Objective: Promoting healthy communities through the provision of accessible quality healthcare services is a common mission shared by schools of pharmacy, public health departments, and governmental agencies. The following study seeks to identify and detail the benefits of collaboration between these different groups. Methods: In total, 112 mobile clinics targeting Medicare beneficiaries were held in 20 cities across Northern/Central California from 2007 to 2016. Under the supervision of licensed pharmacists, trained student pharmacists provided vaccinations, health screenings, Medicare Part D plan optimization services, and Medication Therapy Management (MTM) to patients at each clinic site. Clinic support was extended by public health departments, governmental agency partners, and a health professional program. Results: Since clinic inception, 8,996 patients were provided services. In total, 19,441 health screenings and 3,643 vaccinations were collectively provided to clinic patients. We assisted 5,549 beneficiaries with their Part D benefit, resulting in an estimated aggregate out-of-pocket drug cost savings of $5.7 million. Comprehensive MTM services were provided to 4,717 patients during which 8,184 medication-related problem (MRP) were identified. In 15.3% of patients, the MRP was determined severe enough to warrant prescriber follow-up. In total, 42.9% of clinic patients were from racial/ethnic minority groups and 25.5% had incomes ≤150% of the Federal Poverty Level. Conclusion: Collaboration between a school of pharmacy, public health departments, and governmental organizations can effectively serve Medicare beneficiary populations and result in: 1) lower out-of-pocket drug costs, 2) minimization of medication-related problems, 3) increased vaccination uptake, and 4) increased utilization of health screenings. Conflict of Interest We declare no conflicts of interest or financial interests that the authors or members of their immediate families have in any product or service discussed in the manuscript, including grants (pending or received), employment, gifts, stock holdings or options, honoraria, consultancies, expert testimony, patents and royalties. Treatment of Human Subjects: IRB review/approval required and obtained Type: Original Research

Background: Each year, Medicare beneficiaries can receive their prescription drug coverage from any one of a number of Part D plans. Failure to evaluate Part D plan offerings annually can result in unnecessary out-of-pocket (OOP) costs.Objectives: This study examined the potential OOP cost savings through annual Part D plan reexamination for beneficiaries in a stand-alone prescription drug plan (PDP) as a function of subsidy status and plan offerings in California from 2008 to 2013.Study Design: Six-year longitudinal cross-sectional study.Methods: Fifty-nine community outreach events were held throughout central and northern California during the Medicare open enrollment periods each year from 2007 to 2012. In total, 2262 beneficiaries were assisted, of whom 1476 (68%) had a PDP. During each intervention, beneficiary sociodemographic characteristics (eg, subsidy status) and cost data for their current PDP and the lowest cost PDP in the upcoming year were recorded from the Medicare website (www.medicare.gov).Results: On average, only 20% of beneficiaries would have been enrolled in the lowest cost plan in the upcoming year had they remained in their current plan. The average potential annual cost savings from switching to the lowest cost PDP in the upcoming year during the study period was $728. Subsidy recipients were more likely to be in the lowest cost plan in the upcoming year.Conclusions: Because of the fluctuation of Part D plan offerings each year, annual Part D plan reexamination has been, and remains, essential in ensuring that beneficiaries optimize their prescription medication coverage and minimize OOP costs.

PURPOSE:Medicare beneficiaries' knowledge, attitudes, and perceptions (KAP) of the Medicare Part D prescription drug benefit have been under evaluation since the 2006 inception of the Part D benefit.OBJECTIVE:This study sought to examine beneficiaries' satisfaction with their Medicare Part D prescription drug plan, knowledge of the coverage gap, attitudes about the relative importance of certain insurance parameters, and overall perceptions of the Part D benefit.DESIGN:Cross-sectional, descriptive study design.SETTING:Thirteen outreach events targeting Medicare beneficiaries in northern California during the 2012 open-enrollment period.PARTICIPANTS:A total of 576 Medicare beneficiaries.INTERVENTIONS:Beneficiaries were asked questions related to their KAP of the Part D benefit as part of a plan to evaluate their need for assistance. Sociodemographic data were collected via a standardized survey.MAIN OUTCOME MEASURES:Identify variances in KAP related to beneficiary sociodemographic and clinical characteristics.RESULTS:Forty-seven percent of beneficiaries claimed to be "very" or "extremely" satisfied with Part D, yet only 40.3% of those with a prescription drug plan (PDP) rated their plan as "very good" or "excellent." Those automatically enrolled into their plan by Medicare were significantly less satisfied with their plan (P = 0.048). Almost three in four recipients not receiving Medicare subsidies have heard of the gap in prescription drug coverage, i.e., the "donut hole." Additionally, there were significant racial disparities in knowledge of the gap. Only 62.7% of beneficiaries indicated that "total out-of-pocket cost during the year" was the most important plan characteristic for them.CONCLUSIONS:An understanding of beneficiaries' attitudes may help explain suboptimal Part D plan selection. Moreover, evaluating beneficiaries' knowledge of the Part D benefit can assist advocacy groups in creating educational materials to better assist this vulnerable population in choosing an appropriate plan.

BACKGROUND: The substitution of generic treatment alternatives for brand-name drugs is a strategy that can help lower Medicare beneficiary out-of-pocket costs. Beginning in 2011, Medicare beneficiaries reaching the coverage gap received a 50% discount on the full drug cost of brand-name medications and a 7% discount on generic medications filled during the gap. This discount will increase until 2020, when beneficiaries will be responsible for 25% of total drug costs during the coverage gap.OBJECTIVES To examine the cost variability of brand and generic drugs within 4 therapeutic classes before and during the coverage gap for each 2011 California stand-alone prescription drug plan (PCF) and prospective coverage gap costs in 2020 to determine the effects on beneficiary out-of-pocket drug costs.METHODS: Equivalent doses of brand and generic drugs in the following 4 pharmacological classes were examined: angiotensin II receptor blockers (AFBs), bisphosphonates,HMG-OoA reductase inhibitors (statins), and proton pump inhibitors (PPIs). The full drug cost and patient copay/coinsurance amounts during initial coverage and the coverage gap of each drug was recorded based on information retrieved from the Medicare website. These drug cost data were recorded for 28 California R.RESULTS: The highest cost difference between a brand medication and a Centers for Medicare & Medicaid Services (CMS)-suggested generic treatment alternative varied between $110.53 and $195.49 at full cost and between $51.37 and $82.35 in the coverage gap. The lowest cost difference varied between $38.45 and $76.93 at full cost and between -$4.11 and $18.52 during the gap.CONCLUSION: Medicare beneficiaries can realize significant out-of-pocket cost savings for their drugs by taking CMS-suggested generic treatment alternatives. However, due to larger discounts on brand medications nude available through recent changes reducing the coverage gap, the potential dollar savings by taking suggested genetic treatment alternatives during the gap is less compelling and will decrease as subsides increase

OBJECTIVES:To assess Medicare beneficiaries' willingness-to-pay (WTP) for medication therapy management (MTM) services and determine sociodemographic and clinical characteristics influencing this payment amount.DESIGN:A cross-sectional, descriptive study design was adopted to elicit Medicare beneficiaries' WTP for MTM.SETTING:Nine outreach events in cities across Central/Northern California during Medicare's 2011 open-enrollment period.PARTICIPANTS:A total of 277 Medicare beneficiaries participated in the study.INTERVENTIONS:Comprehensive MTM was offered to each beneficiary. Pharmacy students conducted the MTM session under the supervision of licensed pharmacists. At the end of each MTM session, beneficiaries were asked to indicate their WTP for the service. Medication, self-reported chronic conditions, and beneficiary demographic data were collected and recorded via a survey during the session.RESULTS:The mean WTP for MTM was $33.15 for the 277 beneficiaries receiving the service and answering the WTP question. WTP by low-income subsidy recipients (mean ± standard deviation; $12.80 ± $24.10) was significantly lower than for nonsubsidy recipients ($41.13 ± $88.79). WTP was significantly (positively) correlated with number of medications regularly taken and annual out-of-pocket drug costs.CONCLUSION:The mean WTP for MTM was $33.15. WTP for MTM significantly varied by race, subsidy status, and number of prescription medications taken. WTP was significantly higher for nonsubsidy recipients than subsidy recipients, and significantly positively correlated with the number of medications regularly taken and the beneficiary rating of the delivered services.

Guillain-Barre syndrome (GBS) is an immune-mediated flaccid paralysis that can range from muscle weakness and tingling to respiratory paralysis requiring prolonged respiratory support and ventilation. Overall, GBS is a rare disease, with annual incidence averaging 1 to 2 cases per 100,000 individuals.1

BACKGROUND:Dual-eligible (Medicare/Medicaid) beneficiaries are randomly assigned to a benchmark plan, which provides prescription drug coverage under the Part D benefit without consideration of their prescription drug profile. To date, the potential for beneficiary assignment to a plan with poor formulary coverage has been minimally studied and the resultant financial impact to beneficiaries unknown.OBJECTIVE:We sought to determine cost variability and drug use restrictions under each available 2010 California benchmark plan.METHODS:Dual-eligible beneficiaries were provided Part D plan assistance during the 2010 annual election period. The Medicare Web site was used to determine benchmark plan costs and prescription utilization restrictions for each of the six California benchmark plans available for random assignment in 2010. A standardized survey was used to record all de-identified beneficiary demographic and plan specific data. For each low-income subsidy-recipient (n = 113), cost, rank, number of non-formulary medications, and prescription utilization restrictions were recorded for each available 2010 California benchmark plan. Formulary matching rates (percent of beneficiary's medications on plan formulary) were calculated for each benchmark plan.RESULTS:Auto-assigned beneficiaries had only a 34% chance of being assigned to the lowest cost plan; the remainder faced potentially significant avoidable out-of-pocket costs. Wide variations between benchmark plans were observed for plan cost, formulary coverage, formulary matching rates, and prescription utilization restrictions.CONCLUSIONS:Beneficiaries had a 66% chance of being assigned to a sub-optimal plan; thereby, they faced significant avoidable out-of-pocket costs. Alternative methods of beneficiary assignment could decrease beneficiary and Medicare costs while also reducing medication non-compliance.

OBJECTIVE:To determine the impact of an elective course on pharmacy students' perceptions, knowledge, and confidence regarding Medicare Part D, medication therapy management (MTM), and immunizations.DESIGN:Thirty-three pharmacy students were enrolled in a Medicare Part D elective course that included both classroom instruction and experiential training.ASSESSMENT:Students' self-reported confidence in and knowledge of Part D significantly improved upon course completion. End-of-course student perceptions about the relative importance of various aspects of MTM interventions and their confidence in performing MTM services significantly improved from those at the beginning of the course. Students' confidence in performing immunizations also increased significantly from the start of the course.CONCLUSION:A classroom course covering Medicare Part D with an experiential requirement serving beneficiaries can improve students' attitudes and knowledge about Medicare Part D and their confidence in providing related services to beneficiaries in the community.

OBJECTIVE:Medicare beneficiaries have unique health-related challenges causing significant impact on quality of life. This study examined the overall health-related quality of life (HRQOL) and differences in HRQOL between subgroups of an ambulatory Medicare beneficiary population.METHODS:Nine outreach events were held during the 2011 Medicare Part D prescription drug open-enrollment period, in which 397 beneficiaries were assisted with Part D plan evaluation and comprehensive medication therapy review. Demographic data were collected, and the SF-36v2 was administered to measure beneficiaries' self-reported HRQOL. Correlations were assessed between the mental component summary (MCS) or physical component summary (PCS) scores of the SF-36v2, prescription utilization, number of chronic conditions, and whether beneficiaries were government subsidy recipients.RESULTS:Mean Å standard deviation of PCS and MCS scores were 43.3 Å 11.4 and 52.2 Å 11.7, respectively. Both PCS and MCS scores were negatively correlated with the number of prescription medications and number of self-reported chronic conditions. Both PCS and MCS scores related to sociodemographics were significantly lower (P < 0.05) in subsidy and least-educated recipients.CONCLUSIONS:HRQOL can vary widely as a result of sociodemographic, drug, or disease differences in an ambulatory Medicare beneficiary population.

Despite improvements in screening and treatment, it is estimated that 1 in 8 women will develop breast cancer in their lifetime, and in 2010, it was expected that this would result in an estimated 39,000 deaths and over 207,000 newly diagnosed cases. The median survival for metastatic breast cancer (MBC) is approximately 18 to 30 months. Except for rare cases, MBC is not considered curable. Thus, therapy focuses on maintaining quality of life, delaying disease progression, and prolonging survival. Modern treatment, targeting tumor biology, is expected to yield the best results with the least toxicity. It is recommended that chemotherapy be reserved for patients in visceral crisis, or those with rapidly progressive disease. With the exception of fulvestrant, there have been few advances in treatment of hormone-sensitive disease, as most research has focused on the development of antineoplastic agents and agents that specifically target growth factors or growth factor receptors. Despite advances in these areas, treatment of MBC hinges on multifarious factors and numerous unanswered questions about therapy linger. Agents that are highly active in heavily pretreated patients are needed to optimize outcomes in patients with metastatic disease. This article reviews current and novel treatment options for MBC. (Formulary. 2011;46:130-146.)