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Specialty pharmacy utilization management programs and 30-day supply claims may improve patient outcomes, reduce waste
Date:4/4/2013

program could be successful in better determining safe and appropriate treatment for patients with MS."

Improved medication use as a result of PA programs
In a similar study, Prime researchers in collaboration with Florida Blue evaluated use of linezolid (Zyvox®), an antibiotic that the Infectious Disease Society of America recommends should not be used as a first-line treatment for most infections, but rather reserved to treat drug-resistant strains of enterococcus, staphylococcus, or streptococcus. Researchers assessed the impact of a linezolid PA program, which could help better ensure appropriate use of the drug, but could cause some patients to forego all treatment.

In the study, 1.2 million members were exposed to the PA and another 1.1 million members were not. The study found that after 30 days of follow up, the average per member overall costs of care were $4,189 lower for members exposed to the PA submitting a Zyvox claim (p=0.020). Members submitting a Zyvox claim not exposed to the PA had a non-significant 2.8 percent lower hospitalization rate (p=0.582), 3.9 percent higher ER visit rate (p=0.467), and on average one additional office visit (p=0.332).

"This study indicates PA programs can help ensure medications are used appropriately, without negatively impacting patient outcomes," said Gleason.

30- versus 90-day supply claims
The third study examined use of immunosuppressant drugs taken to reduce the risk of organ transplant rejection, including cyclosporine (Neoral®, Sandimmune®, Gengraf®) and tacrolimus (Prograf®, Hecoria™). Typically, immunosuppressant treatment requires switching to different treatments. However, when drugs are switched, remaining medication could be wasted.

The analysis of claims from 9 million commercially insured members found that during the six-month analysis period, 5,703 (0.06 percent) members were identified with 48
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SOURCE Prime Therapeutics LLC
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