Impact of Just-in-Time TeamSTEPPS Training on Team Performance in a Pediatric Escape Room Interprofessional Experience.

OBJECTIVE: To compare differences in observed and self-reported team dynamics between those who received versus those who did not receive TeamSTEPPS training prior to an interprofessional escape room scenario. METHODS: Final-year pharmacy (N = 27) and physician assistant (N = 88) students participated in an escape room featuring pediatric dosing, asthma, otitis media, type 1 diabetes, and vaccine fundamentals. In total, 29 teams were randomized to control (14) or intervention arm (15). The control group went to the escape room and then returned to the classroom for a team-building module including TeamSTEPPS training. The intervention group started with the team-building module then went to the escape room. One faculty observer was assigned to each team and utilized the Performance Assessment Communication and Teamwork (PACT) expert-observer form to assess team performance. Post-event, students completed an abbreviated PACT post-assessment and a self-reflection on the prompt "What were the most important takeaways from today's interprofessional education experience?" RESULTS: On the PACT expert-observer form, significantly higher global scores were noted for the intervention arm on all items except situation monitoring. On the aggregate observer data from all stations, leadership emerged as statistically different between the 2 groups. On the PACT post-assessment, the intervention arm reported significantly more leadership during the simulation. On the self-reflections, 70.9% versus 64% in the control arm recognized the importance of teamwork in managing patients. CONCLUSIONS: Just-in-time TeamSTEPPS training improved observed and to a lesser extent, self-reported teamwork and communication skills. Incorporating TeamSTEPPS training immediately prior to an interprofessional education experience may enhance team performance.

Exploring the COVID-19 Landscape and Our Path Forward Using a Formalized SWOT Analysis.

OBJECTIVE: This study aimed to share the results of a formalized SWOT (Strengths, Weaknesses, Opportunities, and Threats) analysis focusing on perceptions and the long-term impact of the COVID-19 pandemic. METHODS: The study used a parallel mixed-methods approach. This included a quantitative component, which used presurvey descriptive data, and a qualitative component, which involved SWOT analysis via focus groups. Participants were recruited via email. Volunteers responded to survey questions regarding the COVID-19 pandemic. Ten focus groups were created and conducted in February 2022. Responses were transcribed and coded by 2 independent investigators and a third to resolve disagreement. Group consensus determined the themes. RESULTS: On the survey (n = 55), over half of respondents noted lack of motivation and attention deficit emerging during the pandemic. However, less than half felt that they had access to appropriate support/services. Regarding mental health, some reported increased anxiety, loneliness, depression, and sleep disorders, yet a small percentage of respondents felt that they were provided with support to mitigate these issues. Focus group sessions resulted in 404 statements, which determined the following 8 themes: communication, pivoting the learning and assessment process, COVID-19 safety, interpersonal relationships, health and wellness, finances, student services, and competition in the job market. The top strength was in pivoting the learning process, top weakness was in university communications, and the top opportunities and threats were in pivoting to virtual learning. CONCLUSION: As the country continues to experience COVID-19 waves, it is important to reflect on and understand the effects of the previous reactions, and explore ways to increase and sustain motivation, limit lasting negative effects, and remain proactive and prepared for the future.

Using Emotional Intelligence as a Framework for Students' Professional Identity Formation.

Emotional intelligence and professional identity formation (PIF) intersect at various levels. Professional identity formation requires acute observation of others in the profession and the ability to decipher intentionality in behaviors. The developing pharmacist must make a deliberate effort to emulate positive norms and values that coincide with those associated with the profession while deliberately ignoring those that are incongruent. To learn from others in the profession, social skills are required, so one can ask questions, determine the best course of action, set goals, grow, and maintain relationships, and ask for help. The ability to manage one's emotions regardless of external circumstances can be valuable for any profession. Self-regulation and self-assessment of one's emotions and motivations can be useful for reevaluating our perspectives and priorities as pharmacists. Emotional intelligence is a critical component of building, demonstrating, and improving PIF. This commentary will provide strategies to facilitate and solidify the connection between the two.

Training pharmacy students to deliver bad news using the SPIKES model.

BACKGROUND AND PURPOSE: Delivery of bad news or negative health information is a complex skill critical to the provision of patient care. While counseling models with this focus exist within other health care professions, their use in pharmacy education is lacking. The purpose of this study is to assess pharmacy students' ability to deliver bad news with the implementation of a counseling model titled SPIKES (Setting, Perception, Invitation, Knowledge, Emotions with Empathy, and Strategy/Summary). EDUCATIONAL ACTIVITY AND SETTING: First-year pharmacy students attended a one-hour training on the SPIKES model and completed three simulations with its application. Pre- and post-training surveys were administered to assess confidence, attitudes, and perceptions. Student performance during the simulations was evaluated by teaching assistants (TAs) as well as a self-assessment using the same grading rubric. A paired t-test was used to test for significant mean improvement in competency scores, confidence, attitudes, and perceptions from Week 1 to Week 3. FINDINGS: One hundred and sixty-seven students were included in the analysis. There was a significant improvement in the student's self-assessment of their performance for each of the SPIKES components and summative scores. For the TA assessment, there was a significant mean improvement in the summative SPIKES score; however, within each component of SPIKES, only the knowledge component showed significant mean improvement. There was also a significant improvement in student confidence in the post-training surveys. SUMMARY: Implementation of the SPIKES protocol in the pharmacy curriculum showed an overall improvement in students' self-assessed performance in delivering bad news.

Assessing Learner Engagement and the Impact on Academic Performance within a Virtual Learning Environment.

BACKGROUND: The objective of this pilot study was to examine student engagement with weekly self-paced learning materials in a virtual therapeutics course, and how sub-factors in the Motivated Strategies for Learning Questionnaire (MSLQ) may have influenced academic performance. METHODS: Students within a diabetes module of a therapeutics course were provided with weekly asynchronous optional self-directed learning activities. Student submissions, on-time rates, self-reported weekly study time, and exam performance were collected. Students completed the MSLQ at the completion of the study. Data was evaluated using various correlation analyses to determine the predictive ability of the MSLQ and its 5 subscales. RESULTS: In total, 173 students completed the study. Students' self-efficacy score on the MSLQ subscale and case submission on-time rate have the strongest positive correlation with the exam score, while the test anxiety as reported on the MSLQ test anxiety subscale had the strongest negative correlation with the exam score. CONCLUSIONS: Study results proved the MSLQ to be an effective predictive tool in students' self-regulation skills. Results can be used to develop intentional interventions aimed at improving self-regulation skills while providing opportunities to enhance student learning.

Social and Emotional Development in a Telehealth-Based Ambulatory Care Skills Course.

Objective. To determine the impact of telehealth-based simulations on students' social and emotional development.Methods. First-year pharmacy students enrolled in a professional skills course were eligible to participate in the study. Before and after the course, students completed the Personal-Interpersonal Competence Assessment, which codes onto eight subcategories: situation monitoring, inspire others, intimacy, awareness of one's aptitude, initiative to pursue leadership, empathy, sociability, and awareness of one's emotions. Students participated in seven telehealth-based simulations. Prior to each simulation, students watched a role modeling video highlighting social and emotional competence techniques used by a pharmacist during a consultation. Students then participated in simulated consultations that occurred in Zoom breakout rooms. Each student completed one consult while a teaching assistant completed a rubric derived from the Personal-Interpersonal Competence Assessment. Teaching assistants then provided formative feedback related to the student's social and emotional competence. At the semester midpoint, students completed a video log reflecting on their social and emotional development. Statistical analyses compared different time points of students' scores on the Personal-Interpersonal Competence Assessment and scores given by teaching assistants, while qualitative analysis was used for the video logs.Results. At the end of the course, improvement was noted on all factors of the Personal-Interpersonal Competence Assessment. Scores given by teaching assistants showed significant improvement over the semester, with the highest improvement noted on the subcategories inspiration and situation monitoring. On the video log, 80% of students noted improvements in their consideration of others.Conclusion. These findings suggest value in using role modeling, telehealth-based simulations, and teaching assistant feedback on pharmacy students' social and emotional development.

A telehealth-based interprofessional education module focused on social determinants of health.

BACKGROUND: This report describes a telehealth-based interprofessional education (IPE) module that connected medical and pharmacy students across different geographical locations. The IPE module focused on developing strategies aimed at reducing health inequities related to social determinants of health. INTERPROFESSIONAL EDUCATION ACTIVITY: Teams of one doctor of osteopathic medicine and one or two doctor of pharmacy students were created by the course faculty member. Teams were instructed to meet at least four times via videoconferencing technology to discuss their assigned health inequity. Teams were instructed to design possible interventions to reduce the health inequity in their communities. Students completed the Interprofessional Collaborative Competency Attainment Scale (ICCAS) and a peer evaluation to provide feedback to their team member(s). DISCUSSION: Four hundred and seventy teams comprising 1099 students have participated in this IPE module. On the ICCAS, significant improvement was noted on all items with highest gains on items related to communication and collaboration. On the 2018-2019 peer evaluations, 84.5% of students rated their teammates as exceptional on the item "rate your team member's respect for you and others on the team." On the 2019-2020 peer evaluations, highest agreement was noted on the statement "this student is able to act with honesty and integrity in relationships with other team members." A total of 81% of students felt that the IPE module was useful to their learning. IMPLICATIONS: Improvement in the ICCAS and positive peer evaluations support a telehealth-based model for provision of IPE.

The use of a metacognition and contemplation intervention in improving student abilities to recognize order entry errors.

BACKGROUND AND PURPOSE: To describe a pilot study testing a metacognition and contemplative pedagogy intervention designed to improve student abilities to identify errors on orders entered into a computerized provider order entry (CPOE) system. Educational activity and setting: Student teams worked up five patient cases and entered new orders into a CPOE system. All orders entered by teams were analyzed for errors and faculty members identified fifteen orders representing the top errors and selected these for the pre-exercise, in-class contemplation activity, and post-exercise. Course instructors instructed students to identify all errors on these orders. Students completed a pre/post-survey rating their ability to enter new orders. Two weeks later, students worked up a new patient case and entered orders into the CPOE. These orders were graded and scores were compared to the 2017 cohort to determine any differences in error rates. FINDINGS: Study participants included 205 students The average score of correctly identified errors increased from 22% on the pre-exercise to 62.8% on the post-exercise. On the survey of their skills, students rated their ability to "accurately enter medication orders into the [electronic health record] EHR" more highly after the intervention. The 2017 cohort made 73 errors on 170 orders compared to 45 errors on 165 orders by the 2018 cohort. SUMMARY: Based on improvements in student ability to identify order entry errors and overall positive student feedback, this strategy may be adopted by other educators looking to improve student identification of errors on orders entered into a CPOE system.

Effectiveness of Music Interventions to Reduce Test Anxiety in Pharmacy Students.

BACKGROUND: The main objective of this pilot study was to evaluate the impact of a classroom activity involving music on anxiety associated with preparing for and taking an assessment. METHODS: Two hundred and two (202) pharmacy students were randomly assigned to one of two conditions of the experimental study: active music playing (n = 103) versus passive music listening (n = 99). All students completed a pre-test, a mid-test, and a post-test including: an "Attitudes and Perceptions" survey, State-Trait Anxiety Inventory for Adults (STAI Survey), and a knowledge assessment. Data were analyzed to determine the impact each of the music interventions had on students' test anxiety. RESULTS: Both types of musical interventions produced similar results in terms of anxiety reduction. Faced with an upcoming test prior to the musical intervention, average state-trait anxiety scores increased; after the musical intervention, state-trait anxiety scores decreased. CONCLUSIONS: The use of music helped to reduce test anxiety, even after one brief musical intervention, regardless of whether students passively listened to music or actively played music.

Training Students to Address Vaccine Hesitancy and/or Refusal.

Objective. To determine the impact of a vaccine hesitancy learning unit on student knowledge, attitudes, and ability to address vaccine hesitancy and/or refusal. Methods. The learning unit consisted of two standardized patient simulation encounters performed one week apart. A 13-item attitudes survey was administered prior to the simulations to determine student confidence and knowledge regarding vaccine hesitancy. Students then participated in an encounter with a simulated patient who assessed the students' abilities using a 16-item grading rubric related to the art of the rhetoric, communication skills, and social, emotional competence. Post-simulation, students received feedback, completed a self-reflection exercise, and received formal coursework on addressing vaccine hesitancy. The following week, students participated in a second simulated patient encounter and thereafter completed the same attitudes and satisfaction surveys. Results. There were 203 students who went through the learning unit, with 180 (88.6% response rate) completing all the survey tools. The results showed significant improvements in all 16 items of the assessment rubric. On the pre/post attitudes questions, 9 out of 13 items showed significant improvement. Gains were largest for knowledge on the use of thimerosal as a preservative, speaking about how vaccines will not overwhelm a child's immune system, and knowledge about vaccinations not overwhelming a child's immune system. Overall, 94% of students were satisfied with the learning unit. Conclusion. This learning unit was effective in improving student confidence and ability to address vaccine hesitancy.

Use of Standardized Patient Simulations to Assess Impact of Motivational Interviewing Training on Social⁻Emotional Development.

The objective of this study was to assess the impact of motivational interviewing (MI) training on students' social⁻emotional development. Two simulations using standardized patients (SP) were conducted within a smoking cessation module. Students first completed a 4 h self-study module focused on smoking cessation tools and general counseling techniques. Faculty then administered a 15-item rubric focused on students' self-assessment of their verbal/non-verbal communication, social⁻emotional competence and MI skills. Students then participated in a smoking cessation counseling session with an SP. SPs used the same rubric to assess student performance. Teaching assistants (TAs) observed and assessed the students using the same rubric and an additional 22 items related to clinical skills. TAs and SPs then provided feedback on areas of improvement. The following week, students first completed a 3 h self-study module on MI then participated in a different smoking cessation scenario. After completion, the 15-item self-assessment rubric was administered. There was a significant improvement in TA assessed student performance with an average score improvement of 8% (pre-intervention score = 67%; post-intervention mean = 75%). Students had dramatic gains in their self-assessment with their scores rising by an average of 22%. Using MI techniques can improve students' self-assessed and perceived social⁻emotional competency.

Journal Club Standardization Tool: Helping participants get the JIST.

BACKGROUND AND PURPOSE: Clinical pharmacy practice relies on the ability to critically evaluate clinical trials and apply their findings to patient care. The development of these skills begins in pharmacy school, develops during residency programs, and continues to mature while practicing clinical pharmacy. The purpose of this analysis was to evaluate student attitudes and perceptions following implementation of the Journal Interpretation Summary Tool (JIST) into a pharmacy curriculum. EDUCATIONAL ACTIVITY AND SETTING: The "journal club" is an activity implemented in many curricula with the intent to hone these skills. The JIST is a standardized template aimed at improving the consistency of a journal review by organizing major elements of a trial, allowing the facilitator and participants to navigate through key information and guide the journal club discussion. FINDINGS: Implementation of JIST resulted in an increased level of confidence for a majority of students (63.3%) when conducting and critically evaluating a journal article. More than 80% of students reported they were better able to critically evaluate a published article using JIST, and 91.9% reported JIST provided structure to the journal club process. DISCUSSION AND SUMMARY: JIST provides the appropriate level of guidance and structure, particularly for the novice pharmacy student or pharmacist. The use of a standardized tool for journal club evaluation may lead to further improvements in applying literature to practice and other skills surrounding the critique of medical literature.

Assessing student knowledge, confidence, accuracy, and proficiency in providing Medicare Part D assistance.

PURPOSE: To assess the impact of coordinated didactic, simulation-based, and experiential learning on pharmacy students' knowledge and confidence with Medicare Part D and their accuracy and proficiency with the Medicare Plan Finder Tool. EDUCATIONAL ACTIVITY: Forty-two pharmacy students participated in a two-semester Medicare Part D elective course in which didactic, simulation-based and experiential learning methods were employed. Students' knowledge, confidence, accuracy, and proficiency were assessed at three course time points: first day of class, last day of in-class education, and after completion of outreach. FINDINGS: Student confidence with Part D and efficiency using the Plan Finder Tool significantly improved at each successive time point (p<0.01). Student knowledge was significantly improved both on the last day of class and after outreach completion as compared to the first day of class (p<0.01). SUMMARY: Basic Part D knowledge improved with the didactic and simulation-based portion of the course. The experiential component improved student confidence and efficiency in helping Medicare beneficiaries.

Examining differences between P1 versus P2 students as teaching assistants in a P1 skills-based course.

INTRODUCTION: The purpose of this study was to assess differences between the use of first-year (P1; "peer") versus second-year (P2; "near-peer") students as teaching assistants (TA) in a first-year, skills-based course. METHODS: The practicum course assesses competence in the provision of screening services and patient counseling. TAs review weekly material followed by a one-on-one assessment of each student using a grading rubric. Both qualitative and quantitative data were analyzed to determine if there was a difference in performance between the peer and near-peer teaching assistants. RESULTS: Sixteen peer and 33 near-peer TAs were evaluated by 210 students for six different skill assessments in practicum. There was no significant difference between peer and near-peer TAs in both student perception of TA performance and in TA grading of student performance. CONCLUSIONS: There is no difference in the use of peer versus near-peer TAs in evaluating first-year pharmacy students in the skills-based course. Using peer TAs over near-peer TAs can be useful when faced with scheduling and other resource conflicts.

An overview and study of beneficiaries' knowledge, attitudes, and perceptions of the medicare part d benefit.

PURPOSE: Medicare beneficiaries' knowledge, attitudes, and perceptions (KAP) of the Medicare Part D prescription drug benefit have been under evaluation since the 2006 inception of the Part D benefit. OBJECTIVE: This study sought to examine beneficiaries' satisfaction with their Medicare Part D prescription drug plan, knowledge of the coverage gap, attitudes about the relative importance of certain insurance parameters, and overall perceptions of the Part D benefit. DESIGN: Cross-sectional, descriptive study design. SETTING: Thirteen outreach events targeting Medicare beneficiaries in northern California during the 2012 open-enrollment period. PARTICIPANTS: A total of 576 Medicare beneficiaries. INTERVENTIONS: Beneficiaries were asked questions related to their KAP of the Part D benefit as part of a plan to evaluate their need for assistance. Sociodemographic data were collected via a standardized survey. MAIN OUTCOME MEASURES: Identify variances in KAP related to beneficiary sociodemographic and clinical characteristics. RESULTS: Forty-seven percent of beneficiaries claimed to be "very" or "extremely" satisfied with Part D, yet only 40.3% of those with a prescription drug plan (PDP) rated their plan as "very good" or "excellent." Those automatically enrolled into their plan by Medicare were significantly less satisfied with their plan (P = 0.048). Almost three in four recipients not receiving Medicare subsidies have heard of the gap in prescription drug coverage, i.e., the "donut hole." Additionally, there were significant racial disparities in knowledge of the gap. Only 62.7% of beneficiaries indicated that "total out-of-pocket cost during the year" was the most important plan characteristic for them. CONCLUSIONS: An understanding of beneficiaries' attitudes may help explain suboptimal Part D plan selection. Moreover, evaluating beneficiaries' knowledge of the Part D benefit can assist advocacy groups in creating educational materials to better assist this vulnerable population in choosing an appropriate plan.

Use of Cumulative Assessments in U.S. Schools and Colleges of Pharmacy.

The Accreditation Council of Pharmacy Education (ACPE) has taken a strong stance on assessment in pharmacy education. One available assessment tool is cumulative assessments, which may be administered at various points in the curriculum. This article presents the results of a survey of U.S. schools of pharmacy regarding the use of cumulative assessments within their curriculum. A 20-question survey tool was emailed to 125 schools of pharmacy. A total of 105 out of 125 schools participated (response rate 84%). Of these, 52 schools currently have a cumulative assessment program; 18 have one cumulative exam prior to advanced pharmacy practice experiences (APPEs); 19 have a cumulative exam every didactic year; and seven have accumulative exams every semester, except during APPEs (n = 44). Increased faculty workload emerged as the top challenge faced by schools that have implemented a cumulative assessment program. Eighteen schools indicated that no outcomes are measured to determine the utility of the cumulative assessment. From these results, it appears that almost half of participating U.S. schools have implemented a cumulative assessment plan. However, it is apparent that more research needs to be done to determine which outcomes are expected to improve with the implementation of such an assessment plan.

Minimizing out-of-pocket prescription drug costs for Medicare beneficiaries: not just 'a drop in the bucket'.

OBJECTIVE: To identify the frequency of uptake and financial impact of four cost-minimization strategies used to assist Medicare beneficiaries in lowering their out-of-pocket (OOP) costs. DESIGN: Cost-savings analysis. SETTING: Twelve outreach events were conducted in six different cities throughout Northern and Central California during the 2013 Medicare open enrollment period. PARTICIPANTS: Noninstitutionalized Medicare beneficiaries from various socioeconomic backgrounds, including those receiving Medicaid. MAIN OUTCOME MEASURES: Potential OOP cost savings for the upcoming year. RESULTS: In total, 621 beneficiaries were assisted. Part D plan optimization was performed for 535 beneficiaries; the findings indicated that 435 (81%) could save money (average: $1,334) by switching plans in the upcoming year. The results also demonstrated that 28 beneficiaries could save money (mean: $1,274) through a patient assistance program. In total, 16 beneficiaries had self-reported income and/or assets that were low enough to qualify for additional governmental assistance through the low-income subsidy. Finally, less costly therapeutic alternatives were identified for 7 beneficiaries and prescribers accepted recommendations for change in 6 (85%) such cases. In total, beneficiaries could realize more than $770,000 in potential OOP savings from the performed interventions. CONCLUSION: Targeted assistance to beneficiaries through a variety of cost-lowering strategies can help significantly reduce OOP costs and thus may also result in lower cost-related medication nonadherence and improved beneficiary outcomes.

Medication adherence behaviors of Medicare beneficiaries.

BACKGROUND: Medication adherence is crucial for positive outcomes in the management of chronic conditions. Comprehensive medication consultation can improve medication adherence by addressing intentional and unintentional nonadherence. The Medicare Part D prescription drug benefit has eliminated some cost barriers. We sought to examine variables that impact self-reported medication adherence behaviors in an ambulatory Medicare-beneficiary population and to identify the factors that influence what information is provided during a pharmacist consultation. METHODS: Medicare beneficiaries who attended health fairs in northern California were offered medication therapy management (MTM) services during which demographic, social, and health information, and responses to survey questions regarding adherence were collected. Beneficiaries were also asked which critical elements of a consultation were typically provided by their community pharmacist. Survey responses were examined as a function of demographic, socioeconomic, and health-related factors. RESULTS: Of the 586 beneficiaries who were provided MTM services, 575 (98%) completed the adherence questions. Of responders, 406 (70%) reported taking medications "all of the time". Of the remaining 169 (30%), the following reasons for nonadherence were provided: 123 (73%) forgetfulness; 18 (11%) side effects; and 17 (10%) the medication was not needed. Lower adherence rates were associated with difficulty paying for medication, presence of a medication-related problem, and certain symptomatic chronic conditions. Of the 532 who completed survey questions regarding the content of a typical pharmacist consultation, the topics included: 378 (71%) medication name and indication; 361 (68%) administration instructions; 307 (58%) side effects; 257 (48%) missed-dose instructions; and 245 (46%) interactions. Subsidy recipients and non-English speakers were significantly less likely to be counseled on drug name, indication, and side effects. The presence of certain health conditions was also associated with missing consultation elements. CONCLUSION: While Medicare beneficiaries are generally adherent to medication therapy, adherence barriers must be identified and addressed during comprehensive medication consultation.

A collaborative approach to combining service, teaching, and research.

OBJECTIVE: To describe a faculty-student collaborative model and its outcomes on teaching, service, and scholarship. DESIGN: A Medicare Part D elective course was offered that consisted of classroom and experiential learning where pharmacy students participated in community outreach events to assist Medicare beneficiaries with Part D plan selection. The course training was expanded to include medication therapy management (MTM) and the administration of immunizations. At the completion of the course, students collaborated with faculty members on research endeavors. EVALUATION: During the first 6 years of this course, the class size more than doubled from 20 to 42 students, and all students participating in the course met the IPPE requirements for community outreach. Over that same period, the number of beneficiaries receiving assistance with their Part D plan grew from 72 to 610; and with the help of students starting in 2011, faculty members had 28 poster presentations at national conferences, 7 invited podium presentations at national/international meetings, and published 8 manuscripts in peer-reviewed journals. CONCLUSION: Through collaborative efforts, this model took an elective course and provided classroom and experiential learning for students, needed health services for the community, and opportunities to pursue wide ranging research projects for faculty members and students.

Cost variability of suggested generic treatment alternatives under the Medicare Part D benefit.

BACKGROUND: The substitution of generic treatment alternatives for brand-name drugs is a strategy that can help lower Medicare beneficiary out-of-pocket costs. Beginning in 2011, Medicare beneficiaries reaching the coverage gap received a 50% discount on the full drug cost of brand-name medications and a 7% discount on generic medications filled during the gap. This discount will increase until 2020, when beneficiaries will be responsible for 25% of total drug costs during the coverage gap. OBJECTIVE: To examine the cost variability of brand and generic drugs within 4 therapeutic classes before and during the coverage gap for each 2011 California stand-alone prescription drug plan (PDP) and prospective coverage gap costs in 2020 to determine the effects on beneficiary out-of-pocket drug costs. METHODS: Equivalent doses of brand and generic drugs in the following 4 pharmacological classes were examined: angiotensin II receptor blockers (ARBs), bisphosphonates, HMG-CoA reductase inhibitors (statins), and proton pump inhibitors (PPIs). The full drug cost and patient copay/coinsurance amounts during initial coverage and the coverage gap of each drug was recorded based on information retrieved from the Medicare website. These drug cost data were recorded for 28 California PDPs. RESULTS: The highest cost difference between a brand medication and a Centers for Medicare Medicaid Services (CMS)-suggested generic treatment alternative varied between $110.53 and $195.49 at full cost and between $51.37 and $82.35 in the coverage gap. The lowest cost difference varied between $38.45 and $76.93 at full cost and between -$4.11 and $18.52 during the gap. CONCLUSION: Medicare beneficiaries can realize significant out-of-pocket cost savings for their drugs by taking CMS-suggested generic treatment alternatives. However, due to larger discounts on brand medications made available through recent changes reducing the coverage gap, the potential dollar savings by taking suggested generic treatment alternatives during the gap is less compelling and will decrease as subsidies increase.