Melanoma is the most common kind of cancer in the United States. Low socio-economic status is associated with a diagnosis of melanoma at an advanced stage and higher mortality. The objectives of this study were to examine the healthcare resource utilization and treatment profile of adults with melanoma enrolled in Medicaid program. The 2006-2008 Medicaid data for 36 states were used for the purpose of this study. A retrospective matched cohort study design was used. Study sample included individuals who were continuously enrolled in the Medicaid managed care program from 2006 to 2008, were between 18 to 65 years of age during the study period, had no previous history of cancer and had at least one inpatient and/or two outpatient claims for melanoma. Propensity scores were used to match melanoma patients with non-cancer controls (1:2 ratio). Melanoma-related healthcare use was determined in terms of inpatient (IP), emergency room (ER) visits, outpatient (OT) visits. Drug and treatment use (surgery or radiation therapy) was also studied. Wilcoxon rank sum tests were used to compare all-cause resource use between melanoma cases and non-cancer controls. 14,750 incident cases of melanoma in 2007 were identified. In terms of age, gender, and region, most were white (63.91%), female (72.80%), and from the northeast (32.56%) region of the country. Mean melanoma-related OT visits were significantly lower for blacks (4.038) as compared to whites (4.383). Melanoma surgery (78.75%) was the most commonly used treatment followed by radiation therapy (63.01%). Mean all-cause IP (0.229 vs 0.215), ER (3.637 vs 1.545), and OT visits (87.272 vs 52.785) were significantly higher for melanoma cases as compared to non-cancer controls. The healthcare resource and treatment use for melanoma varied by demographic characteristics. Melanoma diagnosis was found to be associated with significant healthcare resource utilization burden.

The purpose of the study was to calculate primary medication non-adherence (PMN), using the Pharmacy Quality Alliance's (PQA) quality measure with retail pharmacy transaction data. Primary non-adherence is an instance whereby patients fail to initiate a pharmacotherapy regimen following a recommendation by a physician or other health care provider (a prescription). De-identified, pharmacy transactional data for calendar years 2010 and 2011 from 100 pharmacies of a pharmacy grocery chain were used. Primary medication non-adherence was defined as when a new medication was prescribed for a patient age 18 or older, but was not obtained from the pharmacy within 30 days. A set list of chronic medications was constructed that would warrant a patient needing to pick the medication up in a timely manner to begin therapy. Additionally, only electronic prescriptions were assessed as the data captured for prescription origination date and medication pickup date could not be genuinely accounted for in paper prescriptions. A prescription was categorized as new drug therapy if the medicine prescribed (or its generic equivalent) had not been filled for the patient by the pharmacy during the prior 180 days. If the prescription was deemed to be a newly initiated drug therapy, it was included in the denominator for the measure. The numerator was populated when a newly initiated drug therapy or its therapeutic equivalent was not filled within 30 days of the prescription’s origination date. Using the PQA-developed PMN measure, these 100 pharmacies had an overall PMN rate of 9.3%. The measure could be calculated using the pharmacy transaction data; however, some adjustments (e.g., assumption that patient did not receive drug at another pharmacy) had to be made. Retail pharmacy data can be used to measure quality indicators, like PMN. These measures will have limitations, as do other quality indicator measures.

The main objective of this study was to assess the medication adherence among individuals with rheumatoid arthritis (RA) enrolled in a state Medicaid fee-for-service (FFS) program. Factors influencing medication adherence were identified. Lastly, the role of adherence in influencing the utilization of acute care services (hospitalization/emergency room visit) was ascertained. The target population included nonelderly adult recipients (21-64 years) who were continuously enrolled in the Mississippi Medicaid FFS program from January 1, 2006 to December 31, 2007. Recipients who had a medical services claim with a primary or secondary diagnosis of RA in calendar year 2006 were identified. Medication adherence (measured as proportion of days covered (PDC)) was determined using calendar year 2007 data. Recipients with adherence (PDC) ≥80% were classified as adherent. Logistic regression analyses were used to determine factors predicting medication adherence and the effect of adherence on acute care services utilization. Roughly 20% of recipients with RA were adherent. Older age (odds ratio (OR) = 1.031; p<0.005), white race (OR= 1.684; p<0.005), and lower Charlson comorbidity index (CCI) score (OR= 0.785; p<0.005) were significant predictors of adherence. Adherence did not have a significant association with acute care services utilization after controlling for demographic and disease-related covariates. Only one in five Medicaid recipients with RA were found to be adherent. Lower levels of adherence among individuals with RA could contribute to poor outcomes in these individuals over time. Policy makers should undertake intervention programs aimed at increasing medication adherence in this underprivileged population.

On July 1, 2005, Mississippi (MS) Medicaid implemented a prescription cap policy restricting the number of prescriptions filled by a beneficiary during a month to five. The purpose of this study was to examine the effect of this policy on overall medical services utilization and costs. For the purpose of this study, a retrospective analysis of the 2004–2006 MS Medicaid fee-for-service (FFS) administrative claims data was performed. The study included two data periods: 12-month pre- and post-prescription cap date of July 1, 2005. In both study periods (July 1, 2004 to June 30, 2005 [pre-cap] and July 1, 2005 to June 30, 2006 [post-cap]), beneficiaries who were 21 to 64 years of age during the 12-month period and were continuously enrolled for 10 months or more were identified. A final set of 89,110 (pre-cap cohort) and 87,518 (post-cap cohort) beneficiaries remained after applying the study inclusion and exclusion criteria. Using segmented regression analysis, trends in medical services utilization and cost per beneficiary per month (PBPM) were examined over the two-year period. In the 12-month period before the implementation of the cap, a decreasing trend in ER visits was observed (coefficient=-0.0024, p<0.0001). The implementation of the cap resulted in an initial increase in the utilization of ER visits (coefficient=0.0160, p<0.0001; absolute difference=0.0167 visits PBPM). When examining the ER visit costs, a decreasing month-to-month trend was observed in the 12-month pre-cap period (coefficient=-2.4651, p<0.001). The implementation of the cap resulted in a decrease in ER visit costs (coefficient=-20.554, p<0.0001). However, an increasing month-to-month trend in ER visit costs was observed in the 12-month post-cap period (coefficient=1.332, p=0.0008). Results for hospitalization and office visit utilization and costs revealed no significant findings. There was an increase in ER visits utilization among MS Medicaid beneficiaries after the prescription cap implementation.

s A107 with target drugs. The purpose of this study was to ascertain whether revocation of the PA requirement resulted in inferior rates of HbA1C testing amongst new users of these drugs. METHODS: Data on of new users of the target drugs and on HbA1C testing in these patients was extracted from EPR databases for the six-month postrevocation period. The proportion of patients who performed at least one HbA1C test during the four months prior to initiation of treatment and 95% confi dence intervals were calculated. The data were stratifi ed by month to detect possible trends in rates of testing during the post policy-change period. RESULTS: After rescinding the PA requirement, HbA1C testing amongst incident users of the target drugs dropped from 100% during the PA period to rates of 85.6% (95% CI 79.7, 91.5) to 94.4% (95% CI 90.8, 97.9). Statistically signifi cant variance in monthly rates of testing was not observed. CONCLUSIONS: The PA requirement resulted in total performance of a lab test necessary to monitor drug-therapy outcomes in diabetic patients. When PA is implemented as a quality-assurance strategy, revocation should be accompanied by continuing-education efforts to maintain adherence to recommendations for appropriate care. PDB53 SHORT-TERM OUTCOMES FOR AN EMPLOYER SPONSERED PHARMACISTPROVIDED MULTI CENTER DIABETES MANAGEMENT PROGRAM