This podcast is produced by pharmacy faculty to supplement study material and provide relevant drug and professional topics. We're hoping that our real-life clinical pearls and discussions will help you stay up-to-date and improve your pharmacy knowledge.
137 - It’s Time for PBM Reform: How PBMs Have Hurt Pharmacies and Increased Drug Costs
In this episode, we reveal what goes on behind the scenes for drug pricing and pharmacy reimbursement with Dr. Benjamin Jolley. Our discussion covers important concepts like PBMs, DIR fees, MAC pricing, and even possible upcoming changes at the federal government.
Prescription drug reimbursement is a major factor in the decline of independent pharmacies nationwide. Complex reimbursement models, fees, and drug pricing structures are frequently not well understood by both patients and many healthcare providers. A pharmacy benefits manager (PBM) is a company hired by an insurance company to handle prescription drug coverage and reimbursement. Three PBMs control more than three-quarters of the entire US market and can often dictate the terms of a drug reimbursement contract with pharmacies. PBMs determine how much they will pay for the cost of a medication using either a benchmark (such as the average wholesale price minus some percentage) or a list of the maximum allowable cost (MAC) maintained by the PBM. Pharmacies are required to accept the PBM’s reimbursement amount regardless of the cost the pharmacy paid to acquire the drug from a wholesaler. DIR fees, clawbacks, and PBM rebate or discount agreements with manufacturers have resulted in lower reimbursements to pharmacies, higher drug prices for patients, and increased profits for PBMs.
136 - Major Recommendations from the 2021 CHEST Anticoagulation for VTE Disease Guideline Updates
In this episode, we discuss the recently published major updates in the 9th edition of the anticoagulation guidelines from CHEST. These new recommendations range from initiation of therapy, secondary prevention, and management of post-thrombotic syndrome.
Among patients with cancer-associated VTE, DOACs are preferred over low molecular weight heparins (LMWH) EXCEPT in patients with GI cancers. The preferred anticoagulant in those with GI cancers is either LMWH or apixaban. Among patients with antiphospholipid antibody syndrome, warfarin (INR goal 2-3) is preferred over DOAC therapy. In the extended phase of treatment (secondary prevention after 3 months of treatment), lower anticoagulant doses should be used (such as apixaban 2.5 mg BID or rivaroxaban 10 mg daily). In patients with a DVT, IVC filters should only be used when anticoagulation therapy is contraindicated. IVC filters reduce the risk of PE but do not alter the risk of DVT extension or future DVTs. Compression stockings are not recommended for prevention of post-thrombotic syndrome nor for recurrent DVT prevention.
135 - Top Four Medications Myths: BUSTED!
In this episode, we debunk four medication myths that have persisted for decades: metronidazole and alcohol; statins and hepatotoxicity; cidal vs. static antibiotics; and "sulfa" allergies.
Metronidazole does not interact with alcohol (ethanol) and does not cause a disulfiram-like reaction. Statins can cause transient increases in liver function tests; however, these increases are not associated with hepatotoxicity. Routine LFT monitoring is not recommended unless clinically indicated signs or symptoms of liver injury exist. The distinction of bactericidal versus bacteriostatic antibiotics is irrelevant. No evidence exists showing that having a bactericidal drug has superior efficacy to a bacteriostatic drug. A “sulfa” allergy nearly always means an allergy to Bactrim (sulfamethoxazole-trimethoprim). There are many non-antibiotic sulfonamide-containing medications that do not need to be avoided in patients with a sulfa allergy; however, patients with an allergy to any medication have an increased risk of an allergic reaction to other medication classes.
134 - Hypertensive Emergencies Demystified: A Brief Clinical Review
In this episode, we provide a concise review of the diagnostic criteria and general treatment approach to patients with hypertensive emergencies.
Hypertensive “urgency” is a misnomer - patients do not require immediate therapy and definitely should not receive IV therapy. In most cases, the goal blood pressure in hypertensive emergencies is to decrease by no more than 25% in the first hour, achieve a BP of 160/100 in hours 2-6, then over the next 24-48 hours lower to a more normal blood pressure goal. Labetalol is the preferred IV push antihypertensive UNLESS patients have acute heart failure, bradycardia, or possibly in patients with asthma/COPD. Nicardipine is one of the most commonly used IV infusions for hypertensive emergencies. Most other continuous infusions are reserved for special types of hypertensive emergencies (e.g. nitroglycerin for pulmonary edema or acute MI, esmolol for aortic dissection).
133 - Tell Me More: Exploring Covid 19 Vaccine Hesitancy and Solutions!
In this episode, we will explore depths of COVID 19 vaccine hesitancy - what it is, how to identify and address it, and some helpful resources.
When a patient seems hesitant to consider the COVID-19 vaccine, explore their hesitations further with a simple “why” or “tell more more” question. Understand the root of hesitancy and provide personalized responses using motivational interviewing. Key concepts of motivational interviewing include asking open-ending questions, asking the patient to share their concerns, reflective listening, acknowledging without judgement, and asking for permission to share information. The goal of a vaccine hesitancy conversation is not necessarily to have the patient receive the vaccine today; the goal is to move the patient one step closer to validated facts (combating misinformation) and consideration of receiving the vaccine.
132 - The Warp Speed of Covid-19 Vaccine Authorizations: Timeline and Discussion with Dr. Archana Chatterjee
In this episode, we will explore the history of COVID vaccine development and have a heart-to-heart conversation with Dr. Archana Chatterjee regarding her role as a dean of the RFUMS Chicago Medical School, her career path, and her position and functions on the FDA’s Vaccines and Related Biological Products Advisory Committee (VRBPAC).
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I love the different perspectives represented in this podcast! They get to the point but do just the right amount of discussion about each topic. Please continue making episodes!
Great podcast! Go HelixTalks! Go RFUMS COP!
Love the topics and the content! Great to listen to and very helpful to connecting the dots and is applicable to pharmacy education! Thank you so much for doing it! Great podcast! Go HelixTalks! Go RFUMS COP!
Love this podcast
Great, informational and entertaining podcast. I use this as “passive” studying while I’m doing chores or driving. Love it!!