HSM420 Course Discussions Week 4


HSM420 Course Discussions Week 4
How often do pharmacists recommend certain drugs to providers?  Is this recommendation…

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HSM420 Course Discussions Week 4

HSM420 Course Discussions Week 4

All Students Posts – 58 Pages

Managed Care Pharmacy Benefits – 31 Pages

What are the most important elements of a managed care pharmacy benefit program? And how are patient prescription benefits typically different under managed care?  Pharmacy benefits is a controversial topic within managed care.  As a patient, what do you want?  How often do pharmacists recommend certain drugs to providers?  Is this recommendation for costs control or quality products?

With healthcare reform are we seeing more coverage for prescriptions?  How has reform changed pharmacy benefits? What is the protocol is the brand name is not covered, but it has been determined that your body responds better to the brand?  Are concessions made for the patient?  Who is responsible when a patient is prescribed medications that should not be taken together?  The provider?  The pharmacist?  With healthcare reform are we seeing more coverage for prescriptions?  How has reform changed pharmacy benefits?  Although the generic drugs supposedly contain the same ingredients, the effect is often not as effective.  Why do you think that this is?

As a patient I want to be able to get my prescribed medications filled at a cost that I can afford.  I want to be able to fill the medications my provided decides I need and the pharmacy benefits of my plan to cover that medication.  It is really frustrating when you are prescribed a medication and your plan doesn’t cover it therefore if you want to take the medication to help you recover you must pay out of pocket for it.  It can get really expensive.  Another frustrating area is when a patient is prescribed a medication and can’t even begin to cover the copay for that medication.

There is a chemo medication that some cancer patients are prescribed and the copay with Medicare is $60,000 per month.  How can a patient afford that copay?  It is ridiculous. These patients need this medication to survive and many are unable to afford it.  I have a patient that I have been working with to get the copay cover by the manufacturer and it is very difficult.  The patient has to be given the chemo then the organization has to submit a claim to Medicare wait for the denial, appeal that denial, and then appeal to the manufacturer.  It is a long difficult process.  It would be easier to get this patient assistance through the manufacturer if she did not have a government based insurance plan or if she had no insurance at all.  Manufacturers don’t usually help with drug costs if a patient is on Medicare or Medicaid.  This is very frustrating for both the patient and the providers.  So I would like to see medications that a patient needs covered in an affordable manner by the pharmacy plans…

Managed Behavioral Healthcare – 27 Pages

What factors surrounding behavioral health create special challenges and special considerations for managed care programs? How is managed behavioral healthcare different from managed acute medical or managed acute surgical care?  The need for behavioral healthcare coverage is ever-growing in this country.  What is the problem with providing adequate coverage?  Do you think that if patients stopped using the ER as a doctor’s office and used it for emergencies only that there would be adequate staff?

Why is it that society deems behavioral health as taboo?  Because of this, many fail to seek help.  What can be done to change the perception of behavioral health?  What can managed care plans and the Affordable Care Act do to make managing mental health less challenging and more efficient?  If we are increasing access, we need to increase providers.  What can be done to entice individuals to seek a career in behavioral health?  Does the fact that the benefits are minimal which means receiving payment may be difficult have anything to do with the lack of providers?

One issue that I have seen is that most of these patients have to be held in an emergency department for a certain number of hours prior to being admitted for treatment.  This can cause safety concerns for other patients and staff because the emergency department is not equipped to treat these patients or hold them in a safe manner.  In my organization this puts a major strain on our resources.  It takes extra staff to provide the necessary attention to help these patients until they are admitted.  Some of these patients are dangerous and emergency rooms are set up to handle emergency medical treatment not behavioral health patients.  By being held in and emergency department these patients experience delayed treatment.  Yes the are treated by physicians and nurses but not all organizations have behavioral health professionals with in the emergency department.  If a cardiac patient were to come into an emergency department their treatment is not delayed but a behavior health patients is.  I understand that certain patients don’t need as much urgency as others to save their lives but there is still an urgency to treat them.  They need assistance just like the cardiac patient does – just a different form…

HSM420 Course Discussions Week 4