Background: Despite numerous reports of state Medicaid drug utilization review (DUR) programs, little data are available about the prevalence of drugrelated problems (DRPs) in Medicaid patients. A university-based, pharmacist-run DUR program for high utilizers was created as an alternative to imposition of a statutory limit of 7 medications per month in the Utah Medicaid program in 2002. The DUR program was designed to suggest ways that high-utilizing patients could decrease their total number of medications to 7 or fewer prior to imposition of the 7-medication limit at some time in the future.
Objective: To describe the experience in 1 Medicaid DUR program and to report the prevalence of DRPs and cost-saving opportunities (CSOs) among a population of Medicaid recipients who were high utilizers of prescription drugs.
Methods: DRPs were identified by 5 clinical pharmacists employed by the Drug Regimen Review Center (DRRC) in Salt Lake City. The purpose of the center was to provide drug therapy review services for a select number of Utah Medicaid recipients (200-300 per month) who exceeded a 7-medication limit during the calendar years 2003 and 2004.
Results: Out of 391,890 eligible Medicaid recipients, 242,411 (62%) received at least 1 medication, and 16,958 (4.3%) exceeded the 7-medication limit during the review period. Of those exceeding the limit, the DRRC reviewed a total of 3,706 (21.9%) patients, representing the highest utilizers by volume of medication. The prevalence of DRPs considered clinically important in the review cohort was 79.7% of patients, including therapeutic duplications in 54.6% of patients, dose form optimization in 29.7%, and inappropriate uncoordinated care in 25.3%. The average pharmacy cost per month for patients with at least 1 DRP was 1,081 dollars; by contrast, the average pharmacy cost per month for all other patients receiving at least 1 prescription was 91 dollars.
Conclusions: Approximately 4% of Medicaid recipients exceeded the 7-medication monthly limit. Among the 22% highest utilizers in this group, 48% of nursing home residents and 87% of ambulatory recipients had at least 1 DRP, or an overall rate of 80% of high-use Medicaid recipients or as much as 3.2% of the Medicaid population.
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http://dx.doi.org/10.18553/jmcp.2006.12.8.677 | DOI Listing |
Transplant Direct
February 2025
Division of Transplantation, Department of Surgery, University of Iowa School of Medicine, Iowa City, IA.
Background: In 2020, liver allocation policy in the United States was changed to allow for broader organ sharing, which was hypothesized to reduce patient incentives to travel for transplant. Our objective was to describe patterns of travel for domestic liver transplant pre- and post-acuity circle (AC) implementation.
Methods: Incident adult liver transplant listings between August 16, 2016, and February 3, 2020 (pre-AC) or June 13, 2020, and December 3, 2023 (post-AC) were obtained from the Scientific Registry of Transplant Recipients.
Ann Thorac Surg
January 2025
Cardiovascular Outcomes Research Laboratories (CORELAB), University of California, Los Angeles; Division of Cardiac Surgery, Department of Surgery, University of California, Los Angeles. Electronic address:
Background: Socioeconomic disadvantage and Medicaid insurance have been linked with inferior survival following heart transplantation, yet the contributing mechanisms remain to be elucidated. We evaluated the association of Medicaid with the development of cardiac allograft vasculopathy(CAV).
Methods: We considered heart transplant recipients ≥18years within the 2004-2022 Organ Procurement and Transplantation Network.
J Card Fail
January 2025
Center for Advanced Cardiac Care, Division of Cardiology, Columbia University Irving Medical Center, New York, NY, USA. Electronic address:
Introduction: Effective communication and understanding are imperative for heart transplant (HT) recipients who require lifelong adherence to treatment plans and medications. Whether non-native English speaking (NNES) recipients have inferior outcomes compared to native English-speaking recipients (NES) has not been studied post-HT.
Methods: We reviewed adult HT recipients at Columbia University Irving Medical Center from January 2005 through December 2022 with primary language determined by chart review.
J Gen Intern Med
January 2025
Department of Mental Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA.
Background: Hepatitis C virus (HCV) infections and injection drug use have concurrently increased in the last decade. Evidence supports simultaneously treating chronic HCV and opioid use disorder (OUD) with medication. Kentucky is a hard-hit state for both conditions that has undertaken policy and practice efforts to increase access to both types of medications.
View Article and Find Full Text PDFFront Public Health
January 2025
Utah Department of Health, Salt Lake City, UT, United States.
To examine the relationship between socioeconomic deprivation and complex needs, defined as mental and physical comorbidities, we conducted a cross-sectional retrospective cohort analysis of adult Utah Medicaid beneficiaries. Our analysis included Medicaid beneficiaries with geocoded addresses aged ≥18 years in Utah ( = 157,739). We geocoded beneficiary addresses and assigned them to census block groups.
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