Impact of an open enrollment service on costs for Medicare Part D beneficiaries.

OBJECTIVE: The primary objective was to determine total estimated cost savings based on a patient's current medication regimen after comparing available Medicare Part D plans for the upcoming year by using a plan comparison platform. The secondary objective was to determine patient-centered concerns when considering a change in Part D plans. DESIGN: Review of an open enrollment service that included a patient survey and a Part D plan comparison. SETTING: This study took place at a single independent community pharmacy in northwest Alabama. PARTICIPANTS: Fifty-four patients eligible for Medicare Part D were included in this study. MAIN OUTCOME MEASURES: The study was a review of an open enrollment service that aids Medicare beneficiaries in selecting a Part D plan that best fits their needs. It included a patient survey and plan comparison using a plan comparison platform, during the 2015 Medicare open enrollment period (October 15 to December 7). The survey assessed patient demographics, pharmacy preferences, and cost concerns. Survey data were used to aid in plan selection and analysis to determine the most common patient-centered concerns when considering a change in plans. RESULTS: During the open enrollment period, 54 patients compared Medicare Part D plans. The majority of participants were female (57%) and ranged in age from 65-69 years (37%) to 70-74 years (25.9%). The majority of patients reported a preference for independent pharmacies (92.6%). Deductible (40.7%) was the biggest concern for patients when comparing the main cost variables for medication insurance. The average total cost difference per patient per year showed that each patient saved an average of $1166.46. CONCLUSION: The analysis of an independent pharmacy's open enrollment service determined that a plan comparison platform is a valuable tool in helping patients to compare and select cost-effective Medicare Part D prescription plans and in helping patients save money.

Determination of Anticholinergic Medication Use in Patients Prescribed Medications for the Treatment of Dementia.

OBJECTIVE: The primary endpoint of the study is to determine the variations in the use of medications to treat dementia in patients concomitantly or not prescribed anticholinergics. DESIGN: The study is a case series of patients at a single community pharmacy over one year based on prescription claims data. SETTING: The setting is an independent community pharmacy in the South. MAIN OUTCOME MEASURE(S): The main outcome is the variations associated in treatment plans for patients either receiving anticholinergics or not receiving medications with anticholinergic properties. RESULTS: The community pharmacy had 33 patients on medications to treat dementia, and 17 patients (51.5%) were prescribed anticholinergic medications. Only patients on anticholinergic medications were prescribed memantine immediate-release. Fifteen patients (93%) not prescribed anticholinergic medications were on a single medication to treat dementia, whereas 9 patients (52%) prescribed anticholinergic medications were on a single medication to treat dementia. CONCLUSION: Further research should be conducted in this area to better ascertain the impact anticholinergic medications have on patients. This study noted differences from previous data regarding the prevalence of concomitant prescribing of medications for the treatment of dementia and anticholinergics.

A pharmacotherapy review of the novel, oral antithrombotics.

Coagulation disorders account for a high incidence of death in the U.S. due to stroke, myocardial infarction, and venous thromboembolism. In the past few years, numerous agents have been brought to market for the treatment of thromboembolism or prevention of thromboembolism. Similar to warfarin, these agents can cause bleeding disorders, which may exacerbate dental care treatment plans. This literature review examines the newer agents for the treatment of thromboembolism disorders, common side effects and drug interactions, the specific medical conditions each agent treats, and the dental perspective on how to medically management patients prescribed these medications.

Hypoglycemic agents and potential anti-inflammatory activity.

Current literature shows an association of diabetes and secondary complications with chronic inflammation. Evidence of these immunological changes include altered levels of cytokines and chemokines, changes in the numbers and activation states of various leukocyte populations, apoptosis, and fibrosis during diabetes. Therefore, treatment of diabetes and its complications may include pharmacological strategies to reduce inflammation. Apart from anti-inflammatory drugs, various hypoglycemic agents have also been found to reduce inflammation that could contribute to improved outcomes. Extensive studies have been carried out with thiazolidinediones (peroxisome proliferator-activated receptor-γ agonist), dipeptidyl peptidase-4 inhibitors, and metformin (AMP-activated protein kinase activator) with each of these classes of compounds showing moderate-to-strong anti-inflammatory action. Sulfonylureas and alpha glucosidase inhibitors appeared to exert modest effects, while the injectable agents, insulin and glucagon-like peptide-1 receptor agonists, may improve secondary complications due to their anti-inflammatory potential. Currently, there is a lack of clinical data on anti-inflammatory effects of sodium-glucose cotransporter type 2 inhibitors. Nevertheless, for all these glucose-lowering agents, it is essential to distinguish between anti-inflammatory effects resulting from better glucose control and effects related to intrinsic anti-inflammatory actions of the pharmacological class of compounds.

Clinical considerations for insulin pharmacotherapy in ambulatory care, part two: review of primary literature and an evidence-based approach for treatment.

IN BRIEF This article reinforces the dosing guidance from the package inserts of available insulin products and supplemental information provided by the manufacturers of insulin products. It reviews and evaluates pertinent primary literature detailing algorithms for the initiation and titration of insulin therapy that have helped to shape current clinical practice guidelines. The article discusses the clinical applicability of the evidence on insulin pharmacotherapy and offers recommendations for initiation and titration of various insulin products for insulin-requiring people with type 2 diabetes in the ambulatory care setting.

Clinical Considerations for Insulin Pharmacotherapy in Ambulatory Care, Part One: Introduction and Review of Current Products and Guidelines.

In Brief This article describes available insulin products and published guidelines to aid clinicians in making treatment decisions for insulin-dependent patients with type 2 diabetes. It establishes the need for a thorough evaluation of the literature regarding ambulatory insulin dosing to further inform providers who manage insulin therapy for patients with type 2 diabetes.