DEA enforcement in long-term care: is a collaborative correction feasible?

The prescribing and dispensing of controlled substances within long-term care facilities is an important and complex issue from both the clinical and the public policy perspectives. This article reviews the regulatory background and clinical concerns regarding the enforcement of the Controlled Substances Act by the Drug Enforcement Administration within the institutional pharmacies serving long-term care facilities. The article argues that the processes implemented since 2009 in response to concerns about Drug Enforcement Administration enforcement are suboptimal at many levels.

Comparing apples to apples: policymakers take a shine to comparative effectiveness research.

Comparative effectiveness research is gaining attention as a potential means to standardize quality, improve outcomes, and control medication costs. By implementing such research programs and establishing clearinghouses for comparative effectiveness data, government officials, policymakers, payers, researchers, and others hope that practitioners and consumers alike will use this information to make informed decisions about medications and other aspects of care. Pharmacists will have a role in the comparative effectiveness movement, particularly regarding their pharmacologic expertise and their skills as educators.

Disease management and the Medicare Modernization Act: "It's the insurance, stupid".

While definitions of "disease management" (DM) emphasize quality of care for populations with chronic illness, proponents argue it reduces healthcare costs. Buyers may find disease management organizations' (DMOs') use of clinical guidelines, physician collaboration, and promotion of patient self-management intuitively sound, but it is performance guarantees, combined with retrospective effectiveness cost studies, that have driven DMOs' penetration of the commercial insurance market with revenues that exceed $500 million per year. The success of DMOs contributed to the creation of the Chronic Care Improvement Program (CCIP), which is designed to prospectively test the impact of DM on both the quality and cost of care for fee-for-service Medicare beneficiaries with chronic illness.

The Medicare Prescription Drug, Improvement and Modernization Act and the impact on care of people with chronic illness: benefit design and implementation issues.

The Medicare Prescription Drug Improvement and Modernization Act represents the most far-reaching and one of the most controversial reforms of the Medicare program since its enactment in 1965. The Act ushers in a new Medicare prescription drug benefit, revitalizes Medicare Advantage plans and promotes new approaches to care of Medicare beneficiaries with chronic illness. However, while the Act evidences a commitment to improving the care of beneficiaries with chronic illness, reform may prove elusive.