by PGx Medical | Mar 13, 2018 | Aging Services
Long-Term Care may be costly, but your medications shouldn’t be.
Polypharmacy is a growing concern in the elderly population
Prescription drugs are a major component of the overall cost of caring for the elderly. Persons sixty-five and older spend an average of over three percent of their income on prescription drugs. That percentage is even higher when over-the-counter medications are included. While Medicare Part D pays for some medications for those enrolled in a plan, it is reported that over sixty-five percent of seniors’ prescription costs are out-of-pocket.
The average annual cost of prescription drugs widely used by the elderly increased from $5,571 in 2006 to $11,341 in 2013, according to a study on drug price trends conducted by AARP.
According to CBSnews.com, Medicare isn’t allowed by law to negotiate drug prices with pharmaceutical companies. With about 38 million people in its Part D prescription coverage, Medicare covered a massive $121.4 billion worth of drugs in 2014, the latest year for which data is available.
When looking for a long-term care community for a family member or yourself, there are many factors to take into consideration. How will I pay for this is probably first and foremost. But you might want to ask yourself, do they have clinical staff available? How do they handle medication? Will my loved one be given something they don’t need that may do more harm than good?
Many retirees think that Medicare will pay for their long-term care. Unfortunately, this is not true and often one of the biggest misconceptions. Although Medicare covers some home and nursing home care, it is only for rehabilitation purposes and not categorized as long-term.
As long-term care continues to rise, so do medications. Below are a few medications that have increased over the years and the amount paid by Medicare.
Abilify – This psychiatric drug helps Americans with the treatment of a number of issues including bipolar disorder and depression. Generated about $4.9 billion in sales in 2014, according to The Wall Street Journal. Medicare represented about half of those sales. The program shelled out about $2.5 billion on Abilify in 2014. Medicare spent $853 on each prescription, an increase of 17 percent from the prior year when Abilify prescriptions cost about $730 each.
Lyrica – This pain medication jumped 45 percent on a per-prescription basis between 2014 and 2013, according to Medicare data. The increase meant Medicare spent $1.4 billion on Lyrica in 2014, compared with $1.07 billion in the previous year.
Now there is a diagnostic test that can help determine if your body can even metabolize these medications, or if you are spending thousands of dollars on
medications that don’t even have the ability to work based on your genetic profile. It’s call
pharmacogenetics testing. This simple swab of the cheek can help save money on unnecessary medications, re-hospitalizations due to
adverse drug events, and helps you or a loved one live a better quality of life knowing you are on the
right medication.
According to an article in the latimes.com, the nation’s healthcare tab will continue to outpace economic growth over the next decade, and it is driven by rising prices for drugs and medical services,
By 2026, healthcare spending will account for almost one-fifth of the U.S. economy, an all-time record. The U.S. has the highest medical prices in the world, research indicates.
If you would like more information on pharmacogenetics testing for you, your long-term care community, clinic or pharmacy, contact PGx Medical. Your trusted and experienced resource for the implementation of pharmacogenetics in the field of aging services.
PGx Medical
info@pgxmed.com
405-509-5112
www.pgxmed.com
source: payingforseniorcare.com, latimes.com, cbsnews.com
by PGx Medical | Jan 5, 2017 | Aging Services
Person-Centered Care is defined as – providing care that is respectful of, and responsive to, individual patient preferences, needs and values, and ensuring that patient values guide all clinical decisions
In a Person-Centered Care Model a Patients Values Guide All Clinical Decisions
Person-centered care involves transforming the relationship between providers and patients from the traditional model, in which a care provider prescribes the same treatment for most patients with similar diagnoses or conditions, into a patient-provider partnership that considers treatment options based on a patient’s unique concerns, preferences, and values.
Long Term Care:
Normal life is the goal in a LTC person-centered care environment. To achieve this goal, nursing homes adjust care and routines to the resident, instead of the other way around. For example, when a person moves into a nursing home, they typically receive a schedule of the waking time, bathing times, and seating in the dining room. When a community is person-centered, the person who has just moved in is asked about their life-long patterns and the nursing home adapts its schedule of services to support their continuation. This is important even for someone who is only planning a short-stay in a nursing home.
Person-Centered Care Pharmacogenetic Pilot Program:
Making sure an individual is on the right medications that have the ability to give them therapy is extremely important in a person-centered care environment. Having that discussion with the resident and family when they enter a Long Term Care community helps make their transition a smooth one.
Pharmacogenetics is person-centered care and provides valuable information to the physician, nurse, resident and family for each individual person.
PGx Medical is currently enrolling provider communities in a Person-Centered Care Pharmacogenetics Pilot Program. This pilot program is specifically designed to serve residents in the field of aging services and will address new requirements by CMS such as – Patient-Centered Care Plans, Comprehensive Assessments, Monthly Drug Regimen Reviews and Psychotropic Drug Reduction.
To see if your senior community qualifies for the Patient-Centered Care Pharmacogenetic Pilot Program, email PGx Medical at info@pgxmed.com or call 405-509-5112.
by PGx Medical | Dec 18, 2016 | Aging Services
In a recent article by Bill Kubat, LNHA – Move over patient-centered care, make way for precision medicine, Manju Beier explains how pharmacogenetics fills a need in LTC.
Several terms, including “precision medicine,” “stratified medicine,” “targeted medicine,” “pharmacogenetics” and “pharmacogenomics” are sometimes used interchangeably with “personalized medicine.” The American Medical Association describes personalized medicine as “health care that is informed by each person’s clinical, genetic and environmental information.”
Pharmacogenetics Fills a Need
To better understand its implications in long-term care, I visited with Manju T. Beier, PharmD, CGP. Dr. Beier is president and founder of Geriatric Consultant Resources, LLC, a firm that provides clinical expertise in pharmacotherapy and clinical pharmacology to geriatrics professional organizations, managed care organizations, and health care plans. Dr. Beier has been a frequent presenter at AMDA – the Society for Post-Acute and Long-Term Care Medicine conferences.
Dr. Beier explained that the recognition of PGx as a science with clear implications for patient-centered care has been facilitated by the convergence of several factors across all health care, including implications for long-term care:
•The need for improved therapeutics. Studies and numbers frequently cited by the FDA and other regulators include a 2001 study that showed that the response rates of patients to medications from different therapeutic classes ranged from about 80% for analgesics to about 25% for oncology, 52% for osteoporosis, 75% for cancer chemotherapy, 70% for Alzheimer’s disease, 38% for depression, 43% for diabetes, 50% for arthritis, 48% for migraine (prophylaxis), 40% for asthma, and 40% for cardiac arrhythmias. Varying response rates to medications may be explained by a variety of factors; perhaps underlying variability in pharmacogenetics is one of them.
• Increased focus on adverse drug reactions. An estimated 2.2 million adverse drug reactions occur each year in the United States, including more than 100,000 deaths. Older adults with polypharmacy are especially at risk.
• Increased emphasis on medication management. PGx is potentially useful for predicting dosing, toxic side effects, and therapeutic effects, and for eliciting drug-gene interactions.
• Effects on measurable outcomes. Clinical studies evaluating the impact of pharmacogenetic-guided dosing and monitoring on ED visits, hospitalizations, quality of life, and health care costs are few and far between but slowly making their way into the literature.
To move it from the hypothetical to the concrete, consider the following case as described by Dr. Beier in The Consultant Pharmacist (Beier MT. Pharmacogenetics: has the time come for pharmacists to embrace and implement the science? Consult Pharm 2013;11:696–711):
~ Mr. J is an 83-year-old patient who resides independently in a senior living community. His past medical history includes depression comorbid with dementia, hypertension, and type 2 diabetes. He has no known allergies to medications. He has taken several anti-depressants in the recent past, including amitriptyline, paroxetine, and citalopram for his major depressive disorder. However, he either failed to achieve an adequate response or exhibited intolerable side effects to these medications. His current daily medications include simvastatin 20 mg, glipizide 5 mg, sertraline 50 mg, donepezil 5 mg, aspirin 81 mg, lisinopril-hydrochlorothiazide 20 to 25 mg, and metformin 500 mg twice daily. At the request of the consultant pharmacist, and in light of his past history with medication intolerance for depression, the physician orders cytochrome P450 genetic testing.
The resident’s pharmacogenetic results indicate that he is an ultra-rapid metabolizer of the CYP2C19 pathway and could potentially need higher doses of sertraline, which is metabolized via CYP2C19. CYP2D6 is a minor pathway in the metabolism of sertraline, and the resident’s poor metabolizer status suggests the need for extra vigilance. Based on the consultant pharmacist’s recommendation, the physician increases the sertraline dose gradually while monitoring for response over the next several weeks.
Eventually, the patient achieves a significant reduction in symptoms at a dose of 150 mg/day. The ultra-rapid CYP2C19 status may explain why the patient previously did not respond to citalopram, also a CYP2C19 substrate. The citalopram dose was not increased beyond 20 mg daily, complying with FDA-recommended maximum dose limits set for citalopram in the elderly. Amitriptyline is converted to nortriptyline via CYP2C19, and both amitriptyline and nortriptyline are further metabolized via the CYP2D6 pathway. As an ultra-rapid metabolizer of CYP2C19 and a poor metabolizer of CYP2D6, the resident may have had increased levels of nortriptyline, potentially causing his intolerance to the medication.
Similarly, his intolerance to paroxetine may have been as a result of his poor CYP2D6 status. It is well recognized that older patients, especially with dementia, are more susceptible to the anticholinergic side effects from nortriptyline and amitriptyline. This, combined with a poor metabolizer status, could potentially increase the risk for adverse events from paroxetine as well, which exhibits some antimuscarinic activity and has recently been added to the Beers list as a generally inappropriate medication to use in the elderly. Changes were not made to donepezil, as he was clinically stable at the prescribed dose.
This case illustrates how pharmacogenetic testing and appropriate resultant interventions can enable a patient to be maintained in the environment they wish to call home. It also illustrates the need for collaboration across the inter- disciplinary team with patient assessment (note the involvement of the consultant pharmacist) to identify the appropriateness of testing and determining interventions based on those test results.
PGx Medical is the trusted and experienced resource for the implementation of pharmacogenetics in the field of aging services. For more information on pharmacogenetics or to schedule a speaker/educator, contact: PGx Medical, info@pgxmed.com, 405-509-5112.
Read entire article at: caringfortheages.com
by PGx Medical | Nov 9, 2016 | Aging Services
Managing behaviors in individuals suffering from dementia is challenging
When dementia patients get to a stage where they become very agitated, “people are looking for an easy fix.
Historically, antipsychotics have been used in an attempt to address challenging behaviors, but they are now not only in question, but the dangers associated with these medications are coming to light.
As stated on the Medicare.gov website: “Antipsychotic drugs are an important treatment for patients with certain mental health conditions. However, the FDA has warned that antipsychotic medications are associated with an increased risk of death when used in elderly patients with dementia and the medications have side effects.”
In a recent article in Waugh Consulting, LLC, it states, “Professionals are looking at the dangers and working diligently to stop the use of those medications when dealing with elderly individuals suffering from dementia. Knowing the person and using the social aspects of their lives can be successful while lowering or eliminating antipsychotic medications.”
So how do you decrease antypsychotics in dementia care?
Aging services providers across the country are now implementing pharmacogenetics as part of their “medical plan of action” to address this problem.
Pharmacogenetics aligns current and future medications with each persons unique genetic profile. This medication management program, via pharmacogenentic testing, is a simple swab of the cheek that provides clinical caregivers with an individualized report for each resident. The report provides them with evidence-based information on many medication classes, including antipsychotics. While the goal is to eliminate unnecessary medications, pharmacogenetics is also a good starting point to help guide physicians in adjusting dosages based on metabolization, or changing a medication due to a drug-on-drug interaction.
Nothing takes the place of one-on-one care from those who know them best, to be involved in their care. Making sure the resident or loved one is on the proper medications that can give them therapy, makes the caregivers job a little bit easier and helps the resident live a better quality of life.
These personalized reports are also a great tool to show that you are doing everything in your power to help your residents, decrease unnecessary medications, and manage dosages that may not be appropriate for each individual.
For more information on pharmacogenetics and how you can implement it in your senior community, contact: PGx Medical, info@pgxmed.com or 405-509-5112.
**We are presently enrolling provider organizations and communities in a pilot program. For more information on this pharmacogenetics pilot program, contact, Bill Shell at bill@legacymarketservices.com or 952-960-0806, or visit www.LindaShell.com/pharmacogenetics.
by PGx Medical | Nov 3, 2016 | Aging Services
Medicare and Medicaid say antipsychotics are still used too often in nursing home dementia units
When dementia patients get to a stage where they become very agitated, people start looking for an easy fix.
In an article in MedPageToday, Leonard Gelman, MD, CMD, president of the board of directors of the American Medical Directors Association was interviewed on dementia patients and the use of antipsychotics.
When dementia patients get to a stage where they become very agitated, “people are looking for an easy fix. So these medications are used,” even though in many cases they don’t help,” Gelman continued. On the other hand, “the things we know work the best are most difficult logistically, and that is, essentially, having someone be with the patient … all the time.”
“Many people think that most of the medications nursing home patients take have been prescribed by the nursing homes, but that’s not the case, said Gelman. “They get prescribed in the hospital [or by the patient’s primary care physician]. In essence, the nursing home doctors rarely prescribe these things, but we continue them for many different reasons, unfortunately. It’s a merry-go-round that keeps going ’round and ’round but it’s difficult to push the horse off the merry-go-round, because everyone has told the family and the patients they need [the medications].”
Reducing antipsychotics is part of a larger approach on nonpharmacologic treatment for these patients, according to Gelman. “In general, this is one of things we’ve been internally talking about, and also talking with CMS and others,” he said. “There are many instances where medications can be reduced, not just antipsychotics — certainly benzodiazepines, also blood pressure medications and cholesterol medications.”
The agency also released a fact sheet with state-by-state data on antipsychotic reductions. States varied in how much they reduced use of these medications over a 21-month period ending with the first quarter of 2014 — Hawaii reduced use in that state by 31.4%, while Nevada reduced antipsychotic use by 1.6%.
Even though this data is several years old, it gives you an idea of what states are dealing with and which ones met their reduction goal. Along with anti-psychotic medication monitoring, updated CMS regulations coming in 2018 increase the scrutiny of medication review. A simple, straightforward solution is needed – one that offers providers an effective tool that aligns prescribed medications to the unique needs of each resident.
Most nursing homes are being proactive – setting programs in place to be ahead of any future mandates or regulations. That’s where PGx Medical comes in. Our fully reimbursed diagnostic test can help guide healthcare professionals when dosing residents. Right drug, right dose, for the right person. Pharmacogenetics aligns current and future medications with each persons unique genetic profile – individualized treatment that can give them the therapy they need.
If you don’t have a medical plan of action to help reduce antipsychotics along with other medications, contact us and we’ll help you get started.
PGx Medical
Individualized Care – Personalized Medicine
info@pgxmed.com
405-509-5112
source: medpagetoday
by PGx Medical | Nov 2, 2016 | Aging Services
When pharmacists track meds, collaborate with docs, everybody wins
When pharmacist and physicians work together, it improves outcomes for the patient and can save money due to unnecessary medications or re-hospitalization.
According to an article in MedPageToday.com, medication errors, unnecessary emergency room visits, preventable hospital readmissions — all costs can be reduced through better medication management and who knows medication better then the pharmacist?
When pharmacists and physicians work together, we are seeing better patient care and outcomes.
One challenge has been weak interoperability — i.e., electronic medical records that don’t speak well to one another across providers.
Yet when primary care doctors who are docked for poor performance outcomes, such as hospital readmission rates, learn that pharmacists can help doctors lower such rates, they quickly find ways to help pharmacists access their electronic medical records.
PGx Medical works directly with physicians and pharmacists across the country to help provide better quality of care to seniors through medication management. “Our PGx Medical propriety process can integrate test results with EHRs for each individual patient,” said Brant Bullard, Director of Operations for PGx Medical. “It’s seamless and everyone wins. The healthcare team will have evidence-based information at their fingertips to help them provide individualized care, and the patient lives a better quality of life.”
For more information on medication management, via pharmacogenetic testing, contact PGx Medical, info@pgxmed.com or 405-509-5112.
source: medpagetoday.com
