This document summarizes a panel discussion on trends in prescribing practices. The panel included experts from the CDC and pharmacy who discussed current trends in prescribing controlled substances and best practices for utilizing prescription drug monitoring programs. They also evaluated opportunities for pharmacists to collaborate with prescribers to create effective treatment plans for patients.
This document outlines an opioid abuse prevention plan 2.0. It summarizes data showing increasing opioid and heroin overdose deaths between 1999-2013. It discusses efforts to increase prescriber education, expand prescription drug monitoring programs, improve drug disposal, and make naloxone more available. The plan focuses on continued education, monitoring, disposal, enforcement, and expanding treatment and overdose prevention programs like medication-assisted treatment and naloxone access.
The document analyzes trends in Medicare Part B drug utilization and spending from 2002-2006, during which time the Medicare Modernization Act was passed in 2003. This led to changes in reimbursement rates for Part B drugs. The analysis found that while the number of Part B drug users and claims increased over this period, the rate of growth in spending remarkably slowed after the MMA despite increases in utilization. The rankings of the top 20 drugs by spending changed, with some dropping substantially due to decreased reimbursement rates under the MMA.
The document discusses the issue of prescription drug abuse in the United States. It provides statistics showing the dramatic rise in prescription opioids dispensed between 2000-2009, as well as related increases in overdose deaths, emergency department visits, and deaths exceeding other causes like firearms or car accidents. The White House Office of National Drug Control Policy has developed a Prescription Drug Abuse Prevention Plan with four key areas of focus: education for healthcare providers, improving prescription drug monitoring programs, secure medication disposal, and enforcement efforts. The goal is a coordinated federal response to address this public health crisis.
High Society: Drug prevalence in the UK workplaceConcateno
This report analyzes the results of over 1.6 million workplace drug tests in the UK from 2007-2011. Key findings include:
- At least 1 in 30 UK employees test positive for drugs, equating to nearly 1 million people across the workforce.
- Drug use in the workplace has increased 43% from 2007-2011, with the highest rates in 2011 of 1.93% for cannabis and 1.87% for opiates.
- The most commonly detected drugs are cannabis, opiates, and cocaine. Young professionals ages 25-34 test positive for Class A drugs like cocaine more than any other age group.
MedTech Healthcare Group is the largest provider of outpatient substance abuse treatment programs in Westmoreland and Indiana counties in Pennsylvania, operating three clinics over the past decade. It has treated thousands of patients for opioid addiction and helped reduce the impact of the opioid epidemic. MedTech is on track to generate $3 million in revenue and $900,000-1 million in EBITDA in 2015, with steady growth since its founding in 2006. The behavioral healthcare industry, particularly medication-assisted treatment (MAT) for opioid addiction, represents a large and growing market opportunity.
This document provides an update to a 2014 paper on integrating tobacco cessation medications into state and provincial quitlines. It summarizes trends showing an increase in quitlines offering medications from 70% in 2008 to 87% in 2012. The update reviews evidence that providing medications through quitlines increases their reach and effectiveness by improving quit rates. It describes current models for medication integration including information only, limited distribution, full distribution, and partnership distribution. Finally, it summarizes literature finding that medication use improves quit outcomes and increased call volumes when promoted.
John Hammergren, CEO of McKesson, presented an overview of the company's financial results and strategy at a Goldman Sachs healthcare conference. McKesson achieved 22% revenue growth and 20% earnings per share growth in fiscal year 2004. McKesson's strategy is to build strong customer relationships through comprehensive solutions, invest in innovative offerings, and create unique solutions to address emerging healthcare challenges. For fiscal year 2005, McKesson expects earnings per share between $2.20-$2.35, with revenues growing over 10% annually and mid-teens earnings growth once business changes are completed.
The document analyzes pharmacy payment data from 2000-2005 and the impact of a 2004 fee schedule change. Key points:
1. Pharmacy payment growth significantly dropped from 22.4% in 2002 to 3.2% in 2005 after the 2004 fee change.
2. After 2004, brand drug dispenses and payments decreased while generics increased, providing cost savings.
3. Higher-priced brand drugs were more impacted by the benchmark Average Wholesale Price, while generics were more impacted by the dispensing fee.
This document outlines an opioid abuse prevention plan 2.0. It summarizes data showing increasing opioid and heroin overdose deaths between 1999-2013. It discusses efforts to increase prescriber education, expand prescription drug monitoring programs, improve drug disposal, and make naloxone more available. The plan focuses on continued education, monitoring, disposal, enforcement, and expanding treatment and overdose prevention programs like medication-assisted treatment and naloxone access.
The document analyzes trends in Medicare Part B drug utilization and spending from 2002-2006, during which time the Medicare Modernization Act was passed in 2003. This led to changes in reimbursement rates for Part B drugs. The analysis found that while the number of Part B drug users and claims increased over this period, the rate of growth in spending remarkably slowed after the MMA despite increases in utilization. The rankings of the top 20 drugs by spending changed, with some dropping substantially due to decreased reimbursement rates under the MMA.
The document discusses the issue of prescription drug abuse in the United States. It provides statistics showing the dramatic rise in prescription opioids dispensed between 2000-2009, as well as related increases in overdose deaths, emergency department visits, and deaths exceeding other causes like firearms or car accidents. The White House Office of National Drug Control Policy has developed a Prescription Drug Abuse Prevention Plan with four key areas of focus: education for healthcare providers, improving prescription drug monitoring programs, secure medication disposal, and enforcement efforts. The goal is a coordinated federal response to address this public health crisis.
High Society: Drug prevalence in the UK workplaceConcateno
This report analyzes the results of over 1.6 million workplace drug tests in the UK from 2007-2011. Key findings include:
- At least 1 in 30 UK employees test positive for drugs, equating to nearly 1 million people across the workforce.
- Drug use in the workplace has increased 43% from 2007-2011, with the highest rates in 2011 of 1.93% for cannabis and 1.87% for opiates.
- The most commonly detected drugs are cannabis, opiates, and cocaine. Young professionals ages 25-34 test positive for Class A drugs like cocaine more than any other age group.
MedTech Healthcare Group is the largest provider of outpatient substance abuse treatment programs in Westmoreland and Indiana counties in Pennsylvania, operating three clinics over the past decade. It has treated thousands of patients for opioid addiction and helped reduce the impact of the opioid epidemic. MedTech is on track to generate $3 million in revenue and $900,000-1 million in EBITDA in 2015, with steady growth since its founding in 2006. The behavioral healthcare industry, particularly medication-assisted treatment (MAT) for opioid addiction, represents a large and growing market opportunity.
This document provides an update to a 2014 paper on integrating tobacco cessation medications into state and provincial quitlines. It summarizes trends showing an increase in quitlines offering medications from 70% in 2008 to 87% in 2012. The update reviews evidence that providing medications through quitlines increases their reach and effectiveness by improving quit rates. It describes current models for medication integration including information only, limited distribution, full distribution, and partnership distribution. Finally, it summarizes literature finding that medication use improves quit outcomes and increased call volumes when promoted.
John Hammergren, CEO of McKesson, presented an overview of the company's financial results and strategy at a Goldman Sachs healthcare conference. McKesson achieved 22% revenue growth and 20% earnings per share growth in fiscal year 2004. McKesson's strategy is to build strong customer relationships through comprehensive solutions, invest in innovative offerings, and create unique solutions to address emerging healthcare challenges. For fiscal year 2005, McKesson expects earnings per share between $2.20-$2.35, with revenues growing over 10% annually and mid-teens earnings growth once business changes are completed.
The document analyzes pharmacy payment data from 2000-2005 and the impact of a 2004 fee schedule change. Key points:
1. Pharmacy payment growth significantly dropped from 22.4% in 2002 to 3.2% in 2005 after the 2004 fee change.
2. After 2004, brand drug dispenses and payments decreased while generics increased, providing cost savings.
3. Higher-priced brand drugs were more impacted by the benchmark Average Wholesale Price, while generics were more impacted by the dispensing fee.
Prescription Medicines Costs in Context March 2022PhRMA
This document discusses trends in prescription drug costs and spending in the United States. It notes that 60 new medicines were approved by the FDA in 2021 for cancer, hemophilia, and COVID. While brand drug prices declined slightly in 2020, overall drug spending grew modestly. Most drug spending goes to health insurers, pharmacy benefit managers, and other entities rather than drug manufacturers. The majority of drugs dispensed are generics, which provide billions in savings each year. The document argues that while drug spending is projected to increase at a similar rate as overall healthcare costs, patients still face high out-of-pocket costs due to deductibles, coinsurance, and other cost-sharing policies by insurers.
This document outlines a presentation given by Joseph Rannazzisi, Deputy Assistant Administrator at the DEA Office of Diversion Control. The presentation discusses the pharmacological properties and abuse potential of Zohydro ER, an extended release hydrocodone product, and outlines approaches for law enforcement to reduce abuse and diversion of the drug. It also describes potential methods for abuse and diversion of Zohydro ER. The presentation aims to educate on the opioid epidemic, properties of Zohydro ER, and law enforcement strategies to address abuse and diversion.
This document summarizes trends shaping workers' compensation medication policies in 2014. It discusses the influence of various factors, including political influences from the Affordable Care Act and state elections; clinical influences like an aging population and the opioid epidemic; and product influences as new medications enter the market. It also outlines debates around issues like physician dispensing, compounded medications, medical marijuana, and opioid monitoring programs.
How Do Opioid Prices and the Evolving Opioid Crisis Relate to the North Ameri...with Wind
The Role of Opioid Prices in the Evolving Opioid Crisis is a publication by order of the Commander in Chief; Our 45th President, Mr. Donald J Trump.
This is an objective purview of the role pharmaceutical marketing and advertising and the one true law that is Supply and Demand have had on the current crisis North America finds itself in.
I aim to be objective - no subjective - or opinionated argument - merely share the presentation as it was originally published by < whitehouse.gov. >
I will state this - however - the opioid crisis - is real - it is not some propaganda cooked up by CDC - DEA - or the Free Masons (wholly misunderstood by today's youth - Illuminati).
It has - in some, shape, form or fashion - affected every single North American at some point over the entirety of this - ridiculous attempt at going to war - against substances.
For my opinions, feel free to connect on
< https://www.linkedin.com/in/oudcollective >
FOLLOW @oudcollective
< https://www.twitter.com/oudcollective >
or help out in pinning beginnings at
< https://www.pinterest.com/THEWINDLLC >
Best,
< linktr.ee/C.Brennan.Poole >
< https://allmylinks.com/chasing-the-wind >
Chasing the Wind, LLC DBA THE WIND LLC is licensed under a creative commons attribution share-alike (CC BY-SA) International 4.0 license. Link to license at < www.creativecommons.org/licenses/by-sa/4.0 >
TRENDS AND PATTERNS OF GEOGRAPHIC VARIATIONS IN OPIOID PRESCRIBINGwith Wind
The document analyzes trends in opioid prescribing practices across US states from 2006 to 2017. It finds that while the total amount of opioids prescribed decreased over this period, the duration of prescriptions increased. Specifically:
- The total amount of opioids prescribed per person decreased 12.8% on average nationally, though there was significant variation between states.
- The mean duration of opioid prescriptions increased 37.6% nationally, with increases in every state.
- Prescriptions for durations of 30 days or longer, which are more likely to treat chronic pain, increased 37.7% nationally, with increases in 39 states.
- However, prescribing rates decreased for high dosages, short durations,
This document discusses compliance with narcotics guidelines for managing prescription drug abuse. It describes how managed care programs, employers, healthcare providers and insurers are susceptible to increased workers' compensation costs due to prescription drug abuse. It identifies strategies to help drug-dependent employees return to work, and describes how Washington State has addressed overuse of opioids in workers' compensation through dosing guidelines and a prescription drug monitoring program. The agenda includes discussing the problem of prescription drug abuse, efforts to prevent problems, and the cost of addiction.
Prescription Medicines Costs in Context April 2022PhRMA
This document discusses the costs of prescription medicines in the United States. It notes that 60 new medicines were approved by the FDA in 2021 for cancer, hemophilia, and COVID treatments. While brand medicine prices declined slightly in 2020, overall medicine spending grew modestly due to rebates and discounts. The majority of medicine spending goes to entities other than the manufacturers, such as insurers, pharmacy benefit managers, and providers. The document argues for reforms that make insurance work better for patients, modernize Medicare drug coverage, protect safety net programs, and end misaligned incentives in the system.
This document is a webinar presentation on managing drug shortages for colorectal cancer medications. It provides background on the increasing issue of drug shortages in the US, with over 200 shortages reported annually since 2010. For colorectal cancer specifically, 6 of the 9 main drugs used to treat the disease have been in shortage in the past 2 years, including 5-FU, leucovorin, and irinotecan. The presentation discusses reasons for shortages like manufacturing and supply chain issues, and strategies used by health systems and government agencies to help mitigate shortages, such as improved communication and expediting regulatory reviews of alternative products.
Prescription Medicines - Costs in Context - October 2018PhRMA
This document discusses the costs and context of prescription medicines. It notes that while prescription drug spending is a small percentage of total healthcare costs, certain patients face rising out-of-pocket costs. It also outlines the significant costs and risks of developing new medicines, with the average drug taking over 10 years and $2.6 billion to develop. The document proposes reforms to help lower costs for patients while supporting continued research and development of new treatments.
This document summarizes lessons that can be learned from other countries regarding national pharmacare programs. It discusses how countries like Australia, Germany, and the UK have had lower growth in per capita drug costs compared to Canada since 2000. Countries with universal coverage like the UK, Netherlands, and New Zealand provide models for managing drug formularies and costs while maintaining patient access. The experiences of these international programs suggest opportunities for Canada to improve cost containment and better maximize value from drug expenditures through a universal pharmacare plan.
We honor ourselves when we speak out for recovery. We show the world that recovery matters because it brings hope and peace into the lives of individuals and their loved ones. ~ Beth Wilson
The only person you are destined to become is the person you decide to be. ~ Ralph Waldo Emerson
Success is the sum of small efforts, repeated day in and day out.
~ Robert Collier
This document summarizes the key points from a conference on managing risk in the workplace by addressing substance abuse issues. The conference objectives are to identify signs of drug addiction, describe employer procedures for substance abuse, and explain potential liabilities. It discusses the opioid epidemic, prescription drug abuse trends, and provides statistics on prescription drug use. Guidelines are presented for screening employees, using urine drug testing, identifying aberrant behaviors, and establishing treatment plans when substance abuse is suspected.
Prescription Medicines Costs in Context October 2020PhRMA
This document discusses the costs and affordability of prescription medicines in the United States. It notes that while spending on prescription medicines accounts for only 14% of total health care spending, patients face high and rising out-of-pocket costs for medicines. While most medicines sold in the US are generics, brand name medicines face significant price negotiations and rebates paid to insurers and pharmacy benefit managers that often do not lower costs for patients. The document outlines reforms to make medicines more affordable and accessible for patients.
Prescription Medicines Costs in Context April 2021PhRMA
This document discusses the costs of prescription medicines in the United States. It notes that while brand medicine prices have risen 1.7% in 2019, in line with inflation, many patients still struggle with costs. It also discusses that prescription medicines make up only 14% of total healthcare spending in the US. Finally, it summarizes efforts by PhRMA to make medicines more affordable and accessible for patients.
Third-Party Payer Track, National Rx Drug Abuse Summit, April 2-4, 2013. Right Drug, Right Test, Right Time
presentation by Dongchung Wang, Dr. Lennox Abbott and Tron Emptage
Prescription Medicines Costs in Context November 2019PhRMA
This document discusses the costs and context of prescription medicines. It notes that while prescription drug spending is a small percentage of total healthcare spending, patients often face high out-of-pocket costs. It outlines the significant costs and risks of drug research and development. The document also describes the role of generics in reducing costs over time and how rebates and discounts do not always lower costs for patients.
Top Therapeutic Classes by Non-Discounted SpendingIMS Health US
The document is a report from IMS Institute for Healthcare Informatics that lists the top 20 therapeutic classes in the US by non-discounted spending from 2010 to 2014. It shows that oncology had the highest spending of $32.6 billion in 2014, followed by antidiabetes at $32.2 billion, and autoimmune increasing significantly from $11.3 billion in 2010 to $22.2 billion in 2014. The appendix notes the data is from IMS Health and reflects prescription medications excluding over-the-counter products.
1) Prescription drug abuse in the U.S. has reached epidemic levels, with overdose deaths, opioid sales, and treatment admissions all rising in parallel since 1999. 2) To reverse the epidemic, efforts are needed to improve prescription drug monitoring programs (PDMPs), ensure safer opioid prescribing practices, expand access to treatment including buprenorphine, and support state-level prevention strategies. 3) Early evidence suggests that real-time, universal PDMPs; mandating their use; integrating them into electronic health records; and comprehensive laws can all help to reduce doctor shopping, opioid prescribing, and overdose deaths.
This document outlines efforts by several states to leverage prescription drug monitoring program (PDMP) data as public health surveillance tools through CDC's Prevention Boost grant program. It describes Oklahoma's program which expanded PDMP data sharing and used the data for epidemiological analyses to monitor trends in high-risk prescribing behaviors and health outcomes. It also discusses Utah's program which evaluated causes of prescription opioid deaths using PDMP data and supported several pieces of legislation. Finally, it summarizes Kentucky's program which addressed the state's high prescription drug overdose rates by enhancing its PDMP and linking the data to other health databases for surveillance purposes.
Prescription Medicines Costs in Context March 2022PhRMA
This document discusses trends in prescription drug costs and spending in the United States. It notes that 60 new medicines were approved by the FDA in 2021 for cancer, hemophilia, and COVID. While brand drug prices declined slightly in 2020, overall drug spending grew modestly. Most drug spending goes to health insurers, pharmacy benefit managers, and other entities rather than drug manufacturers. The majority of drugs dispensed are generics, which provide billions in savings each year. The document argues that while drug spending is projected to increase at a similar rate as overall healthcare costs, patients still face high out-of-pocket costs due to deductibles, coinsurance, and other cost-sharing policies by insurers.
This document outlines a presentation given by Joseph Rannazzisi, Deputy Assistant Administrator at the DEA Office of Diversion Control. The presentation discusses the pharmacological properties and abuse potential of Zohydro ER, an extended release hydrocodone product, and outlines approaches for law enforcement to reduce abuse and diversion of the drug. It also describes potential methods for abuse and diversion of Zohydro ER. The presentation aims to educate on the opioid epidemic, properties of Zohydro ER, and law enforcement strategies to address abuse and diversion.
This document summarizes trends shaping workers' compensation medication policies in 2014. It discusses the influence of various factors, including political influences from the Affordable Care Act and state elections; clinical influences like an aging population and the opioid epidemic; and product influences as new medications enter the market. It also outlines debates around issues like physician dispensing, compounded medications, medical marijuana, and opioid monitoring programs.
How Do Opioid Prices and the Evolving Opioid Crisis Relate to the North Ameri...with Wind
The Role of Opioid Prices in the Evolving Opioid Crisis is a publication by order of the Commander in Chief; Our 45th President, Mr. Donald J Trump.
This is an objective purview of the role pharmaceutical marketing and advertising and the one true law that is Supply and Demand have had on the current crisis North America finds itself in.
I aim to be objective - no subjective - or opinionated argument - merely share the presentation as it was originally published by < whitehouse.gov. >
I will state this - however - the opioid crisis - is real - it is not some propaganda cooked up by CDC - DEA - or the Free Masons (wholly misunderstood by today's youth - Illuminati).
It has - in some, shape, form or fashion - affected every single North American at some point over the entirety of this - ridiculous attempt at going to war - against substances.
For my opinions, feel free to connect on
< https://www.linkedin.com/in/oudcollective >
FOLLOW @oudcollective
< https://www.twitter.com/oudcollective >
or help out in pinning beginnings at
< https://www.pinterest.com/THEWINDLLC >
Best,
< linktr.ee/C.Brennan.Poole >
< https://allmylinks.com/chasing-the-wind >
Chasing the Wind, LLC DBA THE WIND LLC is licensed under a creative commons attribution share-alike (CC BY-SA) International 4.0 license. Link to license at < www.creativecommons.org/licenses/by-sa/4.0 >
TRENDS AND PATTERNS OF GEOGRAPHIC VARIATIONS IN OPIOID PRESCRIBINGwith Wind
The document analyzes trends in opioid prescribing practices across US states from 2006 to 2017. It finds that while the total amount of opioids prescribed decreased over this period, the duration of prescriptions increased. Specifically:
- The total amount of opioids prescribed per person decreased 12.8% on average nationally, though there was significant variation between states.
- The mean duration of opioid prescriptions increased 37.6% nationally, with increases in every state.
- Prescriptions for durations of 30 days or longer, which are more likely to treat chronic pain, increased 37.7% nationally, with increases in 39 states.
- However, prescribing rates decreased for high dosages, short durations,
This document discusses compliance with narcotics guidelines for managing prescription drug abuse. It describes how managed care programs, employers, healthcare providers and insurers are susceptible to increased workers' compensation costs due to prescription drug abuse. It identifies strategies to help drug-dependent employees return to work, and describes how Washington State has addressed overuse of opioids in workers' compensation through dosing guidelines and a prescription drug monitoring program. The agenda includes discussing the problem of prescription drug abuse, efforts to prevent problems, and the cost of addiction.
Prescription Medicines Costs in Context April 2022PhRMA
This document discusses the costs of prescription medicines in the United States. It notes that 60 new medicines were approved by the FDA in 2021 for cancer, hemophilia, and COVID treatments. While brand medicine prices declined slightly in 2020, overall medicine spending grew modestly due to rebates and discounts. The majority of medicine spending goes to entities other than the manufacturers, such as insurers, pharmacy benefit managers, and providers. The document argues for reforms that make insurance work better for patients, modernize Medicare drug coverage, protect safety net programs, and end misaligned incentives in the system.
This document is a webinar presentation on managing drug shortages for colorectal cancer medications. It provides background on the increasing issue of drug shortages in the US, with over 200 shortages reported annually since 2010. For colorectal cancer specifically, 6 of the 9 main drugs used to treat the disease have been in shortage in the past 2 years, including 5-FU, leucovorin, and irinotecan. The presentation discusses reasons for shortages like manufacturing and supply chain issues, and strategies used by health systems and government agencies to help mitigate shortages, such as improved communication and expediting regulatory reviews of alternative products.
Prescription Medicines - Costs in Context - October 2018PhRMA
This document discusses the costs and context of prescription medicines. It notes that while prescription drug spending is a small percentage of total healthcare costs, certain patients face rising out-of-pocket costs. It also outlines the significant costs and risks of developing new medicines, with the average drug taking over 10 years and $2.6 billion to develop. The document proposes reforms to help lower costs for patients while supporting continued research and development of new treatments.
This document summarizes lessons that can be learned from other countries regarding national pharmacare programs. It discusses how countries like Australia, Germany, and the UK have had lower growth in per capita drug costs compared to Canada since 2000. Countries with universal coverage like the UK, Netherlands, and New Zealand provide models for managing drug formularies and costs while maintaining patient access. The experiences of these international programs suggest opportunities for Canada to improve cost containment and better maximize value from drug expenditures through a universal pharmacare plan.
We honor ourselves when we speak out for recovery. We show the world that recovery matters because it brings hope and peace into the lives of individuals and their loved ones. ~ Beth Wilson
The only person you are destined to become is the person you decide to be. ~ Ralph Waldo Emerson
Success is the sum of small efforts, repeated day in and day out.
~ Robert Collier
This document summarizes the key points from a conference on managing risk in the workplace by addressing substance abuse issues. The conference objectives are to identify signs of drug addiction, describe employer procedures for substance abuse, and explain potential liabilities. It discusses the opioid epidemic, prescription drug abuse trends, and provides statistics on prescription drug use. Guidelines are presented for screening employees, using urine drug testing, identifying aberrant behaviors, and establishing treatment plans when substance abuse is suspected.
Prescription Medicines Costs in Context October 2020PhRMA
This document discusses the costs and affordability of prescription medicines in the United States. It notes that while spending on prescription medicines accounts for only 14% of total health care spending, patients face high and rising out-of-pocket costs for medicines. While most medicines sold in the US are generics, brand name medicines face significant price negotiations and rebates paid to insurers and pharmacy benefit managers that often do not lower costs for patients. The document outlines reforms to make medicines more affordable and accessible for patients.
Prescription Medicines Costs in Context April 2021PhRMA
This document discusses the costs of prescription medicines in the United States. It notes that while brand medicine prices have risen 1.7% in 2019, in line with inflation, many patients still struggle with costs. It also discusses that prescription medicines make up only 14% of total healthcare spending in the US. Finally, it summarizes efforts by PhRMA to make medicines more affordable and accessible for patients.
Third-Party Payer Track, National Rx Drug Abuse Summit, April 2-4, 2013. Right Drug, Right Test, Right Time
presentation by Dongchung Wang, Dr. Lennox Abbott and Tron Emptage
Prescription Medicines Costs in Context November 2019PhRMA
This document discusses the costs and context of prescription medicines. It notes that while prescription drug spending is a small percentage of total healthcare spending, patients often face high out-of-pocket costs. It outlines the significant costs and risks of drug research and development. The document also describes the role of generics in reducing costs over time and how rebates and discounts do not always lower costs for patients.
Top Therapeutic Classes by Non-Discounted SpendingIMS Health US
The document is a report from IMS Institute for Healthcare Informatics that lists the top 20 therapeutic classes in the US by non-discounted spending from 2010 to 2014. It shows that oncology had the highest spending of $32.6 billion in 2014, followed by antidiabetes at $32.2 billion, and autoimmune increasing significantly from $11.3 billion in 2010 to $22.2 billion in 2014. The appendix notes the data is from IMS Health and reflects prescription medications excluding over-the-counter products.
1) Prescription drug abuse in the U.S. has reached epidemic levels, with overdose deaths, opioid sales, and treatment admissions all rising in parallel since 1999. 2) To reverse the epidemic, efforts are needed to improve prescription drug monitoring programs (PDMPs), ensure safer opioid prescribing practices, expand access to treatment including buprenorphine, and support state-level prevention strategies. 3) Early evidence suggests that real-time, universal PDMPs; mandating their use; integrating them into electronic health records; and comprehensive laws can all help to reduce doctor shopping, opioid prescribing, and overdose deaths.
This document outlines efforts by several states to leverage prescription drug monitoring program (PDMP) data as public health surveillance tools through CDC's Prevention Boost grant program. It describes Oklahoma's program which expanded PDMP data sharing and used the data for epidemiological analyses to monitor trends in high-risk prescribing behaviors and health outcomes. It also discusses Utah's program which evaluated causes of prescription opioid deaths using PDMP data and supported several pieces of legislation. Finally, it summarizes Kentucky's program which addressed the state's high prescription drug overdose rates by enhancing its PDMP and linking the data to other health databases for surveillance purposes.
This document discusses the growing problem of prescription drug abuse and misuse in the United States. It summarizes recent trends showing increasing rates of prescription drug misuse and overdose deaths. It outlines how commonly abused drug classes like opioids and stimulants affect the brain and explains why people abuse these drugs for their rewarding effects. It also describes strategies being developed to increase treatment, such as new medications to treat addiction and reverse overdoses, as well as health applications and interventions to address this important public health issue.
An epidemic refers to an occurrence of more cases of a disease than normal in a specific population over a given time period. Prescription drug abuse includes taking someone else's prescription medication, taking a prescription in a way other than intended, or taking medication to get high. Over 100 people die from drug overdoses every day in the United States, largely due to prescription opioid pain relievers. Nonmedical use of prescription drugs has become a major public health problem affecting people of all ages.
The document summarizes a presentation on coordinating multiple stakeholders in pain medicine. It discusses:
1) Changing norms around opioid prescribing for chronic non-cancer pain in the 1990s that were based on weak science.
2) Evidence that long-term opioid therapy has weak evidence of efficacy and risks of tolerance, dependence and increased doses over time without functional improvement.
3) Data linking higher opioid doses (>100mg MED/day) and long-acting opioids to increased risks of overdose, other drug-related emergency room visits, and mortality.
The Skeeterhawk Experiment 2013 Slide Presentation (Prescription Drug Misuse)Skeeterhawk
The Skeeterhawk Experiment was organized in March 2013 to help end the scourge of prescription drug misuse through the testing of innovative prevention, treatment, and overdose rescue strategies in real-life communities, beginning in Northeast Florida. Utilizing data gathered from a multitude of reliable sources, The Skeeterhawk Experiment believes it is possible for every community to devise targeted, data-driven strategies to tackle its unique set of prescription drug misuse problems. This is the organization's Northeast Florida community presentation for 2013.
National Rx Drug Abuse Summit, April 2-4, 2013, General Session presentation "Realities of Addiction," by Dr. Nora Volkow, Director, National Institute on Drug Abuse
R&D Productivity and Costs in Today's Health Care Arena - Pat AudetTTC, llc
The document discusses challenges facing the pharmaceutical industry including increased healthcare costs, decreased R&D productivity, and more difficulty achieving blockbuster drugs. It also outlines strategies the industry is taking to address these challenges such as focusing on specialty and biologic drugs, reducing R&D costs through outsourcing and adaptive clinical trial designs, and pursuing mergers and acquisitions.
Safe Prescribing Practices Conference for Medical Professionals, June 2013Heidi Denton
Participants will:
Report their intent to support and/or actively work towards incorporating best practices in responsible prescribing guidelines into their everyday practice of medicine.
Report an increased knowledge of the Michigan Automated Prescription System (MAPS) and the benefits of reporting regularly to MAPS.
Report intent to support and/or actively work towards incorporating consistent use of the MAPS into their everyday practice of prescribing controlled substances.
Report that at the training they received easy to use tools that can help them to better educate their patients on the importance of taking medications as prescribed.
Gain an increased knowledge of local, state, and national substance abuse and mental health treatment resources.
West Virginia has high rates of opioid and benzodiazepine prescription and misuse according to the document. It ranks third highest for opioid prescriptions per capita and first for benzodiazepine prescriptions. In 2014 over 400,000 opioid prescriptions and 300,000 benzodiazepine prescriptions were filled for West Virginia Medicaid recipients. West Virginia Medicaid has policies like quantity limits and a lock-in program to curb prescription drug abuse and encourages providers and recipients to follow best practices for responsible prescribing and use.
This study analyzed opioid prescription trends among medical specialties in the U.S. from 2007-2012 using a national prescription database. The key findings were:
- Primary care specialties (family practice, internal medicine, general practice) accounted for nearly half of all dispensed opioid prescriptions in 2012.
- Specialties treating pain conditions like pain medicine, surgery, and physical medicine had the highest rates of opioid prescribing.
- Overall opioid prescribing rates increased from 2007-2010 but stabilized from 2010-2012 as most specialties reduced rates.
- The greatest increase in opioid prescribing was among physical medicine specialists, while the largest decreases were in emergency medicine and dentistry.
This document summarizes information about prescription drug monitoring programs (PMPs) and their role in preventing prescription drug abuse. Some key points:
- PMPs track prescriptions for controlled substances to identify patterns of abuse and diversion. Most states now have PMPs operating.
- Studies have found that a small percentage of individuals (around 1-2%) exhibit questionable patterns like using many prescribers and pharmacies. Early PMP queries in Kansas identified some individuals receiving high amounts of controlled substances from multiple providers.
- One study found that states with PMPs in place did not see significant reductions in overdose death rates compared to states without PMPs. However, PMP characteristics like mandatory
Seeking medical attention for chronic pain is often the primary reason behind prescribing opioids. The practice of prescribing opioid painkillers has been so rampant that it led to an epidemic, which the United States has been struggling with for decades. Although medical practices, guidelines and recommendations explicitly point out that prescribing opioid pain pills should always outweigh the risks, they continue to wreak havoc across the North American continent.
This document provides an overview of a presentation given at the Virginia Rural Health Association Annual Conference on December 11, 2014 about the REVIVE! project in Virginia. The presentation discusses the high rates of opioid overdose deaths in the US and Virginia, describes how naloxone works to reverse opioid overdoses, and outlines the development and implementation of the REVIVE! pilot programs which trained laypeople to administer intranasal naloxone to reverse overdoses.
Dr. Tom Frieden, Director of the Centers for Disease Control and Prevention, keynote presentation at the National Rx Drug Abuse & Heroin Summit on March 30, 2016.
Kana Enomoto, Acting Administrator, Substance Abuse and Mental Health Services Administration, keynote presentation at the National Rx Drug Abuse & Heroin Summit March 29, 2016
This document summarizes a presentation on managing morphine equivalent dose (MED) and identifying high-risk opioid use through "red flagging." It discusses how calculating MED at the point of sale can help identify unsafe dosages and decrease opioid prescriptions. It also evaluates different methods to screen for overdose risk, finding that simple opioid use thresholds to flag patients may not accurately target those most likely to experience preventable overdoses. The presentation aims to explain MED management, describe payer solutions that reduced opioid use, and identify more precise ways to intervene with highest-risk patients.
Web rx16 prev_tues_330_1_lawal_2warren_3huddleston_4pershingOPUNITE
This document discusses the role of health departments in preventing neonatal abstinence syndrome (NAS). It notes that NAS rates have increased significantly in recent years, disproportionately affecting women. Health departments engage in surveillance to monitor NAS trends, partner with other organizations, support treatment and recovery programs, and provide education to prevent NAS, which is entirely preventable. The document outlines specific strategies health departments use across these areas to address the opioid epidemic and protect maternal and infant health.
The document discusses the opioid crisis in the United States, including rising rates of prescription opioid misuse and abuse, as well as heroin use and overdose deaths. It outlines how research can help address this crisis through developing less abusable analgesics, expanding access to treatment medications like naloxone and buprenorphine, and exploring new treatment approaches such as immunotherapies and precision medicine targeting genetic factors. The National Institute on Drug Abuse is supporting these research efforts and working to disseminate findings to improve prevention and intervention programs.
This document summarizes the opioid crisis in the United States from 2000 to 2014. It shows that the number of opioid-related overdose deaths more than tripled during this period, increasing from about 8,000 to over 28,000. Additionally, 7.9 million Americans aged 12 or older met the criteria for an illicit drug use disorder in 2013-2014 but only 20% received treatment. The document outlines actions by the Obama administration to address the crisis and increase funding for treatment. It emphasizes that stories can help reduce stigma and that recovery is possible through working together.
Web rx16 prev_tues_200_1_bretthaude-mueller_2scott_3debenedittis_4cairnes copyOPUNITE
This presentation covered multi-media prevention strategies for issues like prescription drug overdoses. It discussed the CDC's digital Rx drug prevention campaign, best practices for digital messaging, and programs using expectancy challenge theory and media literacy education in schools. Presenters included representatives from the CDC, Media Literacy for Prevention, and the Hanley Center Foundation who discussed their work developing and implementing digital communications and single-session prevention programs.
This document discusses strategies for reducing buprenorphine diversion and pill mills while improving access to treatment. It notes that limiting access to buprenorphine treatment is associated with increased diversion, while expanded access to quality treatment decreases diversion and overdose deaths. The document recommends educating prescribers, using medically-derived prescribing standards, ensuring adequate insurance coverage of safe prescribing practices, and addressing diversion risks for other controlled medications. It argues against onerous new regulations that could limit treatment access. The goal is to identify and support high-quality treatment while prosecuting criminal operations.
This document summarizes a presentation on linking and mapping prescription drug monitoring program (PDMP) data. It discusses the benefits of linking PDMP data to clinical data, including improving patient safety, evaluating prescribing decisions, and assessing the impact of PDMP interventions. It describes challenges with linking data, such as obtaining consent and negotiating data use agreements. It also discusses Washington State's MAPPING OPIOID AND OTHER DRUG ISSUES (MOODI) tool, which integrates PDMP data with other databases to map and target treatment and overdose prevention efforts at the community level.
Rx16 prev wed_330_workplace issues and strategiesOPUNITE
This document discusses workplace issues related to prescription drug abuse and strategies for prevention. It begins with introductions of the presenters and moderators. The learning objectives are then outlined as understanding challenges of prescription drug abuse in the workplace, identifying prevention strategies, and describing programs available through SAMHSA. The document then covers topics such as the scope of prescription drug misuse among workers, risks to the workplace, prevention strategies employers can consider, and available resources from SAMHSA.
Web only rx16 pharma-wed_330_1_shelley_2atwood-harlessOPUNITE
This document discusses a presentation on pharmacy burglary, robbery, and diversion of prescription drugs. The presentation covers trends in prescription drug diversion, particularly those involving robbery and burglary of pharmacies. It identifies preventative measures to enhance pharmacy security and safety. Strategies to reduce pharmacy crimes are outlined. The offender perspective is examined based on interviews with convicted offenders. Routine activities theory is discussed as relating to suitable targets, capable guardians, and motivated offenders. Partnerships between regulatory agencies and law enforcement are emphasized as key to prevention efforts.
Linking and mapping PDMP data can provide several benefits but also faces challenges. Linking PDMP and clinical data allows for evaluating the impact of PDMP interventions on outcomes and prescribing decisions. However, obtaining permissions and data is difficult due to legal and resource barriers. Mapping PDMP data using GIS tools in Washington identified areas for targeting overdose prevention efforts by visualizing patterns in prescribing risks, treatment availability, and overdoses. Stakeholders used these maps to guide education and funding decisions. Sustaining these tools requires ongoing funding and expanding included data sources.
This document discusses drug court models and the role of law enforcement in drug courts. It begins with introductions from presenters and outlines learning objectives about explaining drug court operations and benefits, how law enforcement can utilize drug courts, and identifying best practices. The following sections provide details on drug court models, including how they integrate treatment into the justice system using a non-adversarial approach. Key components of drug courts are outlined, and presenters discuss issues like prescription drug and heroin abuse as well as outcomes from drug courts in reducing recidivism and saving money. Law enforcement can play roles in prevention, addressing domestic violence, and targeting the right populations for drug court involvement through assessment.
This document summarizes presentations from two communities - Huntington, WV and Camden County, NJ - on their responses to heroin crises. It outlines programs implemented in Huntington, including a harm reduction program, centralized information system, and drug court expansion. It also discusses the region's history with prescription drug abuse and rise in heroin and associated issues like hepatitis and neonatal abstinence syndrome. Long-term strategies proposed include expanding treatment services, promoting career opportunities for those in recovery, and preventing relapse through environmental design changes.
This document discusses neonatal abstinence syndrome (NAS) and universal maternal drug testing. It provides background information on NAS including trends showing large increases in incidence and costs associated with NAS. It outlines objectives related to describing NAS trends, identifying legislative activities impacting NAS, describing family planning for women in substance abuse treatment, and explaining a hospital program using universal drug testing. The document then covers topics including NAS symptoms, incidence and geographic trends, costs of NAS, opioid use in women of childbearing age, unintended pregnancy rates, contraceptive use among opioid users, and maternal drug exposure sources.
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This document outlines an advocacy track presentation on activating communities to address prescription drug abuse. It provides biographies of the presenters and moderators and discloses any conflicts of interest. The learning objectives are to identify best practices for implementing CADCA's seven strategies for community change to impact prescription drug issues. It then provides examples of how various coalitions across the country are utilizing each of the seven strategies, such as providing education, enhancing skills, supporting communities, and changing policies.
This document discusses recovery ready ecosystems and recovery community organizations. It introduces presenters from Young People in Recovery and Hope House Treatment Track who will discuss interventions, prevention, and recovery programs. Examples of Young People in Recovery chapters, programs, and services are provided, including employment workshops, education workshops, housing workshops, and recovery support services. The document also discusses recovery community organizations and initiatives in Texas and Georgia, such as the Association of Persons Affected by Addiction in Dallas and the Georgia Council on Substance Abuse.
This document summarizes a presentation on health plan involvement in safe prescribing. It includes:
1) Presentations from medical experts on prescription drug abuse trends from medical examiner data and a tribal health system's safe prescribing program.
2) A discussion of health plan policies to reduce "red flag" medication combinations like opioids plus benzodiazepines through prior authorization, formulary changes, and provider restrictions.
3) Examples of one health plan's implementation of policies like restricting methadone prescriptions to pain specialists and removing carisoprodol from its formulary.
Our backs are like superheroes, holding us up and helping us move around. But sometimes, even superheroes can get hurt. That’s where slip discs come in.
Cell Therapy Expansion and Challenges in Autoimmune DiseaseHealth Advances
There is increasing confidence that cell therapies will soon play a role in the treatment of autoimmune disorders, but the extent of this impact remains to be seen. Early readouts on autologous CAR-Ts in lupus are encouraging, but manufacturing and cost limitations are likely to restrict access to highly refractory patients. Allogeneic CAR-Ts have the potential to broaden access to earlier lines of treatment due to their inherent cost benefits, however they will need to demonstrate comparable or improved efficacy to established modalities.
In addition to infrastructure and capacity constraints, CAR-Ts face a very different risk-benefit dynamic in autoimmune compared to oncology, highlighting the need for tolerable therapies with low adverse event risk. CAR-NK and Treg-based therapies are also being developed in certain autoimmune disorders and may demonstrate favorable safety profiles. Several novel non-cell therapies such as bispecific antibodies, nanobodies, and RNAi drugs, may also offer future alternative competitive solutions with variable value propositions.
Widespread adoption of cell therapies will not only require strong efficacy and safety data, but also adapted pricing and access strategies. At oncology-based price points, CAR-Ts are unlikely to achieve broad market access in autoimmune disorders, with eligible patient populations that are potentially orders of magnitude greater than the number of currently addressable cancer patients. Developers have made strides towards reducing cell therapy COGS while improving manufacturing efficiency, but payors will inevitably restrict access until more sustainable pricing is achieved.
Despite these headwinds, industry leaders and investors remain confident that cell therapies are poised to address significant unmet need in patients suffering from autoimmune disorders. However, the extent of this impact on the treatment landscape remains to be seen, as the industry rapidly approaches an inflection point.
Hiranandani Hospital in Powai, Mumbai, is a premier healthcare institution that has been serving the community with exceptional medical care since its establishment. As a part of the renowned Hiranandani Group, the hospital is committed to delivering world-class healthcare services across a wide range of specialties, including kidney transplantation. With its state-of-the-art facilities, advanced medical technology, and a team of highly skilled healthcare professionals, Hiranandani Hospital has earned a reputation as a trusted name in the healthcare industry. The hospital's patient-centric approach, coupled with its focus on innovation and excellence, ensures that patients receive the highest standard of care in a compassionate and supportive environment.
One health condition that is becoming more common day by day is diabetes.
According to research conducted by the National Family Health Survey of India, diabetic cases show a projection which might increase to 10.4% by 2030.
Promoting Wellbeing - Applied Social Psychology - Psychology SuperNotesPsychoTech Services
A proprietary approach developed by bringing together the best of learning theories from Psychology, design principles from the world of visualization, and pedagogical methods from over a decade of training experience, that enables you to: Learn better, faster!
Travel vaccination in Manchester offers comprehensive immunization services for individuals planning international trips. Expert healthcare providers administer vaccines tailored to your destination, ensuring you stay protected against various diseases. Conveniently located clinics and flexible appointment options make it easy to get the necessary shots before your journey. Stay healthy and travel with confidence by getting vaccinated in Manchester. Visit us: www.nxhealthcare.co.uk
- Video recording of this lecture in English language: https://youtu.be/kqbnxVAZs-0
- Video recording of this lecture in Arabic language: https://youtu.be/SINlygW1Mpc
- Link to download the book free: https://nephrotube.blogspot.com/p/nephrotube-nephrology-books.html
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These lecture slides, by Dr Sidra Arshad, offer a simplified look into the mechanisms involved in the regulation of respiration:
Learning objectives:
1. Describe the organisation of respiratory center
2. Describe the nervous control of inspiration and respiratory rhythm
3. Describe the functions of the dorsal and respiratory groups of neurons
4. Describe the influences of the Pneumotaxic and Apneustic centers
5. Explain the role of Hering-Breur inflation reflex in regulation of inspiration
6. Explain the role of central chemoreceptors in regulation of respiration
7. Explain the role of peripheral chemoreceptors in regulation of respiration
8. Explain the regulation of respiration during exercise
9. Integrate the respiratory regulatory mechanisms
10. Describe the Cheyne-Stokes breathing
Study Resources:
1. Chapter 42, Guyton and Hall Textbook of Medical Physiology, 14th edition
2. Chapter 36, Ganong’s Review of Medical Physiology, 26th edition
3. Chapter 13, Human Physiology by Lauralee Sherwood, 9th edition
Does Over-Masturbation Contribute to Chronic Prostatitis.pptxwalterHu5
In some case, your chronic prostatitis may be related to over-masturbation. Generally, natural medicine Diuretic and Anti-inflammatory Pill can help mee get a cure.
Does Over-Masturbation Contribute to Chronic Prostatitis.pptx
Ph 2 paulozzi paone_kelly
1. Pharmacy
Track
Panel
Discussion:
Trends
in
Prescribing
Prac7ces
Presenters:
Len
Paulozzi,
MD,
MPH
Denise
Paone,
EdD
Tom
Kelly,
R.Ph.,
B.Sc
Moderator:
Andrew
Kolodny,
MD
2. Disclosures
• Len
Paulozzi
• Denise
Paone
has
no
financial
rela7onships
with
proprietary
en77es
that
produce
health
care
goods
and
services
• Thomas
Kelly
has
financial
rela7onships
with
proprietary
en77es
that
produce
health
care
products
and
services.
These
financial
rela7onships
are:
– President/C.E.O.
Medicine
To
Go
Pharmacies
• Retail
pharmacies
– President/C.E.O./Partner,
PPTP.net,
LLC
• Online
due
diligence
tool
for
preven7on
of
misuse,
abuse,
and
diversion
3. Learning
Objec7ves
1. Describe
current
trends
in
effec7ve
prescribing
habits.
2. Outline
best
prac7ces
for
u7lizing
data
and
PDMPs
as
effec7ve
tools
in
dispensing
controlled
substances.
3. Evaluate
opportuni7es
for
pharmacists
to
collaborate
with
prescribers
to
create
an
effec7ve
treatment
plan
for
their
pa7ents.
4. TM
Centers for Disease Control and Prevention
National Center for Injury Prevention and Control
Trends
in
Prescribing
of
Controlled
Substances,
United
States,
2007-‐2012
Len
Paulozzi,
MD,
MPH
Centers
for
Disease
Control
and
Preven7on
Na7onal
Prescrip7on
Drug
Summit
Atlanta,
GA
April
22,
2014
5. 5
Overview
Trends
in
mortality
Trends
in
prescribing
of
controlled
substances
Conclusions
6. Motor
vehicle
traffic,
poisoning,
and
drug
poisoning
death
rates,
United
States,
1980-‐-‐2010
0
5
10
15
20
25
1980
1985
1990
1995
2000
2005
2010
Deaths
per
100,000
popula?on
Motor
vehicle
traffic
Poisoning
Drug
poisoning
CDC/NCHS
Na7onal
Vital
Sta7s7cs
System
accessed
through
CDC
WONDER.
7. Drug
overdose
deaths
by
major
drug
type,
United
States,
1999-‐2010
CDC/NCHS
Na7onal
Vital
Sta7s7cs
System,
CDC
WONDER
0
2,000
4,000
6,000
8,000
10,000
12,000
14,000
16,000
18,000
1999
2000
2001
2002
2003
2004
2005
2006
2007
2008
2009
2010
Number
of
Deaths
Year
Opioids
Heroin
Cocaine
Benzodiazepines
16,651
9. 9
Prescrip7on
Data
Source
Purchase
from
IMS
• Na7onal
Prescrip7on
Audit
(NPA)
2007-‐2012
• Data
from
38,000/57,000
pharmacies
• Includes
retail,
mail-‐order,
and
long-‐term
care
• Na7onal-‐level
counts
for
prescrip7ons
and
units
(e.g.,
pills)
es7mated
using
a
proprietary
method
• CDC
converted
to
popula7on-‐based
rates
• Non-‐Butrans
buprenorphine
excluded
from
opioid
rates
10. 10
Total
prescrip7on
rate,
United
States,
2007-‐2012
128,000
129,000
130,000
131,000
132,000
133,000
134,000
135,000
136,000
2007
2008
2009
2010
2011
2012
Prescrip?ons
per
10,000
Source:
IMS
Na7onal
Prescrip7on
Audit
(NPA)®
Extracted
July,
2013
Increase
from
13.1
to
13.5
prescrip7ons
per
person
from
2007
to
2012.
11. 11
Opioid
analgesic
prescrip7on
and
unit
rates,
United
States,
2007-‐2012
7,500
8,000
8,500
9,000
9,500
10,000
0
100,000
200,000
300,000
400,000
500,000
600,000
2007
2008
2009
2010
2011
2012
Prescrip?ons
per
10,000
Units
per
10,000
Unit
rate
Prescrip7on
rate
1%
drop
from
2010
Source:
IMS
Na7onal
Prescrip7on
Audit
(NPA)®
Extracted
July,
2013.
Excludes
buprenorphine
other
than
BuTrans
products.
Units
limited
to
solid
dosage
forms.
1%
increase
from
2010
14. 14
Other
major
opioids
prescrip7on
rate,
United
States,
2007-‐2012
0
100
200
300
400
500
600
2007
2008
2009
2010
2011
2012
Prescrip?ons
per
10,000
Morphine
Fentanyl
Methadone
Codeine
Oxymorphone
Source:
IMS
Na7onal
Prescrip7on
Audit
(NPA)®
Extracted
July,
2013
15. 15
Other
major
opioids
prescrip7on
rate,
United
States,
2007-‐2012
0
100
200
300
400
500
600
2007
2008
2009
2010
2011
2012
Prescrip?ons
per
10,000
Morphine
Fentanyl
Methadone
Codeine
Oxymorphone
Source:
IMS
Na7onal
Prescrip7on
Audit
(NPA)®
Extracted
July,
2013
Methadone
increased
sharply
to
2008,
when
DEA
compelled
restricted
use
of
the
largest
formula7on.
Rate
in
2012
same
as
rate
in
2007.
16. 16
Oxymorphone
prescrip7on
rate,
United
States,
2007-‐2012
0
10
20
30
40
50
60
2007
2008
2009
2010
2011
2012
Prescrip?ons
per
10,000
Source:
IMS
Vector
One® Na7onal
(VONA)
Extracted
July,
2013
Abuse-‐resistant
extended-‐release
formula7on
(Opana
ER)
came
on
market
February,
2012.
Rate
dropped
19%
from
2011
to
2012.
17. 17
Opioid
analgesic
prescrip7on
rate
by
payment,
United
States,
2007-‐2012
0
1,000
2,000
3,000
4,000
5,000
6,000
7,000
8,000
9,000
10,000
2007
2008
2009
2010
2011
2012
Prescrip?ons
per
10,000
Total
Cash
Cash
17%
of
all
opioid
rx
Source:
IMS
Na7onal
Prescrip7on
Audit
(NPA)®
Extracted
July,
2013
Excludes
buprenorphine
other
than
BuTrans
products
Cash
9%
of
all
opioid
rx
18. 18
Hydrocodone
and
oxycodone
prescrip7on
rate
paid
with
cash,
United
States,
2007-‐2012
0
100
200
300
400
500
600
700
800
900
2007
2008
2009
2010
2011
2012
Prescrip?ons
per
10,000
Hydrocodone
Oxycodone
48%
drop
from
20077
39%
drop
Source:
IMS
Na7onal
Prescrip7on
Audit
(NPA)®
Extracted
July,
2013
19. 19
Benzodiazepine
prescrip7on
and
unit
rates,
United
States,
2007-‐2012
200,000
205,000
210,000
215,000
220,000
225,000
230,000
235,000
240,000
2,500
2,700
2,900
3,100
3,300
3,500
3,700
3,900
4,100
4,300
2007
2008
2009
2010
2011
2012
Units
per
10,000
Prescrip?ons
per
10,000
Prescrip7on
rate
Unit
rate
Source:
IMS
Na7onal
Prescrip7on
Audit
(NPA)®
Extracted
July,
2013
21. 21
Carisoprodol
prescrip7on
rate,
United
States,
2007-‐2012
290
300
310
320
330
340
350
360
370
2007
2008
2009
2010
2011
2012
Prescrip?ons
per
10,000
Source:
IMS
Na7onal
Prescrip7on
Audit
(NPA)®
Extracted
July,
2013
DEA
places
carisoprodol
in
Schedule
IV,
Jan
2012;
11%
drop
22. Conclusions
Drug
overdose
epidemic
driven
by
overdoses
of
prescrip?on
opioids,
oPen
combined
with
benzodiazepines
and/or
muscle
relaxants
Opioid
overdose
rates
parallel
prescrip?on
rates
Steady
increase
in
opioid
prescribing
rate
since
1999
has
finally
leveled
off
Abuse-‐resistant
formula?on,
scheduling
change
appear
to
be
associated
with
largest
declines
in
certain
drugs
Overall
declines
alone
likely
too
small
to
reduce
prescrip?on
overdose
mortality
aPer
2010
23. Comments or questions:
Len Paulozzi, MD, MPH
lpaulozzi@cdc.gov
The
findings
and
conclusions
in
this
report
are
those
of
the
author
and
do
not
necessarily
represent
the
official
posi6on
of
the
Centers
for
Disease
Control
and
Preven6on/the
Agency
for
Toxic
Substances
and
Disease
Registry.
The
presenter
has
no
conflicts
of
interest
to
report.
Acknowledgements:
Jinnan Liu, PhD
Karin Mack, PhD
Chris Jones, PharmD, MPH
24. Prescrip?on
Monitoring
Program
(PMP)
in
New
York
City
Denise
Paone,
EdD
Director
of
Research
and
Surveillance
Bureau
of
Alcohol
and
Drug
Use
Preven7on,
Care,
and
Treatment
New
York
City
Department
of
Health
and
Mental
Hygiene
25. Disclosure
Statement
Denise
Paone
has
no
financial
rela7onships
with
proprietary
en77es
that
produce
health
care
goods
and
services
25
26. PMP:
Background
• Historically
,
seen
as
a
law
enforcement
tool:
– To
iden7fy
pa7ents
and
prescribers
engaged
in
possible
aberrant
behavior
– To
iden7fy
“doctor
shoppers”
– To
inves7gate
drug
diversion
&
fraud
• NYC
DOHMH
using
PMP
as
a
public
health
surveillance
tool:
– To
iden7fy
and
describe
palerns
of
opioid
analgesic
use
at
pa7ent
and
prescriber
levels
– To
iden7fy
pa7ents
at
risk
for
fatal
and
non-‐fatal
overdose
–
To
reduce
prescrip7on
drug
misuse
and
diversion
–
As
a
drug
epidemic
warning
system
• NYC
DOHMH
uses
PMP
as
a
pa7ent
care
tool:
– To
iden7fy
pa7ents
with
possible
substance
use
disorders
– To
avoid
risky
drug
Interac7ons
– To
iden7fy
and
reduce
pa7ent
visits
to
mul7ple
prescribers
• PMP
not
meant
to
infringe
on
the
legi7mate
prescribing
of
controlled
substances
Source: http://www.pmpalliance.org/content/prescription-monitoring-frequently-asked-questions-faq
27. PMP:
public
health
surveillance
tool
• Number
of
prescrip7ons,
pa7ents,
prescriber,
pharmacies
• Rate
of
opioid
analgesic
prescrip7ons
filled
overall
and
by
drug
type
• Median
day
supply
• Rate
of
pa7ents
filling
opioid
analgesic
prescrip7ons
• Rate
of
high
dose
opioid
analgesic
prescrip7ons
filled
28. PMP
surveillance
used
to
inform
public
health
ini?a?ves
• Opioid
prescribing
guidelines
• City
Health
Informa7on
(CHI)
–
primary
care
• Emergency
Department
guidelines
• Staten
Island
detailing
campaign
• Focused
on
prescribers
• Morphine
milligram
equivalent
calculator
• Media
campaign
• Public
Service
Announcement
on
“prescrip7on
painkiller
use”
29. Analy?c
methods
• Focus
on
schedule
II
prescrip7on
opioid
analgesics
(excluding
codeine-‐cII)
• Exclude
missing
pa7ent
or
prescriber
IDs,
veterinarians,
or
ins7tu7onal
licenses
• Report
rates
per
1,000
residents
and
adjust
to
2000
US
Standard
popula7on
31. Prescrip?on
variables
• Dura7on
of
ac7on
– Long-‐ac7ng
or
short-‐ac7ng
• Day
supply
• Morphine
Equivalent
Dose
(MED)
– Conversion
of
the
daily
dose
of
an
opioid
analgesic
prescrip7on
to
its
morphine
milligram
equivalent
– High
MED,
or
high
dose,
prescrip7ons
confer
increased
risks
of
overdose,
specifically
when
MED
≥
100.
32. USING
PMP
TO
DESCRIBE
PATTERNS
OF
OPIOID
ANALGESIC
PRESCRIPTION
USE
IN
NEW
YORK
CITY
33. Opioid
analgesic
(OA)
prescrip?ons
NYC,
2008–2012
0
500,000
1,000,000
1,500,000
2,000,000
2,500,000
2008 2009 2010 2011 2012
NumberofPrescriptions
YearSource: New York State Department of Health, Bureau of Narcotic
Enforcement, Prescription Drug Monitoring Program, 2008–2012
Opioid analgesic prescriptions
Oxycodone
Hydrocodone
Note:
Schedule
II
opioid
analgesics
34. From
2008–2012
there
was
a
17%
increase
in
the
number
of
pa?ents
filling
OA
prescrip?ons
0
100,000
200,000
300,000
400,000
500,000
600,000
700,000
800,000
2008 2009 2010 2011 2012
Numberofprescriptions
Year
Patient
Prescriber
Source: New York State Department of Health, Bureau of Narcotic
Enforcement, Prescription Drug Monitoring Program, 2008-2012
35. 15%
of
prescribers
wrote
83%
of
opioid
analgesic
prescrip?ons
48%
2%
37%
15%
14%
49%
1%
34%
0%
10%
20%
30%
40%
50%
60%
70%
80%
90%
100%
Prescribers Prescriptions
Prescribing frequency
Very Frequent
Prescribers
530-10,185 Rx/year
Frequent
Prescribers
50-529 Rx/year
Occasional
Prescribers
4-49 Rx/year
Rare Prescribers
1-3 Rx/year
Prescrip7ons
filled
by
NYC
residents,
2012
15%
83%
Percent
Source: New York State Department of Health, Bureau of Narcotic
Enforcement, Prescription Drug Monitoring Program, 2012 35
Note:
Schedule
II
opioid
analgesics
36. In
2012,
10%
of
prescribers
(n
=
5,384)
wrote
75%
of
prescrip?ons
(n
=1,623,157)
0%
10%
20%
30%
40%
50%
60%
70%
80%
90%
100%
0-29 30-39 40-49 50-59 60-69 70-79 80-89 90-99
Percentofprescriptions
Percent of prescribers
Note: Schedule II opioid analgesics
Source: New York State Department of Health, Bureau of Narcotic Enforcement, Prescription Drug Monitoring Program, 2012
37. Two-‐thirds
of
pa?ents
filled
only
one
prescrip?on;
one-‐third
filled
78%
of
all
opioid
analgesic
prescrip?ons
63%
22%
14%
9%
5%
6%
8%
14%
10%
49%
0%
10%
20%
30%
40%
50%
60%
70%
80%
90%
100%
Patients Prescriptions
Prescription Frequency
15 prescriptions
5 prescriptions
3 prescriptions
2 prescriptions
1 prescription
Prescrip7ons
filled
by
NYC
residents,
2012
Percent
Source: New York State Department of Health, Bureau of Narcotic
Enforcement, Prescription Drug Monitoring Program, 2012 37
37%
78%
Note:
Schedule
II
opioid
analgesics
38. Pa?ents
visi?ng
mul?ple
prescriber
and
mul?ple
pharmacies
are
rare
• In
2012,
1.2%
(9,137)
of
pa7ents
visited
4+
prescribers
and
4+
pharmacies
– Filled
7.9%
(170,282)
of
all
prescrip7ons
– Visited
15,042
unique
prescribers
– Visited
2,913
unique
pharmacies
Source: New York State Department of Health, Bureau of Narcotic Enforcement, Prescription Drug Monitoring Program, 2012
39. Two-‐thirds
of
opioid
analgesic
prescrip?ons
filled
were
paid
with
commercial
Insurance
67%
14%
8%
6%
4%
1%
Commercial
Insurance
Private
Pay
(Cash,
Charge,
Credit
Card)
Medicare
Other
Medicaid
Workers
Comp
Note:
Schedule
II
opioid
analgesics
Source: New York State Department of Health, Bureau of Narcotic
Enforcement, Prescription Drug Monitoring Program, 2012
40. Staten
Islanders
filled
OA
prescrip?ons
at
higher
rates
in
2012
0
50
100
150
200
250
300
350
400
450
500
NYC Bronx Brooklyn Manhattan Queens Staten Island
Age-adjustedrateofprescriptionsfilledper
1,000residents
Borough of Residence
Opioid Analgesics Oxycodone Hydrocodone
Source: New York State Department of Health, Bureau of Narcotic
Enforcement, Prescription Drug Monitoring Program, 2012
Note:
Schedule
II
opioid
analgesics
Rates are adjusted to 2000 US Census population
41. OA
prescrip?ons
filled
by
Staten
Islanders
have
longer
median
day
supply
0
5
10
15
20
25
30
NYC Bronx Brooklyn Manhattan Queens Staten Island
MedianSupply,Days
Borough of ResidenceSource: New York State Department of Health, Bureau of Narcotic
Enforcement, Prescription Drug Monitoring Program, 2012
Note:
Schedule
II
opioid
analgesics
Median
day
supply
is
calculated
from
day
supply
of
each
prescrip7on
filled
in
the
year.
42. OA
prescrip?ons
filled
by
Staten
Islanders
are
more
frequently
high
dose
(>100
MED)
0
20
40
60
80
100
120
140
160
NYC Bronx Brooklyn Manhattan Queens Staten Island
Age-adjustedrateofhighdoseprescriptions
filledper1,000residents
Borough of Residence
2008 2009 2010 2011 2012
Note:
Schedule
II
opioid
analgesics
High
dose
is
any
opioid
analgesic
prescrip7on
with
a
calculated
morphine
equivalent
dose
(MED)
greater
than
100.
Among
pa7ents
receiving
opioid
prescrip7ons,
overdose
rates
increase
with
increasing
doses
of
prescribed
opioids.
Source: New York State Department of Health, Bureau of Narcotic
Enforcement, Prescription Drug Monitoring Program, 2008–2012
Rates are adjusted to 2000 US Census population
44. Neighborhoods
with
high
rates
of
OA
prescrip?ons
have
high
rates
of
uninten?onal
(overdose)
deaths
involving
opioid
analgesics
*Paone D, Bradley O’Brien D, Shah S, Heller D. Opioid analgesics in New York City: misuse, morbidity and mortality update. Epi Data
Brief. April 2011. Available at http://www.nyc.gov/html/doh/downloads/pdf/epi/epi-data-brief.pdf .
OA PRESCRIPTION RATES OA MORTALITY RATES
45. Opioid
prescribing
guidelines
• Less
oqen:
avoid
prescribing
opioids
for
chronic
non-‐cancer,
non-‐end-‐of-‐life
pain
e.g.,
low
back
pain,
arthri7s,
headache,
fibromyalgia
• Shorter
dura7on:
when
opioids
are
warranted
for
acute
pain,
3-‐day
supply
usually
sufficient
• Lower
doses:
if
dosing
reaches
100
Morphine
Milligram
Equivalents
(MME)
,
reassess
and
reconsider
other
approaches
to
pain
management
• Avoid
whenever
possible
prescribing
opioids
in
pa7ents
taking
benzodiazepines
Cita7on:
Paone
D,
Dowell
D,
Heller
D.
Preven7ng
misuse
of
prescrip7on
opioid
drugs.
City
Health
Informa7on.
2011;
30(4):
23-‐30
New
York
City
Opioid
Treatment
Guidelines,
Clinical
Advisors:
Nancy
Chang,
MD;
Marc
N.
Gourevitch,
MD,
MPH;
Mark
P.
Jarrel,
MD,
MBA;
Andrew
Kolodny,
MD;
Lewis
Nelson,
MD;
Russell
K.
Portenoy,
MD;
Jack
Resnick,
MD;
Stephen
Ross,
MD;
Joanna
L.
Starrels,
MD,
MS;
David
L.
Stevens,
MD;
Anne
Marie
S7lwell,
MD;
Theodore
Strange;
MD,
FACP;
Homer
Venters,
MD,
MS
45
46. New
York
City
Emergency
Department
Discharge
Opioid
Prescribing
Guidelines
Clinical
Advisory
Group:
Jason
Chu,
MD,
Brenna
Farmer,
MD,
Beth
Y.
Ginsburg,
MD,
Stephanie
H.
Hernandez,
MD,
James
F.
Kenny,
MD,
MBA,
FACEP,
Nima
Majlesi,
DO,
Ruben
Olmedo,
MD,
Dean
Olsen,
DO,
James
G.
Ryan,
MD,
Bonnie
Simmons,
DO,
Mark
Su,
MD,
Michael
Touger,
MD,
Sage
W.
Wiener,
MD.
Emergency
Department
guidelines
Released
January,
2013
Adopted
by
35
NYC
emergency
departments
46
47. Staten
Island
public
health
“detailing”
campaign
• 1-‐on-‐1
“detailing”
visits
from
Health
Department
representa7ves
• Deliver
key
prescribing
recommenda7ons,
clinical
tools,
pa7ent
educa7on
materials
• ~1,000
Staten
Island
physicians,
nurse
prac77oners,
physicians
assistants
• June–August
2013
• PMP
data
analyzed
to
evaluate
prescribing
palerns
pre-‐
and
post-‐
campaign
47
49. Morphine
Milligram
Equivalent
(MME)
calculator
• A
tool
to
calculate
total
MME
per
day
• Gives
alert
for
dosages
>100
MME
• Quick
and
easy
to
use
• Web-‐based
applica7on
– Search
for
“NYC
MME
Calculator”
hlp://www.nyc.gov/html/doh/html/mental/MME.html
• Smartphone
app
49
51. Media
campaigns
• Campaign
One:
– Goal:
Increase
awareness
of
risk
of
opioid
analgesic
overdose
– Ran
twice
(2012,
2013)
• Campaign
Two:
– Goal:
Reduce
s7gma
and
raise
awareness
of
opioid
analgesic
misuse
– 2
tes7monials
• Mom
lost
son
to
opioid
analgesic
overdose
• NYC
resident
in
recovery
– Ran
2013
and
2014
51
52.
53. Summary
• PMPs
can
be
used
as
a
public
health
surveillance
tool
to
understand
palerns
of
opioid
analgesic
prescrip7on
use
• New
Yorkers
filled
~2
million
opioid
analgesic
prescrip7ons
per
year
from
2008-‐2012
• From
2008-‐2012
Staten
Island
residents
filled
high
dose
prescrip7ons
(>100
MED)
at
highest
rates
• High
rates
of
opioid
analgesic
prescrip7on
use
mirror
high
rates
of
opioid
analgesic
overdose
mortality
54. Improving
Outcomes
while
Deterring
Misuse,
Abuse,
&
Diversion
Tom
Kelly,
R.Ph.,
B.Sc.
C.E.O./Partner:
Medicine
To
Go
Pharmacies,
PPTP.net
55. Disclosures
• Thomas
Kelly
has
financial
rela7onships
with
proprietary
en77es
that
produce
health
care
products
and
services.
These
financial
rela7onships
are:
• President/C.E.O.
Medicine
To
Go
Pharmacies
– Retail
pharmacies
• President/C.E.O./Partner,
PPTP.net,
LLC
– Online
due
diligence
tool
for
preven7on
of
misuse,
abuse,
and
diversion
56. Learning
Objec7ves
1. PMP's
and
PDMP's
are
valuable
clinical
tool
promo7ng
improved
outcomes.
2. There
is
a
difference
between
healthcare
and
enforcement.
57. How
Did
We
Get
Here?
• 1980
prehistoric
• 1996
Oxycon7n
launched
“less
poten7al
for
addic7on
and
abuse”,
chronic
pain
pa7ents
undertreated.
• Non
profits
funded
by
opiate
pharma
manuf.
(Am.
Pain
Founda7on)
• 8/31/2000
FDA
approves
NDA
for
Roxicodone
15mg
&
30mg
• Current
Trends:
– 6/3/2011
Fla:
HR
7095
an7-‐pill
mill
legisla7on
signed
by
Gov.
Rick
Scol
– DEA
suspends
permits
for
2
CVS
and
6
Walgreens
pharmacies
and
some
independent
pharmacies
in
Fla.
– DEA
suspends
permits:
3
Cardinal
Health
distribu7on
centers,
Walgreen’s,
Juniper,
Fl.,
AmerisourceBergen,
Orlando,
Fl.,
Harvard
Drug
Group,
Livonia,
Mi.
– McKesson
pays
$13
million
in
fines
for:
Fl.,
Tx.,
Md.,
Ut.,
Co.,
Ca.
58. The
Strange
Down
Stream
Trends
• Viola7ons
everywhere,
wholesale
distributors:
“But
how
much
can
we
sell?”
• Blind
speed
limits
• Contrac7on
in
opioid
analgesic
distribu7on
• Some
pa7ents
struggle
to
get
medica7ons,
really?
– 4.8%
of
worlds
popula7on
consumes
80%
opioid
analgesics
but
significant
hitches
in
supply
stream
• Wholesalers
using
numbers,
not
encouraging
or
establishing
the
use
of
sound
clinical
guidelines
– Place
pharmacist
on
review
team
59. Unfortunate
Reali7es
• Growing
popula7ons
trends
for
chronic
pain
pa7ents
– Advanced
trauma
care
leading
to
more
survivors
(fortunate
reality)
–
Diabetes
explosion
CDC
1980-‐2011
2.5
to
6.9%
-‐
genera7ng
more
neuropathies?
–
Arthri7s
rates
increasing
–
Obesity
increasing
• As
they
say
in
enforcement:
“Follow
the
money”
– 2008
recession
compounds
problem,
economic
relief
in
black
market
• 60%
of
diverted
medica7ons
sourced
from
friends
and
family,
Get
Rx
for
120,
use
40
divert
80.
Difficult
to
detect.
– Is
black
market
larger
than
legal
market?
• #120
oxycodone
15mg
@
$60
legal
via
insurance,
black
market
at
$1/mg
@$1,800
– Heroin
cheap,
easy
to
turn
• Prescrip7on
opioid
analgesics
&
heroin
more
valuable
than
cash
• We
cannot
enforce
our
way
out
• What
are
liabili7es
for
not
performing
due
diligence?
• Fewer
Fellowships
offered
in
pain
management,
family
prac7oners
and
GP’s
are
prescribing
– Only
a
couple
of
extra
pain
pa7ents
per
prescriber
add
up
• Not
my
pa7ents
60. Its
busy,
What
Can
I
Do?
(opportuni7es)
• Promote
and
u7lize
PMPs
as
a
tool
to
achieve
posi7ve
outcomes
(healthcare
term,
not
enforcement,
&
not
an
excuse
to
dispense!)
• Establish
PMP
review
in
workflow,
promote
states
to
allow
registered
technicians
and
nurses
to
access
data
bases
• Reduce
liability
with
due
diligence
• Verify
pa7ent
iden7ty
at
drop
off:
government
issued,
commercial
services
• Collaborate,
let
prescribers
know
around
the
clock
IR
meds
for
pain
control
not
illegal
but
frowned
upon,
decrease
#
doses
on
the
street,
use
sound
clinical
judgment
• Collaborate,
perform
random
medica7on
counts
for
pa7ents
exhibi7ng
adherent
behavior
for
your
prescribers
• Review,
review,
review
clinical
risks
with
pa7ents,
par7cularly
those
who
are
opiate
naive
• Counsel
all
regarding
secure
storage,
i.e.
dental
rxs,
loaded
gun
in
medicine
cabinet
analogy
• Ins7tute
a
treatment
agreements,
aka
narco7c
contract
61. But
What
Can
I
Do?
Con7nued…
(more
opportuni7es)
• Market
topically
compounded
analgesics-‐
far
lower
poten7al
for
abuse
• Partner
with
adver7zing
vendors
to
include
medica7on
guide
specific
for
commonly
abused
medica7on,
i.e.
LDM
Group,
CarePoints
(slide)
• Increase
sensi7za7on:
Use
social
media
&
poster
up,
“Who
Knew
Grandma
Kept
a
Stash”,
Partnership
for
a
Drug
Free
New
Jersey,
DEA’s
Na7onal
Prescrip7on
Drug
Take
Back
Day,
etc.
(slide)
• Partner
with
teaching
ins7tu7ons.
Sponsor
substance
abuse
CE
+
CME’s
for
health
care
providers,
including
pediatricians,
den7sts,
and
oral
surgeons
(slide)
• Get
involved,
collaborate,
join
work
groups,
encourage
community
based
ac7on,
no
one
group
can
defeat
this
scourge
alone
(slide)
– Form
local
coali7ons,
churches,
schools,
enforcement,
civic
groups,
etc.
• Sponsor
a
local
drop
off
box
for
unused
medica7ons
– www.americanmedicinechest.com/_media/permcollec7on1.pdf
62. Provide
Naloxone
Rescue
Kits
(opportunity)
• A
lille
work
results
in
most
significant
outcomes
alainable
• Develop
collabora7ve
prac7ce
agreements
• Trails
already
blazed,
follow
the
footsteps
– hlp://stopoverdose.org/index.htm
– hlp://harmreduc7on.org/
– hlp://prescribetoprevent.org/about-‐us/
63. Educa7on
Opportuni7es:
Pharmacy
Student
and
Technician
Training
• Establish
and
teach
clinical
guidelines
for
counseling
pa7ents
to
avoid
issues
associated
with
controlled
medica7ons.
• Encourage
training
in
detec7ng
evidence
of
misuse,
substance
abuse,
addic7on,
pseudo
addic7on,
and
diversion
in
pa7ent
popula7ons.
• Amplify
the
value
of
PMPs
as
a
clinical
tool.
• If
a
palern
of
abuse
is
detected,
provide
outline
on
how
to
assist
the
pa7ent
and
associated
healthcare
providers
move
forward
toward
posi7ve
outcomes.
i.e.
addic7on
services,
mental
health
services,
etc.
• Provide
protocols
on
when
and
how
to
engage
enforcement.
64. Big
Ideas-‐
Opportuni7es
to
do
beler?
• Develop
systems
for
ease
of
use
for
busy
prac7ces,
pharmacies
and
prescribers
alike.
Current
models
D+
– Allow
nurses
and
pharmacy
technicians
access?
• Reward
health
care
professionals
for
accessing
PMPs.
– Direct
compensa7on,
rebate
professional
license
fees,
tax
credits?
• Establish
and
encourage
realis7c
reimbursements
to
pharmacies
for
Medica7on
Therapy
Management
(MTM)
reviews
for
chronic
pain
pa7ents.
• Develop
Accountable
Care
Organiza7on
(ACO)
models
for
how
dispensing
pharmacies
can
partner
with
ACOs
&
manage
chronic
pain
pa7ents
to
improve
outcomes
and
subsequently
reduce
costs.