Discussion 3
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American Sentinel University *
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521
Subject
Medicine
Date
Dec 6, 2023
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docx
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Uploaded by BrigadierBear3312
1. Discuss Pharmacoeconomics, including the impact of formularies, the concepts of
therapeutic interchange, generic substitution, dispensing limitations, and prior
authorization. Be sure to schedule II medications in your answer.
Pharmacoeconomics evaluates the bottom-line value of medications for cost and human data.
Formularies are considered a list of medications that insurance companies deem the safest.
Medications outside the list require prior authorization, attempts with other medications first,
quality limits, and tiered copayments. Generic substitution is a process insurance
companies/pharmacies use to cut down on costs. Pharmacies will dispense an equally appropriate
drug instead of a brand-name drug that costs more. Another way to cut costs is prescribing a
medication with the same therapeutic value versus another drug at a higher cost. While both
medications do the same thing, they may be formulated differently. The most common drugs
with dispense limitations are analgesics and antibiotics, which are used for short-term treatment
(Arcangelo et al., 2021, pp. 132–135). Schedule II drugs have a dispense limitation in terms that
refills are not permitted. A physician can rewrite sequential prescriptions but cannot provide a
refill (Anderson, 2023). Prior authorization is how insurance companies approve a medication
before it is given. This may occur because a medication is not on the insurance company’s
formulary list (Arcangelo et al., 2021, p. 135).
2. How can you assist patients with medication compliance/adherence?
Send the patient home with handouts. Frequently, patients have no questions at the moment, but
a day or so later, they think of questions that arise. You can also provide tips for your patients to
help them stay compliant. Some tips I would suggest are to take medication at the same time
daily, mix your medication into a routine (such as when you brush your teeth or make your
morning coffee), keep a medicine calendar, and utilize a pill container with the days of the week
on it (U.S. Food and Drug Administration, 2016).
3. What are the legal requirements in your state surrounding prescriptions and refills for
controlled substances?
Specifically for opioids, a provider may not prescribe more than seven days for acute pain.
MAPS must be reviewed before prescribing greater than a three-day supply of a controlled
substance (Licensing and Regulatory Affairs, 2019). In the State of Michigan specifically, an
APRN can prescribe any drug within Schedule Two through Schedule Five with the authority of
a physician. The physician and APRN must include names and DEA numbers on the prescription
(Molina, 2022).
4. What are some resources available to assist you in ensuring the prescription of
affordable medications?
The cost of prescriptions is based on an insurance company's formulary list and drug tiers. A
provider can look up these lists to ensure the patient gets the lowest price. Based on Blue Cross
Blue Shield, there are five different tiers which range from cheapest to most costly:
Tier 1 = Preferred generic (cheapest)
Tier 2 = Generic
Tier 3 = Preferred Brand
Tier 4 = Nonpreferred Drug
Tier 5 = Specialty (most expensive)
(BCBS, 2023)
Other resources can include prescription programs. Some suggested by the State of Michigan
include Michigan’s Prescription Drug Discount Card, RxAssist, Together Rx Access,
NeedyMeds, and Michigan Drug Prices (Health and Human Services, n.d.).
References
Anderson, L. A. (2023, January 30).
What are the rules for controlled substance prescription
refills?
Drugs. Retrieved September 24, 2023, from https://www.drugs.com/medical-
answers/rules-controlled-substance-prescription-refills-3572555/
Arcangelo, V. P., Peterson, A., Wilbur, V., & Reinhold, J. A. (2021).
Pharmacotherapeutics for
advanced practice: A Practical Approach
. Lippincott Williams & Wilkins.
BCBS. (2023, January 9).
Medicare | How do drug tiers work?
Blue Cross Blue Shield Blue
Care Network. Retrieved September 24, 2023, from
https://www.bcbsm.com/medicare/help/understanding-plans/pharmacy-prescription-
drugs/tiers.html
Health and Human Services. (n.d.).
Free or low cost prescription medication
. Retrieved
September 24, 2023, from https://www.michigan.gov/mdhhs/assistance-
programs/healthcare/help/type/free-or-low-cost-prescription-medication
Licensing and Regulatory Affairs. (2019, March 6). Michigan Opioid Laws.
Licensing and
Regulatory Affairs
. Retrieved September 24, 2023, from
https://www.michigan.gov/lara/-/media/Project/Websites/lara/bpl/MAPS/Michigan-
Opioid-Laws---Frequently-Asked-Questions.pdf?
rev=3f94e736057b4bba87aa5a05f6abdbe9&hash=6DD3E332066E691B421812AEE146
C89F
Molina, E. (2022). Michigan APRN Controlled Substance Prescribing Authority.
Chapman Law
Group
. https://www.chapmanlawgroup.com/michigan-aprn-controlled-substance-
prescribing-authorit/
U.S. Food and Drug Administration. (2016). Why you need to take your medications as
prescribed or instructed.
U.S. Food And Drug Administration
.
https://www.fda.gov/drugs/special-features/why-you-need-take-your-medications-
prescribed-or-instructed
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