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| A Member of Lahey Clinical Performance Network Clinical Newsletter |
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February / March 2017
Volume: 6 Issue: 2
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for more information, including: calendars, health plan information, fee schedules and more
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WHAT'S NEW: Pharmacy Fact Sheets
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- Northeast PHO (NEPHO) is an Accountable Care Unit (ACU) member of Lahey Clinical Performance Network (LCPN), the contracting umbrella for NEPHO, Lahey Accountable Care Unit (LACU) and Winchester PHO (WinPHO).
- Pharmacists from each of the ACUs are introducing "Pharmacy Fact Sheets" focusing on cost savings ideas, prescribing tips and drug treatment updates.
- Three "Pharmacy Fact Sheets" have been developed to date and are available via the links below on the following topics:
Your feedback on the "Pharmacy Fact Sheets" would be appreciated. Please contact Carol Freedman at cfreed@nhs-healthlink.org or 978 236 1774.
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Coupons, Co-pays, and Costs
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| Selecting medications for patients that are both effective and affordable is a challenge for providers. If a generic is available, this is usually a good start, HOWEVER, many generics have had increases in their prices over the last few years.
(e.g. generic Glumetza - metformin 500 & 1000 mg ER ~ $800; Use generic Glucophage XR)
- What does COST mean in terms of a prescription medications?
- Cost to the patient (co-pay). The amount patient pays out of pocket.
- Cost to the health plan and NEPHO. The amount billed to NEPHO and is part of Total Medical Expenses (TME). About 25% of TME is pharmacy related expenses.
- How does a patient discount work?
- When patients use coupons, co-pay discounts, or receive patient assistance, the health plan and NEPHO still incurs the full cost of the medication.
- Generally if a coupon is available, the drug is expensive.
- Usually coupons cannot be used for Medicare Part D plans but can be used for cash paying and some commercial plans.
- Here are some medication "cost charts" that may give providers and practices an overview of the variances in prices for medications for the following classes:
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More on Epinephrine Auto-Inectors
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- Finally, Epipen has an authorized generic from Mylan called "Epinephrine auto-injector". This generic formulation has the same dose, administration procedure and product formulation as the respective brand, Epipen.
- Consider writing your scripts for "Epinephrine auto-injector" to assure your patients get the product they prefer and can afford.
- See the Epinephrine auto-injector FAQ sheet from Pharmacists/ Prescriber Letter for more information and available coupons.
- In addition, Auvi-Q, the "talking" epinephrine auto-injector is back on the market at a hefty price. (see below)
- PLEASE NOTE: When coupons are used for any of the epinephrine auto-injector products, Epipen, Mylan's epinephrine auto-injector, or Auvi-Q, the cost to the patient is reduced, HOWEVER, approximate cost listed below is charged to health plan and NEPHO!
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Product
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Price
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| Epipen 2-pak |
~$610 |
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Epinephrine auto-injector (Mylan generic)
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~$300
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| Auvi-Q "talking" epinephrine auto-injector |
~$4,500
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NEPHO Clinical Newsletter
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Produced by Northeast Physician Hospital Organization
For more information contact:
Carol Freedman, RPh, MAS, BCGP
Clinical Pharmacist NEPHO
Louis Di Lillo M.D., Northeast PHO Medical Director
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Copyright © 2016. All Rights Reserved.
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