Rising Costs and Improved Measurements: Top AJPB Papers of 2015

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The rising cost of drugs was in the spotlight in 2015, and the manuscripts in The American Journal of Pharmacy Benefits highlights the growing concerns of the healthcare industry in regards to rising expenditures.

The rising cost of drugs was in the spotlight in 2015, and the manuscripts in The American Journal of Pharmacy Benefits highlights the growing concerns of the healthcare industry in regards to rising expenditures.

The most-read manuscripts of the year included a discussions on hepatitis C drugs, a look at medication therapy management, and an analysis of the trend in rising generic drug costs.

10. Implementing Guideline-Recommended Therapy for Patients With CKD: Is Hope on the Horizon?


This commentary on chronic kidney disease from the March/April issue addresses the reason why there are gaps between the recommended therapy and the realities of current practices. In addition, Nancy L. Reaven, MA, and colleagues examine potential ways to bridge the gap.

They point out that the gap between guidelines and actual use of renin-angiotensin-aldosterone system inhibitors may increase the societal burden of chronic kidney disease. While hyperkalemia may be a reason for the underuse of this therapy, new agents to manage hyperkalemia could help close the treatment gap.

9. What Roles Do Patient Characteristics Play in Value-Based Performance?

As the healthcare system evolves into one based on delivering better care at a lower cost, measurement is important for determining payment to hospitals, health plans, physicians, and others. However, the healthcare industry cannot overlook the importance of outside factors that affect health outcomes, such as sociodemographic status.

The Pharmacy Quality Alliance (PQA)’s Woody Eisenberg, MD, and Kristen A. Butterfield, MPH, encourage measure developers to determine if sociodemographic status risk adjustment may be appropriate when assessing measures. PQA will incorporate this risk adjustment into its own measure development process, they explain.

8. Medication Management: Measuring What Matters


Medication-related measures do not address mediation optimization, medication coordination, and medication follow-up, but as new care delivery models evolve, there is room to develop new measures to close these gaps.

In this paper, the authors identify areas where measures are needed and how to develop and implement measures that matter.

7. Pharmacist Glycemic Control Team Associated With Improved Perioperative Glycemic and Utilization Outcomes

Using a pharmacy-led management team improved glycemic control and postoperative outcomes for noncritically ill postoperative surgical patients. The researchers assessed patient-level outcomes during 12 months before the intervention period and compared them at 1 year and 2 years.

The intervention was associated a decline in hypoglycemia in year 1 post implementation, and in years 1 and 2 after intervention, post-discharge hospital admissions, emergency department utilization, and per patient per month medical costs all declined.

6. Trends in High-Cost Generic Drug Utilization and Spend

With the rising price of generic drugs receiving considerable press coverage in 2015, Sara C. Erickson, PharmD, and colleagues examined the prevalence and proportion of spend on high-cost generic drugs.

Overall, high-cost generics account for 13.8% of all generic fills and 54.1% of general spend. They accounted for a large proportion of generic drug costs in all plan types. In addition, the authors wrote that the causes of rising generic drug costs is multifactorial, and the various factors are unlikely to resolve in the coming years.

5. Toward a Better Understanding of High-Risk Medications in the Elderly

Plans are seeking strategies and innovation to limit potentially inappropriate medications in older adults to help improve patient outcomes and ease the economic burden. The Pharmacy Quality Alliance and the National Committee for Quality Assurance have developed performance measures to capture trends in high-risk medication use among older adults.

4. Proposed Rule Changes for 340B Programs: Overview and Impact (1,559)

Recent proposed change to the 340B drug discount program could result in lower savings and more rigorous compliance oversight requirements, which entities should be aware of, according to Anthony Zappa, PharmD, MBA.

In his paper, Dr Zappa looked at several changes to the 340B program, which could remove 30% to 40% of currently included prescriptions and increase administrative oversight.

3. The Formularies Fight Back: AJMC Panelists Discuss How Discounts, Exclusivity Deals Should Expand HCV Treatment (1,798)

The rising prices of drugs became a big issue in 2015, and it all stems back to the $1000 pill: Sovaldi. In this panel discussion, experts explain the impact that increased competition, from AbbVie’s Viekira Pak, had as pharmacy benefit managers were able to take aggressive steps to negotiate lower prices through exclusivity deals and discounts for one drug over the other.

2. Strategies to Improve PBM Management of an Employee Prescription Drug Plan

Better informed employers will be able to better manage the prescription drug benefit they offer to employees. The authors explain that employers with internal expertise can assume greater management to the benefit of the company. Some things that the employer should become knowledgeable about include: the fundamentals of the pharmaceutical supply chain and the role of pharmacy benefit managers.

1. Implementation Strategy to Bring Medication Therapy Management Into High-­Volume Community Pharmacies (2,420)

The most-read article from The American Journal of Pharmacy Benefits observed the work flow in a high-volume community pharmacy and created a strategy to implement medication therapy management (MTM) services.

The researchers conducted MTM services at 3 stores and assessed the outcomes 1 month later to evaluate the potential change in Medicare Star ratings. They found that the MTM services closed gaps in patient therapy, tentatively improved Star ratings, and increased revenue.