Paying for Cures: How Can We Afford It? Managed Care Pharmacy Stakeholder Perceptions of Policy Options to Address Affordability of Prescription Drugs.

BACKGROUND: High-priced medications with curative potential, such as the newer hepatitis C therapies, have contributed to the recent growth in pharmaceutical expenditure. Despite the obvious benefits, health care decision makers are just beginning to grapple with questions of how to value and pay for curative therapies that may feature large upfront cost, followed by health benefits that are reaped over a patient's lifespan. Alternative policy options have been proposed to promote high value and financially sustainable use of these therapies. It is unclear which policy options would be most acceptable to health care payer and biomedical manufacturer stakeholders. OBJECTIVES: To (a) briefly review pharmaceutical policy options to address health system affordability and (b) assess the acceptability of alternative policy options to health care payers and biomedical manufacturers before and after an Academy of Managed Care Pharmacy (AMCP) continuing pharmacy education (CPE) session. METHODS: We searched MEDLINE and Cochran databases for pharmaceutical policy options addressing affordability. With input from a focus group of managed care professionals, we developed CPE session content and an 8-question survey focusing on the most promising policy options. We fielded the survey before and after the CPE session, which occurred as part of the 2016 AMCP Annual Meeting. We first conducted a chi-squared goodness-of-fit test to assess response distributions. Next, we tested how responses differed before and after by using an ordered logit and a multinomial logit to model Likert scale and unordered responses, respectively. RESULTS: Although risk-sharing payments over time remained the most favorable choice before (37%) and after (35%) the CPE session, this choice was closely followed by HealthCoin after the session, which increased in favorability from 4% to 33% of responses (P = 0.001). About half of the respondents (54%) indicated that legislative change is the most significant barrier to the implementation of any policy. CONCLUSIONS: As high-cost curative drugs reach the market, managed care stakeholders need information from a balanced education source regarding alternative policies to address affordability. We found that after the AMCP CPE session, risk-sharing payments over time and HealthCoin were the most favorable options. DISCLOSURES: No funding was provided for this research. Carlson reports consulting fees from Genentech, Pfizer, and Seattle Genetics. The other authors have nothing to disclose. Study concept and design were contributed by Yeung, Garrison, and Carlson. Yeung collected the data, which were interpreted by Yeung and Basu. The manuscript was written by Yeung, Suh, and Bansal and revised by Yeung. A portion of this research was presented at the Academy of Managed Care & Specialty Pharmacy Annual Meeting as a continuing education session entitled "Paying for Cures: How Can We Afford It?" on April 20, 2016, in San Francisco, California.

Pharmaceutical industry funding of educational events for pharmacists in Australia: an analysis of data from the first 6 months of a mandatory disclosure programme.

OBJECTIVE: The aim of the study was to assess the extent of pharmacist participation in pharmaceutical industry-sponsored educational events in Australia. METHODS: A descriptive analysis was performed of 14 649 educational events provided by 43 companies between July and December 2007, using publicly available reports posted on the Medicines Australia website. Pharmacist participation was assessed according to duration and type of event, whether continuing professional education credits were awarded, type of venue, hospitality provided and cost of hospitality. KEY FINDINGS: Most of the 14 649 industry-sponsored events reported in this mandatory reporting programme were targeted at doctors (specialists and general practitioners). Pharmacists were present at 621 events (4.2%); 209 events were pharmacist-only events. Of pharmacist-only events, 68% were held in hospitals and professional rooms and 13% in restaurants. In contrast, 32% of events involving doctors were held in restaurants (difference in proportions 18.9%; 95% confidence interval 13.5-22.9%) Sixty-six per cent of pharmacist-only events were 1 h or less in duration; 81% were 2 h or less. Almost 40% were reported as training or in-service activities, generally conducted in hospitals. Only three events had continuing professional education credits assigned. The most common topics discussed were oncology, diabetes, haematology, cardiology and gastroenterology; a specific medicine was mentioned in the descriptor for 23 of the 209 (11%) events. Hospitality provided was generally modest, averaging AU$36.24 per pharmacist across all pharmacist-only events, and lower in hospital (AU$9.21 per head) than those held in restaurants (AU$51.42). CONCLUSIONS: The data from this first report suggest pharmacists were not a major target for industry-funded educational events. Exposure to such events will likely increase as pharmacists take on enhanced prescribing roles and it is important that this is captured under the mandatory disclosure requirements that have been introduced in a number of jurisdictions. It is also desirable that such schemes include generic medicines manufacturers and that pharmacy professional bodies use these data to monitor and manage the level and impact of interactions between pharmacists and industry.

A model for continuing pharmacy education.

OBJECTIVE: To develop and implement a continuing pharmacy education (CPE) program at Kaiser Permanente Colorado (KPCO) DESIGN: To address the continuing education needs of its diverse pharmacy staff, an internal continuing pharmacy education (CPE) program was developed. The pharmacy department became an accredited provider by the Accreditation Council for Pharmacy Education (ACPE). Live, interactive, and evidence-based CPE programs, presented by highly qualified internal staff members, utilized videoconferencing and a Web-based learning management system. Cross-accreditation of medical and pharmacy educational programs was offered to KPCO staff members. ASSESSMENT: Annual needs assessments were conducted to ensure the provision of relevant educational topics and to assess learning needs. To demonstrate outcomes of the CPE programs, 2 methods were utilized: objective effectiveness assessment and knowledge acquisition assessment. This program met the objectives for CPE activities a large majority of the time (usually over 90%), demonstrated statistically significant (p < 0.05) improvement in knowledge from before to after the CPE activity in 11 of 13 questions asked, and minimized the cost to acquire CPE credit for both the pharmacy department and its staff members. CONCLUSION: The KPCO continuing pharmacy education program has developed a high quality and cost-favorable system that has resulted in significant improvements in attendee knowledge.

Board of Pharmaceutical Specialties-certified faculty: a survey of United States colleges of pharmacy.

Board certification of pharmacists has been a reality in the United States since 1976, when the Board of Pharmaceutical Specialties (BPS) was founded. Little has been reported about the effects of board certification of pharmacists, particularly pharmacy practice faculty, since 1992, when the BPS administered its first certification examination. We developed and pretested a survey to describe and measure the effect of BPS certification on the realm of academia as perceived by deans of colleges of pharmacy in the United States. Deans or other appropriate officials at all 84 colleges of pharmacy in the United States were asked to complete and submit this 13-question survey, which was administered through the Web and maintained respondents' anonymity. Officials from 35 of the 84 colleges completed the survey, for a response rate of 42%. No college reported that board certification was a condition for employment. Eight schools (23%) anticipated a certification requirement in the future. The most commonly reimbursed items associated with certification were fees for the American College of Clinical Pharmacy preparatory course and the BPS examination. Twelve schools (34%) provided no reimbursement toward certification. The most common incentive for faculty to obtain certification was consideration in promotion and tenure (66%). We believe that this information will facilitate efforts to gauge the effects of BPS certification on colleges of pharmacy. We also anticipate that it will assist colleges as they attempt to recruit and retain the most qualified faculty members possible, particularly in light of the national pharmacist shortage.

Educational strategies to promote evidence-based community pharmacy practice: a cluster randomized controlled trial (RCT).

BACKGROUND: Community pharmacists have increasing involvement in the self-management of minor illness as a result of the availability of a wider range of over-the-counter (OTC) medicines. We undertook a randomized controlled trial (RCT) to assess the effectiveness and efficiency of educational strategies to implement evidence-based guidelines for the sale of OTC anti-fungals in the community pharmacy setting. OBJECTIVE: The aim of the study was to compare the effectiveness and efficiency of two guideline dissemination strategies in community pharmacy settings. METHODS: A 2 x 2 factorial, cluster RCT was conducted with 60 community pharmacies in the Grampian region of Scotland. The interventions included dissemination of an evidence-based guideline for OTC management of vulvovaginal candidiasis (thrush) by postal dissemination (control), educational outreach visit or attendance at a continuing professional education session. Pre- and post-intervention simulated patient visits were made to participating pharmacies. The simulated patients completed assessment forms following each visit. The primary outcome was the appropriateness (based upon the guidelines) of sale or no sale of OTC anti-fungals. RESULTS: There were no significant differences in the proportion of appropriate outcomes following educational outreach [odds ratio (OR) = 1.1; 95% confidence interval (CI) 0.52 to 2.45] or continuing professional education (OR = 0.88; 95% CI 0.41 to 1.91). CONCLUSIONS: Neither strategy was effective in improving the appropriateness of OTC management of vulvovaginal candidiasis by community pharmacy staff. Further research is needed to identify barriers to guideline implementation and evidence-based practice in this setting.

Impact of a pharmacist education program on nonformulary drug use.

The effect of an educational program for pharmacists that included instructions for handling nonformulary drug requests and determining suitable formulary alternatives for frequently prescribed nonformulary drug requests was measured. Results indicate a significant increase in the number of appropriate nonformulary drug dispensings when the postintervention phase was compared with the preintervention phase. Other values, including the financial impact per nonformulary drug request, did not differ significantly between the two phases. Since all nonformulary drug requests require pharmacist time, a more cost-effective nonformulary drug policy might focus the pharmacist's efforts on nonformulary drug products that are more costly than their formulary alternatives.

Post-doctoral education for pharmacy practice faculty.

Post-doctoral training is becoming increasingly important as a means of preparing for faculty positions in the clinical or pharmacy practice departments of colleges of pharmacy. This article suggests that such training is the most appropriate means of providing the research skills necessary for growth in the academic environment and discusses the impact of post-doctoral programs on the individuals taking them, on the colleges of pharmacy, and on the profession as a whole. For the profession, there is seen a very positive gain as a result of high-training is essential to produce the manpower needed. Some suggestions are offered for enhancing the current level of training.

Budgetary considerations in planning pharmacy continuing education programs.

This article presents three years of financial data on pharmacy continuing education programs offered by a college of pharmacy. Forty-one programs were offered resulting in the generation of 35,702 instructional units of activity and 3028.8 CEUs. Total costs were $295,797.00 of which $125,822.00 was for direct costs. Income totaled $127,754.00. Costs and income per registrant, instructional unit, and program are presented, as are comparative data by program type for the three-year period. The total cost of one hour of programming for one participant was $8.29. Some thoughts on who should pay for the costs of CE for professionals are presented. Figures are discussed in light of situational factors influencing program delivery. Staff productivity was determined to be 11.7 programs per FTE or 13.7 programs per year. This last figure translated to serving 2,654 participants per year. Total income accounted for only 43.2 percent of total expenses. Increase in registration fees was suggested as one way to offset all expenses.

Institutional support of continuing education as a fringe benefit for hospital pharmacists.

The purpose of this study was to examine the extent to which hospital pharmacists in Wisconsin received compensation for continuing education (CE) from their institutions and to compare this with their participation in CE activities. The study was conducted by a mail questionnaire sent to all pharmacists practicing in a hospital setting in Wisconsin. The usable response rate was greater than 45%. Persons in administrative positions received greater support for CE activities than staff in the areas of registration fees (P less than 0.005), travel expenses (P less than 0.0005), dues for professional organizations (P less than 0.0005), and compensatory time (P less than 0.0005). Pharmacists in the sample participated in an average of 123.8 hours of CE yearly, including 77.2 hours of journal reading. Staff size influenced the method of obtaining CE, with smaller staffs relying more heavily on journals and larger staffs on in-house programs. The amount of compensation did not influence total CE participation, suggesting that other factors might influence CE participation.