-Weekly Pharmacy Updates
provided by Paula Straub, RPh, Precision Healthcare Delivery
Medication Adherence Tip of the Week- Medication adherence is critical to successful hypertension control for many patients. As a health care professional, you can empower your patients to take their hypertensive medications as prescribed. Effective two way-communication is key; in fact, it doubles the odds of your patients taking their medications properly. Write down prescription instructions clearly, and reinforce them verbally. Provide websites or brochures for additional reading and information. Remind your patients to have a routine for taking their medications.
Pharmacy Update- US Antibiotic Awareness Week is November 11-18, 2019
Do you promote antibiotic awareness? During November there is a one week observance that gives providers an opportunity to raise awareness on the appropriate use of antibiotics and reduce the threat of antibiotic resistance. The Centers for Disease Control and Prevention (CDC) has many tools for you at https://www.cdc.gov/antibiotic-use/week/toolkit.html. Posters, prescriptions pads, social media posts, patient education pieces, sticker and counter clings, and more can be found on the CDC website. The CDC also has Be Antibiotics Aware, an educational effort to raise awareness about the importance of safe antibiotic prescribing and use. Be Antibiotics Aware has resources to help you educate your patients about antibiotic use and risks for potential side effects. For more information visit: https://www.cdc.gov/antibiotic-use/?s_cid=NCEZID-AntibioticUse-005.
Medication Adherence Tip of the Week- Make sure you explain to your patients how long to take their medication. Please ensure your patient knows if he/she needs to empty the bottle, or stop taking medication once one feels better. Remind your patients to refill medication for maintenance medication when bottle is empty. Ask your patients if medication side effects are bothering them. Communication is key in improving medication adherence.
Pharmacy Update- Anthem Medicare Advantage Part D members can receive some medications at a $0 copay. When clinically appropriate, consider the list of drugs below as low-cost options to treat patients with diabetes.
- Metformin ER
- Glipizide ER
Medication Adherence- One of the easiest to use tools that supports adherence is a pill organizer. Ask your patients to use this tool. There are boxes with separated sections labeled for the day of the week. More detailed versions include containers for each day of the week broken out further by time of day (e.g., breakfast, lunch, dinner, before bed).
Pharmacy Update- Anthem Medicare Advantage Part D members can receive some medications at a $0 copay. When clinically appropriate, consider the list of drugs below as low-cost options to treat patients with high blood pressure.
ACE inhibitors & ARBs
- Benazepril, Benazepril-HCTZ
- Enalapril, Enalapril-HCTZ
- Lisinopril, Lisinoril-HCTZ
- Losartan, Losartan-HCTZ
Medication Adherence Tip of the Week- You need to be diligent about looking for clues to identify medication nonadherence. Some clues may include patients who have suboptimal critical outcomes, such as uncontrolled A1C, blood pressure and lipid profiles. Other clues are patients who are “frequent flyers” when it comes to hospital admissions or readmissions, or patients who miss their appointments and follow-ups. Also, patients may have psychological stressors, anxiety disorders, a history of depression and even low literacy can be clues to investigate further.
Pharmacy Update- According to a new study published in July in JAMA Pediatrics physicians seem to be recommending fewer OTC cough and cold medications. This isn’t the case for antihistamines which increased overall and appeared strongest for children younger than 12 years per researchers who examined data from 3.1 billion pediatric visits from 2002 to 2015. In general, colds do not need to be treated with medication, and a cough caused by a cold or upper respiratory infection is usually self-limiting. There are non-drug options that can provide symptom relief for short periods such as nasal saline, a humidifier, and nasal aspiration.
Medication Adherence Tip for the Week - Be realistic with expectations from your patients in terms of medication adherence! You should not expect perfection and recognize that medication adherence is a tough thing to discover. Some patients may state that they are honest about their medication-taking behavior; however, you need to recognize that there’s a “white-coat adherence.” Patients may be adherent a week or month before they come to your office, so they can honestly say, “yes, I’m taking my medication as prescribed.”
Pharmacy Update- According to a new study published in the Journal of the American College of Cardiology, fluoroquinolones may be linked to a greater risk of heart problems. The cardiac adverse effects include aortic ruptures and tears. In this study researchers reviewed data from the FDA’s adverse reporting system database and U.S. PharMetrics Plus. In the random sample of 9,053,240 patients , they identified and analyzed 12,505 cases of valvular regurgitation and 125,020 case-control participants. Patients that were currently taking fluoroquinolones had a 2.4 times greater risk of developing aortic and mitral regurgitation. The researchers noted that only recent fluoroquinolone use (within 60 days) was the timeframe associated with the cardiac events.
Medication Adherence Tip of the Week- Even though adherence to medications is a critical problem, the good news is that opportunities exist for providers to improve patient adherence to medications and lifestyle. The most effective interventions consider the relationship between medication-taking behaviors and patient understanding, beliefs, feelings and everyday life. You can continually fine-tune your interviewing skills into structured, repeatable methods of asking questions the right way, identifying barriers and working with your patients to improve adherence.
Here are tips for communicating with your patients:
- Avoid judgmental statements and the use of the word “why” when possible.
- Remember to listen more and talk less.
- Ask open ended questions when possible like…Do you know why I prescribed the medications you are taking?
- Ask about the benefits of taking medications correctly. What are the benefits of taking your medicine?
- Use plain language.
Pharmacy Update- Breo Ellipta-This medication is for adult patients (18 years and older) for asthma and COPD. Some health plans have added age edits to ensure this is being prescribed for adult patients. Some cost effective options for treating patients <18 YO for asthma include generic Air Duo or generic Advair Diskus.
Medication Adherence Tip of the Week- Simply “forgetting” to take medication accounts for less than 30 percent of nonadherence. Instead, most of the time, patients decide not to take their medication for a specific reason, such as concern about a drug’s safety, side effects, or cost, or confusion about why they need to take it. This means as their provider you need to tailor the solution to the problem. For example, a patient with diabetes might stop daily insulin injections because the benefits of adherence (or the harms of nonadherence) seem too far into the future. The solution is to help the patient identify a more immediate and personal benefit, such as keeping blood glucose levels at goal to avoid having to continually update expensive eyeglasses. Each patient may have a unique reason for not taking their medicine. By identifying and discussing these unique reasons you can develop a personalized approach that promotes adherence in the future.
Pharmacy Update-New study addresses levothyroxine dosing concern
The question of generic equivalency of levothyroxine products has remained unanswered for many years. But, a new study led by Mayo Clinic researchers found that for patients with predominantly benign thyroid disease and newly treated hypothyroidism, there were no differences in cardiovascular event risks between patients treated with brand or generic levothyroxine. Researchers reviewed the records of 88,000 patients with an equal division of generic or brand levothyroxine. The team reviewed the number of hospitalizations for heart attacks, CHF, atrial fibrillation, and strokes and did not find any difference in event rates for both groups. This study helps to show that, even for narrow therapeutic index medications, the same patient outcomes can be achieved. The authors did note that more providers are prescribing generic levothyroxine today than in prior years. There were 2 major limitations in the study: the lack of information on lab results while patients were on thyroid hormone, and the short duration of follow-up (the average was 1 year). For more information on this study please contact Paula Straub at email@example.com.
Medication Adherence Tip of the Week- Coordinate with your patients and their pharmacist to see whether they can schedule the timing of when they obtain medications on an ongoing basis. Many pharmacies now can help their patients align refill dates so that medications can be picked up at the same time each month. This ensures a lack of interruptions in therapies and a better overall experience for your patients. Also, encourage your patients to participate in any medication therapy management initiatives that the health plans offer. The comprehensive medication review (CMR) summaries allow for more one-on-one conversations with patients that will help to uncover adherence issues. The education provided with these conversations can improve a patient’s health and well-being.
Pharmacy Update- Just reminding that the CDC’s seasonal flu vaccination campaign materials are available to assist providers in communicating about the importance of vaccination. There is a digital toolkit that includes details on events/activities, sample social media and newletter content, graphics, web assests, and media prep material. This material is downloadable and some of the material is customizable. For additional information on this valuable resource visit https://www.cdc.gov/flu/resource-center/tollkit/index.htm.
Medication Adherence Tip of the Week- Nurture relationships with your patients. You should ask how your patient is feeling, if a new dosage is working better or if they are experiencing any new side effects. All of these questions can start a conversation and allow a patient to open up about concerns that could possibly lead to non-adherence later. An open dialogue is important for building trust.
Pharmacy Update- Reminding all providers that Generic Air Duo (Fluticasone Propionate/Salmeterol) is a great option for your patients with asthma aged 12 years and older. It is MDPI that meters 55mcg, 113mcg, or 232 mcg of Fluticasone Propionate with 14 mcg of Salmeterol that should be administered as one inhalation twice daily by the orally inhaled route. This medication is covered on the preferred drug list for all the MCOS (lower strength only for Humana Caresource) and is only $1.00 copay for your patients.
Medication Adherence Tip of the Week- Educate your patients about what to expect. New therapies begin with great promise for patients, but when a provider doesn’t prepare a patient for all potential outcomes, he or she may stop taking the drug. If a patient starts feeling better, he or she might think the drug is no longer needed. If he or she feels worse, the patient could discontinue therapy to avoid side effects. If the patient experiences no change whatsoever, he or see may conclude the drug isn’t working. Please spend time on new therapies to update your patients on how a drug works and how they should expect to feel.
Pharmacy Update-New Boxed Warning
The FDA has approved a new box warning for Xeljanz/Xeljanz XR oral tablets and extended-release tablets ergarding the risk of serious infections, mortality, malignancy, and thrombosis.
Medication Adherence Tip of the Week-The tip this week is to review a patient’s medication plan at every visit. Each medication should be discussed individually, highlighting the reason for taking, how it will achieve goals, and possible side effects. This review often determines if the patient isn’t adherent and why.
Pharmacy Update-The FDA has approved multiple applications for generics of Lyrica (pregabalin) for the management of neuropathic pain associated with diabetic peripheral neuropathy, postherpetic neuralgia, fibromyalgia, and neuropathic pain associated with spinal cord injury; and as an adjunctive therapy for the treatment of partial-onset seizures in patients 17 years and older.
Medication Adherence Tip of the Week-Remind your patients to plan ahead for refills. Planning is so important to ensure your patients have the necessary medication. Advise your patients when they fill their prescriptions to check the bottle for the number of remaining refills. Prompt them to call you for a new prescription when one refill is left, or sign up for automatic refills through their pharmacy. When traveling remind them to count their pills to make sure they have enough medication while away. Always have your patients take their list of medications with them in case of emergency while away.
Pharmacy Update-Guidelines for Shingles vaccine
It is important to apply the recommendations of the CDC when prescribing or administering Shingrix and Zostavax. Shingrix is a recombinant zoster vaccine for prevention of herpes zoster in adults aged 50 years and older. It is administered IM in two doses given 2 to 6 months apart. Best practice guidelines for immunization from the CDC advise that Shingrix can be administered concomitantly at different anatomic sites with other vaccines, including the flu shot. If a person has previously received Zostavax, the minimal interval before they can receive Shingrix is 8 weeks. Zostavax is a live shingles vaccine given as a single dose for adults 60 years of age and older. Zostavax should not be administered to anyone who has ever had a life-threatening severe allergic reaction to gelatin or the antibiotic neomycin. Zostavax can be administered concurrently with all other live and inactivated vaccines such as influenza and pneumococcal vaccines. Just a reminder that people suffering from a moderate or severe or acute illness including anyone with a temperature of 101.3 degrees or higher- should wait until they recover before getting either vaccine.
Medication Adherence Tip of the Week- Advise your patients that there are a number of things they can do to get organized to remind them to take their medications at the right time and in the right dose. Have them mark it on their calendar the date they are due for their next refill or follow-up appointment. Talking to their pharmacist about scheduling refills at the same time or refilling medications for 90 day will help to reduce the number of trips to the pharmacy. Some patients also count their pills. If patients know how many pills they have left, it is easier to determine if a dose has been missed or already taken.
Pharmacy Update- Uloric and Tekturna Tablets are now available in generic formulations.
Medication Adherence Tip of the Week- Once you have clues that a patient may be nonadherent, then you have to start the dialogue and ask your patient some questions. Patients don't want to be reprimanded. They don't want to be scolded. How you ask and who does the asking makes a really big difference to discover a patient's true medication-taking behavior. Look your patient in the eyes and ask about it in an encouraging way. Don't type away on your computer as you're discussing this.
Pharmacy Update- Many plans make changes to their formularies in order to control costs and provide the best possible therapy options for your patients. While these changes are very important, it is frustrating for providers to know what medication is covered or isn’t. With that in mind, we have updated guides that provide the changes for June 2019. Please contact Paula Straub at 502-814-3156 or firstname.lastname@example.org to get copies of the pharmacy guides for the Medicaid Managed Care Organizations for adults/pediatrics, Medicare plans and the Anthem Commercial Enhanced Personal Healthcare program.
Medication Adherence Tip of the Week-Sometimes another set of ears can help with medication adherence. Identify those patients that may need extra help and ask them to bring a trusted friend, family member or caregiver along to their doctor’s appointment or pharmacy visit if you think they might need help understanding or remembering instructions. Asking for help is the first step in developing a plan to improve medication adherence.
Pharmacy Update-Wellcare of Kentucky Medicaid Preferred Drug List Update
Effective 7/15/2019 the following changes will occur:
Wixela (Generic Advair Diskus) 100/50mcg, 250/50mcg and 500/50mcg
Generic Air Duo (Fluticasone Prop/Salmeterol) 55mcg/14mcg, 113mcg/14mcg and 232mcg/14mcg
Anora Ellipta 62.5-25mcg, Combivent Respimat 20-100mcg
Dulera 100/5mcg and 200/5mcg
Symbicort 80-4.5mcg and 160-4.5mcg-Removed for ages 13 YOA and older
Medication Adherence Tip of the Week-Encourage your patients to use only one pharmacy. This way the pharmacy can help manage refills and check for drug interactions. Many pharmacies now can help your patients align refill dates so that they can pick up medications at the same time each month.
Pharmacy Update- Generic Releases
Aripiprazole Orally disintegrating tablet 10mg, 15mg
Generic now available
Generic now available
Generic now available
Generic now available
Medication Adherence Tip of the Week- Medication adherence is key to improving patients' confidence to manage their illness, improving clinical outcomes, and lowering utilization. Asking the right questions can make a real difference in your practice.
Here is some advice for discussion:
1. Be aware of the tendency to use medical jargon. Instead of saying, “This will treat your hypertension,” say, “Let's try this for your high blood pressure.”
2. Don't judge. Instead of saying, “Why aren't you taking your metformin?” say, “I'm curious to know what happens when you take your metformin.”
3. Be aware of costs. Most patients are hesitant to say they can't afford a medication, so ask the patient to get back to you if the copayment or cost is too high.
4. Look for underlying conditions. For example, patients who are depressed rarely take their medications, so consider treating the depression first.
5. Be clear about the benefit of the medicine. For example, you might say, “If you take your diabetes medicines and control your blood sugar, you may not need to have your eyeglass prescription changed as often.”
Pharmacy Update- A series of articles in the Journal Dermatologic Clinics reviewed prescribing patterns on acute and long-term acne treatments to identify trends. The study authors from Rutgers University of Medicine have acknowledged that acne is an inflammatory, not infectious condition which has led to a call for reduction in antibiotic use. This has caused for a re-evaluation of the highly efficacious combination topical therapy. The study points out that, in patients using topical and oral antibiotics:
- An increase of bacteria in the back of the throat and tonsils compared with nonusers was three times more likely
- Long-term use of antibiotics in acne treatment is associated with an increase in upper respiratory infections and skin bacteria; and
- Glucose levels are affected by long-term antibiotic therapy.
Overuse of antibiotics can also promote the growth of resistant bacteria thus making treatment more challenging. To address these problems, there has been renewed interest in using benzoyl peroxide. The study authors also suggest that, in severe acne, early intervention with retinoid isotretinoin is effective without antibiotics. The researchers do expect the use of antibiotics to continue at some level. But antibiotics should be used as a supplement with benzoyl peroxide or a topical retinoid for moderate-to-severe cases of inflammatory acne. Studies have shown that these combination treatment regimens are fast and effective and help to reduce the development of resistant strains of bacteria that causes acne, but the CDC recommends that antibiotics be used for a maximum of six months.
Medication Adherence Tip of the Week- The Give and Take of Medication Adherence
50% of patients do not take their medicines as prescribed. What can we as providers do about this? Anyone taking less than 80% of prescribed medicines would be considered non-adherent. Sometime patients will be adherent to several medications and not adherent to one or two of them. It’s not an “all-or-none” issue. As providers you shouldn’t expect perfection. But you need to recognize that medication adherence can sometimes be a tough thing to discover. Some patients are stating that they’re honest about their medication-taking behavior; however, as providers we need to recognize that there’s a “white-coat adherence.” Patients may be adherent a week before they come to your office so they can say, “yes I am taking my medication as prescribed.” Look for clues for non-adherence. Patients may have suboptimal critical outcomes, such as uncontrolled A1C, blood pressure or lipid profiles. Other clues could be those patients that are “frequent flyers” when it comes to hospital admissions or readmissions, or patients that miss their appointments and follow-ups. Patients with psychological stressors, anxiety disorders, a history of depression and even low health literacy are clues for further investigation.
Pharmacy Update-Safety of long-term use of PPIs
- Proton pump inhibitors (PPIs), which are used for treatment of gastroesophageal reflux disease (GERD) and for prevention of upper gastrointestinal adverse effects caused by NSAIDs and aspirin, are one of the most commonly prescribed classes of drugs in the US. Al PPIs are similarly effective and are generally well tolerated, but their long-term use as been associated with a number of safety concerns. These concerns are related to the suppression of gastric acid secretion namely: Clostridium difficile infection
- Pneumonia, Osteoporotic fractures and Rebound acid hypersecretion. PPIs have revolutionized the management of acid-related diseases. There is strong evidence supporting their superior efficacy and overall safety profile. Unfortunately, this has also led to their overuse and inappropriate use. When used appropriately, the overall benefits significantly outweigh the potential risks in most patients. Almost half of all patients taking a PPI do not have a clear indication. Nearly all adverse effects associated with PPIs occur among patients who receive long-term therapy. Through effective counseling providers can ensure that PPI use is associated with appropriate indications utilizing the lowest effective dose for the shortest duration possible.
Medication Adherence Tip of the Week-It is important to provide communication and trust when discussing medication adherence with your patients. Allow your patients to speak freely. Time is of the essence, but research shows that most patients will talk no longer than 2 minutes when given the opportunity. Use plain language when speaking with patients. Say, “Did you take all of your pills?” instead of using the word “adherence.” Ask for patients’ input when discussing recommendations and making decisions. Remind patients to contact your office with any questions.
Pharmacy Update-The FDA has approved an expanded indication for Lyrica (pregabalin) oral capsules and oral solution for adjunctive therapy for the treatment of partial-onset seizures in patients 1 month and older. Lyrica was previously approved for this indication in patients 4 years and older. Lyrica is also indicated for management of postherpetic neuralgia, fibromyalgia, neuropathic pain associated with diabetic peripheral neuropathy, and neuropathic pain associated with spinal cord injury.
Medication Adherence Tip of the Week-Prescribing generic medications can improve compliance. Multiple studies have shown that cost is an important factor leading to lower adherence. A more affordable generic medication that is taken regularly is more effective than a brand name medication that is not. Recommend use of mail order if cost is an issue because your patients can save money on copays.
Pharmacy Update-The FDA has approved AstraZeneca’s Qternmet XR (dapagliflozin/saxagliptin/metformin hydrochloride) extended-release oral tablets as an adjunct to diet and exercise to improve glycemic control in adults with type 2 diabetes mellitus.