A proactive medical necessity review program reduces revenue loss associated with outpatient medical benefit drugs.

Purpose: A common denial trend that occurs with "outpatient medical benefit drugs" (ie, medications covered by a medical benefit plan and administered in an outpatient visit) is payers not requiring or permitting prior authorization (PA) proactively, yet denying the drug after administration for medical necessity. In this situation, a preemptive strategy of complying with payer-mandated requirements is critical for revenue protection. To address this need, our institution incorporated a medical necessity review into its existing closed-loop, pharmacy-managed precertification and denials management program.

Prescribing pharmacists in the ambulatory care setting: Experience at the University of North Carolina Medical Center.

Purpose: The prescribing authorities, clinical activities, and productivity documentation strategies of ambulatory care clinic-based pharmacists practicing within a large academic health system are described.

Summary: North Carolina law encourages progressive pharmacy practice through acquisition of the clinical pharmacist practitioner (CPP) designation. Qualified CPPs are authorized to provide collaborative drug therapy management services, including medication prescribing and ordering of laboratory tests, according to defined protocols and under physician supervision.

Spuriously elevated testosterone measurements caused by application of testosterone gel at or near the phlebotomy site.

Objective: To report 2 cases of spuriously elevated testosterone measurements caused by contamination of blood samples by testosterone gel applied near the phlebotomy site.

Case Summaries: A 21-year-old male with primary hypogonadism and a 67-year-old male with secondary hypogonadism were prescribed standard replacement doses of testosterone gel. The patients' symptoms improved without adverse effects.

Prospective study of supplemental vitamin K therapy in patients on oral anticoagulants with unstable international normalized ratios.

Background: It is not known whether patients on oral vitamin K antagonists who have unstable INRs achieve more stable INRs with daily vitamin K supplementation. We sought to determine whether vitamin K supplementation may decrease INR variability in patients with a history of unstable INRs, how soon the INR decreases after vitamin K therapy is initiated, the time to reach a therapeutic INR after vitamin K initiation, and how much of an increase in oral anticoagulant dose is needed to maintain the INR in the desired range.

Methods: This is a prospective open label crossover study of patients on warfarin with a history of fluctuating INRs.

Bioterrorism web sites for pharmacists.

Objective: To identify Internet Web sites for ease of accessibility to bioterrorism-related information, comprehensive provision of bioterrorism-related information, and provision of bioterrorism information that specifically pertains to the pharmacy profession.

Data Sources: Web sites of national pharmacy organizations, US government agencies, and medical organizations, as well as Web sites related to bioterrorism.

Data Synthesis: Pharmacists need access to relevant bioterrorism information in a timely manner.