Safeguarding injured Victorians: development and implementation of an evidence-informed system to manage therapeutic uncertainty and decision making in a compensable environment

WorkSafe Victoria and the Transport Accident Commission are two Victorian government agencies that determine the policies that guide decisions to fund treatments and services provided to Victorians injured in transport or workplace accidents. These agencies identified that an internal system was required to manage requests for funding of new or emerging treatments. In particular, the agencies recognised a system that supported consistency in decision making in the context of therapeutic uncertainty and ensured the safety of injured Victorians was needed. The New, Emerging or Non-Established Treatments (NENETs) policy was launched in its current form by the agencies in 2013. The NENETs system includes a record of contemporary evidence for emerging treatments and an evidence-informed decision-making system to ensure consistency and information sharing. A system of recording decisions on emerging treatments was also implemented to ensure that funding decisions could later be reversed if necessary. The NENETs system has proved to be a robust and sustainable method of managing uncertainty for WorkSafe Victoria and the Transport Accident Commission and could be transferable to other funding bodies. What is known about the topic?An algorithm to guide clinicians when prescribing off-label medications was developed in 2006, although it has not been used widely in everyday practice. In 2019 the Medical Board of Australia launched a discussion paper on ‘complementary and unconventional medicine and emerging treatments’ because no system for managing such treatments exists. Third-party payers have a responsibility to make objective and reliable decisions about new, emerging or non-established treatments to ensure high value care is offered to health consumers. What does this paper add?This paper provides an overview of the policy and decision-making system implemented by WorkSafe Victoria and the Transport Accident Commission to managing requests for new, emerging or non-established treatments. The system is adaptable to other third-party payers, health service funders and regulators in Australia and internationally. What are the implications for practitioners?It is important that practitioners caring for injured Victorians are aware of the systems used to inform decision making around requests for funding new, emerging or non-established treatments. Knowledge of the principles underlying this system may assist other funding bodies and the Medical Board of Australia to develop systems in other jurisdictions.

Third-Party Payers…. The Silver Bullet?

Healthcare reform brought about many changes in the healthcare industry including the hearing aid delivery model. Third-party payers (TPPs) became a growing trend with health insurance companies. The traditional hearing aid delivery model changed from provider and patient to provider, TPP, and patient. Due to the insertion of this middle man, profit can be diminished from the hearing aid sale, along with processes. Based on this decrease in revenue, decisions need to be made if using a TPP is profitable or even affordable for a clinic. Recent polls indicate more than half of those clinics polled currently do not participate with TPPs.

Ohio Community Pharmacist Provision of Clinical Preventive Services

Objective: The primary objective of this study was to assess whether Ohio community pharmacists currently provide certain evidence-based clinical preventive services. Secondary objectives were to explore whether there were any differences in provision of services based on respondent education, position, employment status, location, practice setting, or years in practice and to gather information on how pharmacists provide specific services, barriers to providing specific services, pharmacists’ perceptions on specific services needed in their patient population, and pharmacists’ interests in providing services if not already doing so. Methods: A random sample of 500 community pharmacists licensed in Ohio received a Qualtrics survey via email assessing current practices and perspectives regarding clinical preventive services. The U.S. Preventive Services Task Force (USPSTF) “A” and “B” recommended services that can be provided in a community pharmacy served as the framework for the survey questions. Reminders were sent every 3-4 days; data collection continued for a month. The study was IRB-approved. Results: Ninety-three responses were included in the final analysis (18.9% response rate). Approximately 63% of respondents were female; 51.6% held a Doctor of Pharmacy degree. Only 21.5% of respondents were familiar with the USPSTF. However, many respondents were providing clinical preventive services in their pharmacy; the most common were blood pressure screening (51.6%), tobacco use screening or counseling (43%), and diet and/or physical activity counseling (22.6%). These services were provided in varied ways including patient counseling, medication therapy management sessions, screening events, and health fairs. Those who are not currently providing services showed interest in developing them. Pharmacists reported barriers such as lack of time, staff, and reimbursement by patients or third-party payers. Conclusion: Many surveyed community pharmacists in Ohio reported providing clinical preventive services in a variety of ways. Many pharmacists who did not provide these services indicated an interest developing such services. Staffing concerns, time constraints, and a lack of reimbursement by patients and third-party payers were reported as barriers by community pharmacists in providing these services. As many respondents reported being unfamiliar with USPSTF recommendations, the opportunity to educate pharmacist on these recommendations and potentially increase their activity in these prevention activities exists. Article Type: Original Research

Financial impact from in-office dispensing of oral chemotherapy

Background Oral chemotherapy agents are being prescribed more frequently in many cancer types. In-office dispensing of oral chemotherapy agents has demonstrated clinical benefits and also shown financial benefit to third-party payers. A previous publication estimated over $200,000 in cost savings annually from in-office dispensing solely from medications returned to stock for credit. However, pharmacists in the in-office setting perform many other interventions that may affect financial outcomes. Objective Assess financial impact of oral chemotherapy in-office dispensing by a clinic-based oral chemotherapy program serving five outpatient cancer centers in Southern Idaho. Outcomes include calculated monetary waste and cost avoidance of oral chemotherapy prescriptions from in-office dispensing and mail-order pharmacies. Methods Prescriptions received by the clinic-based oral chemotherapy program for filling through in-office dispensing and mail-order pharmacies were monitored for monetary waste and cost avoidance events from December 2016 through May 2017. Information was collected on the number of returned medications, therapy discontinuations, and dose adjustments. Monetary outcomes were calculated using average wholesale price. Results During the six-month evaluation, prescriptions filled through in-office dispensing had a total cost avoidance of $1,020,193 ( n = 154) and total waste of $154,985 ( n = 36) resulting in an estimated net cost avoidance annually of $1,730,416. Prescriptions filled through mail-order had a total cost avoidance of $20,497 ( n = 4) and a total waste of $80,394 ( n = 15) resulting in an estimated $119,794 net annual waste. Conclusions In-office dispensing of oral chemotherapy provided significant cost savings to third-party payers compared to mail-order pharmacy dispensing. Continued evaluation may help further justify the importance and value of in-office dispensing.

The Influence of Chemistry on Personalized Medicine

The medical profession, patients, and third party payers of healthcare have greeted personalized medicine with a wave of enthusiasm worldwide.While genetics, pharmacology, neurology, pediatrics, psychiatry, oncology, biotechnology, infectious disease departments, and public health have received the majority of the well-deserved recognition, developments within chemistry have been responsible for many of the significant contributions to the possibilities envisioned in the future of medicine. This article demonstrates just how chemistry has unraveled the mysteries of what we now call genomic medicine.