2024
Real-World Analysis of Insurer Rejection Rates for Specialty Oral Anticancer Prescriptions in a Nationwide Sample of Patients with Blood Cancer
Doshi J, Li P, Geng Z, Lei X, Pettit A, Armstrong K, Huntington S, Lin J. Real-World Analysis of Insurer Rejection Rates for Specialty Oral Anticancer Prescriptions in a Nationwide Sample of Patients with Blood Cancer. Blood 2024, 144: 786-786. DOI: 10.1182/blood-2024-203410.Peer-Reviewed Original ResearchInsurance typeBlood cancerMedicare patientsCommercial insuranceStep therapyFormulary coverageNationwide sample of patientsPrior authorizationTreatment plan changesDelayed treatment initiationMonths pre-indexOdds of rejectionLonger treatment durationLife-extending therapyReal-world studyOral anticancer medicationsSample of patientsBlood cancer patientsPatient ageClinical characteristicsTreatment initiationReal-world analysisBrand-nameRetrospective analysisPre-indexStreamlining Prior Authorization to Improve Care
Busis N, Khokhar B, Callaghan B. Streamlining Prior Authorization to Improve Care. JAMA Neurology 2024, 81: 5-6. PMID: 37983023, DOI: 10.1001/jamaneurol.2023.4324.Peer-Reviewed Original Research
2022
Medicare Coverage and Out-of-Pocket Costs of Quadruple Drug Therapy for Heart Failure
Faridi K, Dayoub E, Ross J, Dhruva S, Ahmad T, Desai N. Medicare Coverage and Out-of-Pocket Costs of Quadruple Drug Therapy for Heart Failure. Journal Of The American College Of Cardiology 2022, 79: 2516-2525. PMID: 35738713, DOI: 10.1016/j.jacc.2022.04.031.Peer-Reviewed Original ResearchConceptsSodium-glucose cotransporter 2 inhibitorsAngiotensin receptor neprilysin inhibitorQuadruple therapyOOP costsMedicare coveragePocket costsAngiotensin-converting enzyme inhibitorPrior authorizationAngiotensin receptor blockersQuadruple drug therapyCotransporter 2 inhibitorsMineralocorticoid receptor antagonistsReduced ejection fractionDrug plansReceptor blockersEjection fractionHeart failureDrug therapyReceptor antagonistPrescription drug plansMedicare patientsEnzyme inhibitorsTherapyRegimensMedication pricesPractice Patterns Related to Mitigation of Neurocognitive Decline in Patients Receiving Whole Brain Radiation Therapy
Jairam V, Park HS, Yu JB, Bindra RS, Contessa JN, Jethwa KR. Practice Patterns Related to Mitigation of Neurocognitive Decline in Patients Receiving Whole Brain Radiation Therapy. Advances In Radiation Oncology 2022, 7: 100949. PMID: 35521071, PMCID: PMC9065721, DOI: 10.1016/j.adro.2022.100949.Peer-Reviewed Original ResearchWhole-brain radiation therapyBrain radiation therapyRadiation oncologistsPractice patternsRadiation therapyHA-WBRTNeurocognitive declineCommon reasonHippocampal avoidance whole brain radiation therapyNational practice patternsDeleterious cognitive effectsRoutine clinical practiceNeurocognitive preservationBrain metastasesTreatment delayProvider characteristicsEffective treatmentCurrent evidencePearson χMemantineClinical practicePatientsPrior authorizationMajority of respondentsTherapy
2021
A Survey of Community Dermatologists Reveals the Unnecessary Impact of Trial-and-Error Behavior on the Psoriasis Biologic Treatment Paradigm
Strober B, Pariser D, Deren-Lewis A, Dickerson T, Lebwohl M, Menter A. A Survey of Community Dermatologists Reveals the Unnecessary Impact of Trial-and-Error Behavior on the Psoriasis Biologic Treatment Paradigm. Dermatology And Therapy 2021, 11: 1851-1860. PMID: 34275121, PMCID: PMC8484423, DOI: 10.1007/s13555-021-00573-1.Peer-Reviewed Original ResearchPatient outcomesCommunity dermatologistsPsoriasis treatment responseNon-responding patientsFirst-line therapySuboptimal patient outcomesBiologic switchingBiologic agentsPsoriasis managementTherapy utilizationBiologic classesTherapeutic responseTreatment paradigmTreatment responseClinical utilityBiologic drugsPatientsDrug selectionMethodsA surveyPrior authorizationDermatologistsFirst choiceTrialsBiologic responsePrecision medicine
2020
Transparency in Prior Authorization
Kebaish KJ, Galivanche AR, Grauer JN. Transparency in Prior Authorization. Clinical Spine Surgery A Spine Publication 2020, 33: 325-327. PMID: 32554984, DOI: 10.1097/bsd.0000000000001032.Peer-Reviewed Case Reports and Technical Notes
2018
Coverage of Novel Therapeutic Agents by Medicare Prescription Drug Plans Following FDA Approval
Shaw DL, Dhruva SS, Ross JS. Coverage of Novel Therapeutic Agents by Medicare Prescription Drug Plans Following FDA Approval. Journal Of Managed Care & Specialty Pharmacy 2018, 24: 10.18553/jmcp.2018.24.12.1230. PMID: 30479199, PMCID: PMC10397592, DOI: 10.18553/jmcp.2018.24.12.1230.Peer-Reviewed Original ResearchConceptsNovel therapeutic agentsPrescription drug plansOrphan drug statusFDA approvalYear of approvalTherapeutic agentsNovel therapeuticsPrior authorizationNovel therapiesPriority reviewStep therapyMedicare prescription drug plansDrug plansDrug coverageNational InstituteDrug statusPart D prescription drug benefitMedicaid ServicesDrug characteristicsTherapeutic areasCross-sectional studyDrug benefit coverageHealth insurance payerBlue Cross Blue Shield AssociationPrescription drug benefit
2012
Medicare Prescription Drug Coverage and Home Use of Erythropoiesis-Stimulating Agents for MDS-Associated Anemia: A Medicare-Database Analysis.
Davidoff A, Hendrick F, Stuart B, Zeidan A, Shenolikar R, Gore S, Baer M. Medicare Prescription Drug Coverage and Home Use of Erythropoiesis-Stimulating Agents for MDS-Associated Anemia: A Medicare-Database Analysis. Blood 2012, 120: 3176. DOI: 10.1182/blood.v120.21.3176.3176.Peer-Reviewed Original ResearchErythropoiesis stimulating agentsLow-income subsidyPart D claimsMyelodysplastic syndromePart D plansPrior authorizationStudy cohortD claimsOOP paymentsMDS diagnosisPart DUse of ESAsPart D.Lower-risk myelodysplastic syndromesPoor functional statusChronic renal failureD plansErythropoiesis-stimulating agentsMultivariate logistic regressionTreatment of anemiaPart D coverageMedicare Part APlan characteristicsPrescription drug coveragePatient-level observationsState Medicaid Programs Did Not Make Use Of Prior Authorization To Promote Safer Prescribing After Rosiglitazone Warning
Ross JS, Jackevicius C, Krumholz HM, Ridgeway J, Montori VM, Alexander GC, Zerzan J, Fan J, Shah ND. State Medicaid Programs Did Not Make Use Of Prior Authorization To Promote Safer Prescribing After Rosiglitazone Warning. Health Affairs 2012, 31: 188-198. PMID: 22232110, PMCID: PMC3319744, DOI: 10.1377/hlthaff.2011.1068.Peer-Reviewed Original ResearchConceptsState Medicaid programsPreferred drugDrug listPrior authorizationMedicaid programSafety warningsPrior authorization programHigh-cost drugsDiabetes medicationsPrescribing ratesEffective prescribingSafe prescribingMedicaid beneficiariesDiabetes drugsPrescribingState MedicaidHeart attackRosiglitazoneDrug availabilityDrugsAuthorization programPrescriptionMinimal changesMedicationsProviders
2009
Developing A Policy For Second-Generation Antipsychotic Drugs
Rosenheck RA, Sernyak MJ. Developing A Policy For Second-Generation Antipsychotic Drugs. Health Affairs 2009, 28: w782-w793. PMID: 19622538, DOI: 10.1377/hlthaff.28.5.w782.Peer-Reviewed Original ResearchConceptsSecond-generation antipsychoticsAntipsychotic drugsRisk/benefit profileSecond-generation antipsychotic drugsMetabolic side effectsTreatment of schizophreniaAdverse eventsBenefit profileLower riskOld drugsSide effectsPrior authorizationDrugsCheaper drugsGeneric drugsEducational preparationWidespread implementationGood acceptanceSuch proceduresAntipsychoticsPatientsTherapySchizophrenia
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