All three plans provided almost identical coverage, with the bronze there is not charge for office visits, specialist service, hospitalization, and generic drugs after meeting deductibles obligations. The silver plan has a $30 deductible for office visit, $40 for specialist service and $10 co-pay for generic drugs, with $75 co-pay for brand named drugs after meeting deductible requirements. The gold plan also have no copay for office visit, a $30 co-pay for specialist service, for hospitalization a $450 per day co-pay for a maximum of $2,250, no co-pay for generic drugs and $50 co-pay for brand named after deductible requirements are met. This example service to illustrate the valued service, that are provided for Maryland residents who are recipient of Medicaid and use any one of the eight managed care organization for their health care needs. Pharmacy Formulary is a list of drugs that are covered for patients. Priority Partners web site states that, a committee of doctors, nurses, and pharmacists created the list, and reviewed how well the drug works, including safety information, and how they work in comparisons to similar drugs. This formulary list is regularly updated, to include new drugs with recent safety information. This formulary drugs list is true of all the Medicaid managed plans in Maryland. It went on to say that, medications not listed in the formulary require prior authorization. Many health maintenance organizations managed care plans have implemented
It’s not simply the particular giving of the medications that fare up all the time. It is checking the medical record with the hand written prescriptions, grouping the varied medications and also the instrumentation for giving them, and ensuring all the patients safety measure are covered.
The Medication Policy and procedure and Mars Handbook covers assessment of individuals’ needs, administering, storage, recording and disposal of medicines including their effects and potential side effects
States have chosen to two forms of Medicaid managed care to better deliver healthcare services besides the traditional fee-for-service Medicaid programs; primary case management and traditional health maintenance organizations. “In primary care case management, the state Medicaid agency contracts with a primary gatekeeper entity (e.g., physician, clinic) that coordinates primary and specialty care for Medicaid beneficiaries. For healthcare maintenance type programs, a State Medicaid agency contracts with an existing healthcare maintenance organization, prepaid health plan, or other institutional health care provider who, in addition to proving primary care services, assumes insurance risk of providing covered services. Typically primary case management are paid on a fee-for-service basis plus a monthly case management fee per enrollee, while health maintenance organization plans are paid a capitation rate and are at full financial risk.” (1)
It is composed of actively practicing physicians, other prescribers, pharmacists, nurses, administrators, quality improvement managers, and other health care professionals and staff who participate in the medication-use process. The P&T committee should be responsible for overseeing policies and procedures related to all aspects of medication use within an institution. The P&T committee is responsible to the medical staff as a whole, and its recommendations are subject to approval by the organized medical staff as well as the administrative approval process. The P&T committee’s organization and authority should be outlined in the organization’s medical staff bylaws, medical staff rules and regulations, and other organizational policies as appropriate. Other responsibilities of the P&T committee include medication-use evaluation (MUE), adverse-drug-event monitoring and reporting, medication-error prevention, and development of clinical care plans and guidelines. The hospital’s internal policies follow all national standards for how the P&T committee should
Due to the large number of consumers being prescribed multiple medications, and the complexity of managing those medications, it is of a major safety concern that systems are in place for clinicians to reconcile patients medications to resolve any discrepancies in what the patient is using, or should be using, and newly added ones.
An analysis by the Robert Wood Johnson Foundation indicates that the most popular ‘silver’ tier of coverage through the Obamacare plans has a $2,267 deductible. Richard Gundling is the vice president of the Healthcare Financial Management Association, which is a trade group. Gundling states that it is much more difficult to collect these monies from a patient than from the Medicare program or insurance company.
The metal tiers deliver basic understanding for consumers of health coverage categories such as Bronze, Silver, Gold, and Platinum that will greater or lesser cover health care costs, but not include quality of care. In other words, the higher the metal level, the highest payment from health plan will be received for users care overall. On the other hand, the lower the metal level the more users have to pay for provided care. Out of four categories Platinum and Gold (higher premium) compensate higher costs of health care than Bronze and Silver (lower premium). Bronze and Silver categories have lowest monthly insurance bill for users, however highest deductibles and out-of-pocket costs. In opposite site Platinum and Gold categories offered highest monthly payment and lowest deductible and out-of-pocket costs. Based on the consumer income after enrolling in a Silver plan user could qualified for cost-sharing reductions benefits of that is fairly low premium, lower deductible, and pay lower from out-of-pocket costs when care needed.
Why pharmaceutical reps leave samples with doctors: The representatives leave samples with doctors because it is a marketing ploy. They know it influences how they will write prescriptions to the patient even though the drug they leave may not even be the best drug for the patient. They use the prescription records that the pharmacies sell to certain companies Distribution companies track 70% of filled prescriptions in pharmacies and can track the individual physicians so they can figure out what prescriptions those physicians are most often writing for the patients. Drug reps then aim for these specific doctors and press them into writing prescriptions for their brands of drugs. They also do this to increase their awareness of these drugs.
Encourage the use of computer-generated or electronic medication administration records. Plan for the implementation of computerized prescriber order entry systems. Consider the use of machine-readable code (i.e., bar coding) in the medication administration process. Use computerized drug profiling in the pharmacy. Be a demanding customer of pharmacy system software; encourage vendors to incorporate and assist in implementing an adequate standardized set of checks into computerized hospital pharmacy systems (e.g., screening for duplicate drug therapies, patient allergies, potential drug interactions, drug/lab interactions, dose ranges, etc.)”. (Association,
When admitted to the hospital they are placed on esomeprazole (Nexium) as that is on the hospital formulary. If the discharge physician is not astute, the patient then gets sent home with a prescription for esomeprazole which is not preferred on their insurance and hence not covered, creating confusion with patients, pharmacy staff and primary care providers. As a prescriber it also becomes difficult to know which medications are recommended by each payer. A basic essential medicine list may allow for more simplified ease of use for all involved.
There are many different mental illnesses and ailments and just as many medications to treat them. The problem is that sometimes the medications are not correct for your disorders due to similar symptoms. This leads to problems with the patients who need help, but the patients are not getting the right medications and treatment they need.
Most seniors over the age of 70 cannot name all of the medications that they are taking. They may remember that they need 2 red pills, one yellow one, and two of the little white ones, etc, but they can't tell you all of the names. With the crazy names of the medications and the mix of names between generics and name-brand, who can blame them? Yet, if there is a problem, doctors, first responders, emergency room personnel, etc, need to know exactly what they are taking, how much and when. A good medication management plan addresses this.
The management team at the over-the-counter cold medicine (OCM) group of Allstar Brands is looking to utilize revenue generated by Allround to help fund new opportunities in emerging markets. Therefore, it is critical that Allround maintain its market-leading position in terms of market share, profitability, and sales in order to fund these new initiatives.
Pediatric patients specifically have a propensity to be exceptionally soft to most medications, from this time they need to figure the bigger percentage of their pharmaceutical doses by weight. The minimum erroneous conclusion could prompt an unfriendly medication impact. More grown-up this is including the elderly, then again, are limited to, numerous doctor prescribed medications for their endless sicknesses which require examination to hold away from contraindications. On the other hand, paying little mind to whether the patient might be at danger of encountering a pharmaceutical mistake or not, all drug organizations should in a perfect world take after the "seven rights" which incorporate "the right patient, right prescription, right measurement, opportune time, right course, right reason, and right documentation". (Bonsall,
According to the Institute for Healthcare Improvement, “Medication reconciliation is the process of creating the most accurate list possible of all medications a patient is taking — including drug name, dosage, frequency, and route — and comparing that list against the physician’s admission, transfer, and/or discharge orders” (Institute For Healthcare Improvement, n.d). This process includes three steps: collecting the medication history, ensuring that the medications and dosages are appropriate for the patient, and documenting the changes in the orders. This occurs when the patient is admitted, transferred and discharged from the hospital (Institute for Healthcare Improvement, 2011). The purpose is to avoid any duplications, incorrect