You will be offered AWP minus some such percent, like AWP minus 12%. Sounds great, right.
Controlling Pharmacy Costs in Corrections
Top Tips for Reducing Your Pharmaceuticals Budget Jeffrey E. Keller MD
Objectives Understand pharmaceutical pricing, including Acquisition Cost plus, Fill fees, Medicaid pricing and AWP. Understand how to develop and maintain an appropriate formulary. Understand how an OTC Commissary works.
How Are You Doing Now? Calculate pharmacy costs per inmate per day. <$0.50 per inmate per day = Excellent! $0.50-$1.00 per inmate per day = OK! $1.00-$1.50 per inmate per day = Average >$1.50 per inmate per day = Problem!
Compare Prices to Medicaid MAC Ifyou are paying more than MAC, negotiate lower prices.
Acquisition Price Plus Prices fluctuate day to day. Set routine to spot check prices
Fill Fees Fee pharmacy charges for filling prescription Should not be over $5.00 Often the most important part of fee
Fill Fees Cost of Prescription for 1 HCTZ tablet: – $0.01 + $4.00 = $4.01 Cost of 30 HCTZ tablets – $0.30 + $4.00 = $4.30
Tips for reducing fill fees 50mg po qAM, 100mg po qPM – TWO fill fees 50mg one po qAM and 2 po qPM – ONE fill fee
Wastage Opened meds cannot legally be reused Source of significant waste
Tips for Reducing Wastage Institute dosage changes after current month’s prescription finishes
Check Pharmacy Bill Mistakescommon $44.77? Or $4.77?
FormularyFormularies are the Community Standard of CareFormularies, properly done, do NOT restrict access to appropriate medicine
Formulary Consider a formulary a “Pre-Approved Medication list” If a medication is not on the formulary, that does NOT mean you cannot prescribe it. It means you have to get approval first. Reason could be price. Or not.
Formulary--Price Should you use Nexium? Or Omeprazole?
Formulary--Convenience Bupropion? Or Bupropion SR?
Psychiatric Medications Polypharmacy Jailvs outside considerations Fluidity of treatment Drug abuse
HIV Hepatitis C Treatment algorhythm Off-on treatment worse than no treatment at all
Treatment Guidelines Clinical Criteria designed to avoid unnecessary medication prescriptions
CDC RecommendationsPharyngitis Four Clinical Criteria1. Fever2. Exudate3. Lymphadenopathy4. NO cough
CDC RecommendationsSinusitis1. Symptoms for more than 7 days.2. Pain or tenderness of face or teeth3. Purulent nasal discharge.4. Moderate to severe symptoms.
CDC RecommendationsBronchitis No Pneumonia—No Antibiotics1. No Fever2. No tachypnea3. No asymmetric crackles
SSRI Dosing For most drugs (SSRIs), raising the dose beyond the usual therapeutic range does not speed up response but rather causes greater severity of side effects (TREATMENTS OF PSYCHIATRIC DISORDERS - 3rd Ed.) For sertraline, the dose is 50 mg once daily for almost all patients (Cecil Textbook of Medicine, 21st ed). For fluoxetine, it is well established that doses higher than 20 mg per day do not produce a better therapeutic response in most patients (Schweizer et al 1990).
SSRI Dosing The established minimum effective dose of paroxetine is 20 mg per day. Doses higher than 20 mg per day have not been documented to improve percentage of response or response rate (Grimsley 1992) There is little evidence that total daily doses of fluvoxamine greater than 150 mg provide added efficacy.
Atypical Antipsychotics vs. TraditionalAntipsychotics Atypical Antipsychotics in the No difference in symptom Treatment of Schizophrenia: reduction if conventional dose is Systematic Overview and Meta- less than 12mg per day. regression Analysis. Geddes, Atypicals do cause less extra- J. and Bebbington, P. pyramidal symptoms, but the BMJ 2000; 321: 1371-1376. overall tolerability is identical Meta-analysis of 52 between groups. Randomized trials comparing “There is no clear evidence that atypical antipsychotics with atypical antipsychotics are more conventional antipsychotics effective or are better tolerated than conventional antipsychotics.”
The Best of the BestInformation Sources1. Primary Care Medical Abstracts2. The Oregon Drug Utilization Review Newsletter3. The Prescriber’s Letter