Healthcare Reform and Changes in Medicaid
- Tue, 11/29/11 - 5:43pm
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Atlanta—Medicaid is a low-income family health insurance program funded jointly by federal and state governments. It is administered by the Centers for Medicare & Medicaid Services for individuals who meet financial and category requirements. At a Contemporary Issues session at the AMCP meeting, Cynthia Kirman, RPh, PharmD, of Molina Healthcare, presented a session titled Understanding the Changing Medicaid Landscape.
Prostate Cancer Treatments Pose Challenges for Managed Care
- Tue, 11/29/11 - 5:41pm
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Atlanta—With the introduction of several new therapies, the treatment for castration-resistant prostate cancer (CRPC) has gone through a dramatic shift in recent years. By the end of the decade, the market for prostate cancer is expected to double, with the new agents and more in the pipeline playing an expanded role in helping patients.
Guideline for Pharmacy Claims Audits Could Add Consistency to the Process
- Tue, 11/29/11 - 5:29pm
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Atlanta—A guideline for pharmacy claims audits could help improve collaboration and minimize friction between managed care organizations (MCOs) and community pharmacists, according to a Contemporary Issues session at the AMCP meeting. An AMCP task force has been working on developing an audit guideline goal and discussed their process, current problems with pharmacy claims audits, and their hopes for the guideline during the session.
Specialty Medications Becoming More Popular
- Tue, 11/29/11 - 5:26pm
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Atlanta—Although <1% of patients use specialty medications, they account for 15% of drug spending. The trend is expected to continue, as numerous expensive specialty drugs have recently been approved by the US Food and Drug Administration (FDA) and many more are in the pipeline.
Aimee Tharaldson, PharmD, senior clinical consultant for emerging therapeutics at Express Scripts, Inc, spoke about the topic at a Contemporary Issues session at the AMCP meeting titled Specialty Pharmaceuticals Pipeline Update.
Pharmacy and the Medicare Star Rating System
- Tue, 11/29/11 - 5:24pm
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Atlanta—The Star Rating System created by the Centers for Medicare & Medicaid Services was added to Medicare programs to help educate beneficiaries about quality of care and increase the transparency of quality data available to consumers. The ratings are based on 5 domains and are released each year; beginning in 2012, payments to Medicare Advantage plans will be tied to Star Rating scores. Bonuses will be available for plans with ≥4 stars, and contracts for plans with <3 stars for 3 consecutive years will be terminated.
Pharmacy Benefit Management Supported by Employer Case Study
- Tue, 11/29/11 - 5:22pm
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Atlanta—During a Managed Care Essentials session at the AMCP meeting, Kathleen Thompson, manager of total rewards, Matthews International, and Mara Pawlis, senior analytic consultant, CVS Caremark, presented Results of a PBM/Employer Strategic Pharmacy Benefit Partnership. The transition by Matthews International, a prominent product marketing company, to a pharmacy benefit manager (PBM) plan was used as a case study to highlight the potential value of PBM plans.
Performance Measures to Enhance Care and Reduce Costs
- Tue, 11/29/11 - 5:20pm
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Atlanta—The Patient Protection and Affordable Care Act of 2010 was designed to achieve 3 goals: better health, better care, and lower costs. The National Quality Forum (NQF) has convened the National Priorities Partnership (NPP), a multistakeholder group charged with providing annual input to the US Department of Health and Human Services (DHHS) on the development of a National Quality Strategy (NQS).
Partnership for Patients and Transitions of Care
- Tue, 11/29/11 - 5:17pm
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Atlanta—The Partnership for Patients, a public–private initiative to improve hospital care and transitions of care, was launched in April 2011 by Kathleen Sebelius, secretary of the US Department of Health and Human Services, and Donald Berwick, administrator of the Centers for Medicare & Medicaid Services. The partnership is committed to reducing preventable hospital-acquired conditions by 40% compared with 2010 levels and decreasing preventable complications during transitions of care by 20% compared with 2010 levels.
Fraud, Waste, and Abuse Impact Costs, Care, and Safety
- Tue, 11/29/11 - 5:13pm
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Atlanta—Each year, billions of dollars are lost to Medicare fraud. In addition to the financial burden, instances of waste and abuse jeopardize both quality of care and patient safety. Raising awareness of the problem is as important a tool in dealing with the issue as are education, training, and proactive deterrent measures.
Evaluating New Medications with Evidence-Based Value Analysis
- Tue, 11/29/11 - 5:11pm
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Atlanta—Of the medications approved by the US Food and Drug Administration (FDA) in 2010 and 2011, many are specialty, biologic, and oncology treatments, making it especially important for healthcare plans to establish reproducible and transparent methods for assessing the value of these emerging therapies. At a Managed Care Essentials session at the AMCP meeting, speakers addressed the issue of value assessment in a presentation titled “Evidence-Based Value Analysis of Mew Medications: 2011 Update.”




