a state-mandated PDL, controlling for sociodemographic confounders. METHODS A retrospective analysis with a pre-post design was conducted using deidentified administrative claims data from a large pharmacy benefit manager. The prepolicy evaluation period was January 1 through June 30, 2014, and the postpolicy period was January 1 through June 30, 2015. Continuously eligible Florida MMC plan members were matched on sociodemographic and health characteristics to their counterparts enrolled in a comparable MMC health plan in another state without a state-mandated formulary. Outcomes were drug use, measured as the number of 30-day adjusted nonspecialty drug prescriptions per member per period, and total drug plan costs per member per period for all drugs, with separate measures for generic and brand drugs. Bivariate comparisons were conducted using t-tests. Employing a difference-in-differences (DID) analytic approach, multivariate negative binomial regression and generalized estimating equation models were used to analyze prescription drug use and costs. RESULTS The final analytical sample consisted of 18,372 enrollees, evenly divided between the 2 groups. In the postpolicy evaluation period, overall and generic use declined, while brand use increased for members in the Florida health plan. Drug costs, especially for brands, significantly increased for Florida health plan members. No significant changes were observed over the same time period in the control health plan members. DID analyses indicated that the decline in overall drug use was 6% lower (P = 0.020), and the increase in plan costs was 27% higher (P = 0.002) among Florida health plan members compared with control group members. CONCLUSIONS Members in a Florida Medicaid health plan with a state-mandated PDL saw declines in overall and generic drug use and an increase in drug plan costs. States considering a state-mandated PDL should take into account potential effects of decreased generic drug use and increases in prescription drug plan costs. DISCLOSURES Funding for this study was provided internally by Express Scripts Holding Company. The authors and acknowledged contributors are employees of Express Scripts Holding Company. All authors contributed to the study concept, and study design was provided by Munshi, Mager, and Henderson. Munshi and Mager collected the data, and Munshi provided the statistical analysis. Data interpretation was performed by Munshi, Mager, and Henderson. The manuscript was written by Munshi, Henderson, and Mager and revised by Munshi, Ward, Mischel, and Henderson.