The PEIA PPB Plan is governed in part by the Omnibus Health Care Act which was enacted by the West Virginia Legislature in April 1989. This Law requires that any West Virginia health care provider who treats a PEIA insured must accept assignment of benefits and cannot balance bill the insured for any portion of charges over and above the PEIA fee allowance or for any discount amount applied to a provider's charge or payment. This is known as the "prohibition of balance billing." The prohibition of balance billing applies when services are provided in West Virginia and when the PEIA PPB plan is the primary payor. When the PEIA PPB plan is the secondary payor, the provider may bill you for disallowed amounts and for the provider discounts. Remember, you are always responsible for deductibles, copayments, coinsurance amounts and non-covered services. A PEIA insured who has Medicare as the primary payor has protection against balance billing when the provider accepts Medicare assignment. If the provider accepts Medicare assignment, you are not responsible for amounts which exceed the Medicare allowances.
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Relying on single-source suppliers can and does result in shortages and stockouts. This year major U.S. media outlets reported on shortages of GlaxoSmithKline's Epivir known as lamivudine or 3TC ; , Merck's Sustiva known as efavirenz ; , and Bristol Myers Squibb's ZERIT known as stavudine or d4t ; leaving PEPFAR-funded programs scrambling to continue treatment for their patients. Some mission hospitals and clinics were told by drug companies to stop adding people to their treatment rolls, although the capacity existed to treat many more, because of the shortages. At the time of the reports, generic versions of 2 out of the 3 drugs were listed on the WHO pre-qualified list. Although at a Congressional briefing the Global AIDS ambassador Randall Tobias was asked to use his right to waive regulations and barriers to generic sources of drugs, given the severe drug shortages, he has refused to do so.vii.
This diagnostic fact sheet is provided to you as a service by AmeriPath, Inc. It is intended for patient education and information only. It does not constitute advice, nor should it be taken to suggest or replace professional medical care from your physician. Your treatment options may vary, depending upon medical history and current condition. Only your physician and you can determine your best option.
Population and there were ongoing concerns stemming from sectarian discord. In 1950, for example, Greece argued that Cyprus should be united with Greece. During the era of post-World War II decolonization, Britain began the process of granting the island independence and fostering a stable government to rule Cyprus. It had to keep the interest of the various communities in mind. In 1960, Cyprus' population was 80 percent Greek Cypriot, 18 percent Turkish Cypriot and 2 percent "Other." With Britain, Greece, and Turkey playing the role of "guarantor states, " the Greek and Turkish Cypriot communities signed a series of agreements in 1960 known as the 1960 Accords. These Accords included the Basic Structure, essentially to Constitution of the newly independent Cypriot state, the Treaty of Guarantee in which the guarantor States promised to "recognize and guarantee the independence, territorial integrity and security of Cyprus as well as the Basic Structure, and the Treaty of Alliance, which set up a means for the guarantor states to cooperate. There was disagreement and factionalization almost from the point of independence. There was widespread civil unrest in 1963. The guarantor powers unfortunately did more to sow discord than heal wounds: in 1974 Greece engineered a coup in Cyprus and as a response Turkey invaded and took control of the Northern third of the island. In February 1975, the leaders of Turkish Cyprus announced that they had formed the "Turkish Federated State of Cyprus, " "TFSC" ; which was not an independent sovereign state, but an autonomous part of a federation with a Greek Cypriot state.196 In this way, Turkish Cyprus attempted to seize territory first, and then re-negotiate the constitutional order. This has similarities to Moldovan-Transnistrian-Russian relations in the 1990s. In September 1975, the assembly of the TFSC declared full sovereignty. Although the TFSC has effective control of northern Cyprus, the TFSC remains generally unrecognized.197 While the Security Council did not call for non-recognition of the island, it did note its regret over the proclamations of the TFSC and did say that no action should be taken by any Member State of the UN that would divide the island.198 The situation further devolved with a November 1983 proclamation by what had been the TFSC that the now newly named Turkish Republic of Northern Cyprus "TRNC" ; was an indepen196. See OPPENHEIM supra note 114, at 55, p. 189, n. 16. 197. ID. at 55, p. 189-90. 198. SC Res. 367 1975 ; available at : un Docs sc unsc resolutions ; see also OPPENHEIM supra note 114, at 55, p. 190.
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Information in the report, at which time he noted that she had highlighted specific employee names and drugs. All of.
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Outpatient ancillary Visit to or progress note by ancillary providers such as diabetic counselor, registered dietitian RT ; , physical therapist, pharmacist. Psychotherapy session visit regardless of the reason for the visit ; with the following providers: Counselor, ACSW, MC, Marriage Counselor, MSW Masters in social work ; Cardiac rehabilitation center visits Outpatient procedure Dates on which only an outpatient procedure was performed i.e., the patient was not admitted to the hospital ; . Include procedures during which a blood pressure was taken. Includes but is not limited to: Arthroscopy Breast biopsy or FNA fine needle aspiration ; Bone Scan Bronchoscopy Cardiac catherization angioplasty Cataract extraction Colonoscopy Cystoscopy Dexa Scan Diagnostic D&C Electromyographic testing EMG ; Electrophysiologic study EPS ; Endometrial biopsy Endoscopic retrograde cholepancreatography - ERCP Esophogastroduedenoscopy EGD ; , upper endoscopy Herniorraphy hernia repair Hysterectomy, vaginal Laparoscopy any type ; Liver biopsy Lung biopsy Mammogram Mastectomy Prostate biopsy Radiation therapy Radioactive implantation procedure Renal biopsy Sigmoidoscopy Flex sig ; Stress exercise or pharmacological ; testing e.g., treadmill, ETT, thallium, echo ; Transurethral resection of prostate TURP ; Tubal ligation Ultrasound Doppler ; Do not accept the following outpatient visits, procedures or surgeries as an Outpatient Procedure. Plain x-rays Sleep studies Electrocardiogram ECG ; only Visits for lab test only e.g., blood drawn, urine sample taken ; Outpatient procedure that occurs during an outpatient office visit in which the patient was assessed and or treated e.g., chief complaint, assessment, plan, etc. ; This should be entered as an Outpatient Medical visit and oretic.
Tive against the hepatitis B virus HBV ; . If Epivir is stopped abruptly, it can cause liver disease to "flare" and damage the liver. See the "What about side effects?" sections of Ziagen and Epivir for additional possible side effects.
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Model 2: Satellite care delivery at family planning sites by managed care providers. In this model, the family planning clinic serves as an extension of the managed care system. In a satellite delivery model, each time a client uses the family planning clinic, a summary of pertinent information is sent to the appropriate managed care plan to be incorporated into the client's medical record. Adolescents enrolled in the plan must sign a release for an exchange of information when they appear at the clinic. The arrangement allows coordination and avoids duplication of care. This model recognizes and protects confidentiality. For example, the family planning clinic provides confidential information to the managed care plan only when follow-up care is necessary and will be delivered by another facility. Model 3: Capitation. When a family planning clinic enters into a capitated contract for primary care services, it commits to provide a defined range of services to clients. Therefore, risk reimbursement and risk sharing arrangements must be clearly defined. There may be no reimbursement for clients who do not choose the family planning clinic as their primary care provider. The philosophy of the family planning clinic encourages use of services whenever needed, an approach at odds with the managed care philosophy of limiting service utilization. On the other hand, appropriate documentation of services to demonstrate appropriate service utilization can diminish the conflict in service philosophies. Several different issues arise in contract negotiations between family planning clinics and MCOs. The following guidelines may be useful in establishing the value of clinics to MCOs. Use needs assessment data and research to convince MCOs that prevention is a valuable investment. Use data such as pregnancy and birth rates, STD and HIV rates, and hospitalization rates to demonstrate the extent of teen sexual behavior and pregnancy in the community. Demonstrate that the clinic and the MCO share similar goals and agendas. Demonstrate the significant cost savings of health promotion, prevention, and early intervention, especially related to pregnancy prevention. Document the number of clients served at the family planning clinic who are also beneficiaries of the MCO. Use client utilization data to illustrate the need for compensation from the MCO. Emphasize the service gaps being filled by the clinic, such as education and contraceptive counseling. Demonstrate that adolescent health problems often arise from risk behaviors which require interventions beyond the traditional medical care model offered by MCOs. Show that the physical and mental health needs of adolescents differ from those of adults. Stress the importance of health care, health education, and social services combined as pregnancy prevention strategies. Emphasize that medical services often preclude prevention services or interventions of personal choice, such as contraceptive use and abortion. Demonstrate the costs of prevention versus the costs of treating preventable conditions. Emphasize the unique role of community clinics which serve adolescents. Discuss the special developmental and access needs of adolescents as well as the value of counseling and outreach. Offer lessons learned from other programs nationally. Provide examples of how other MCOs have linked with or reimbursed family planning providers and adolescent health clinics. For example, Medica, a Minneapolis-based managed care plan, covers the full operating costs of a school-based health center. Brindis, 1995 ; In California and Pennsylvania, networks of family planning clinics, rather than individual clinics, have negotiated successfully with MCOs. Orbovich, 1995.
Although there are insufficient data to recommend a specific dose adjustment of epivir in pediatric patients with renal impairment, a reduction in the dose and or an increase in the dosing interval should be considered and eulexin.
Table 6. Frequencies of Selected Grade 3 4 ; Laboratory Abnormalities in Patients with Asymptomatic HIV Infection ACTG 019 ; RETROVIR 500 mg day Placebo Adverse Event n 453 ; n 428 ; Anemia Hgb 8 g dL ; 1.1% 0.2% 3 Granulocytopenia 750 cells mm ; 1.8% 1.6% Thrombocytopenia platelets 50, 000 mm3 ; 0% 0.5% ALT 5 x ULN ; 3.1% 2.6% AST 5 x ULN ; 0.9% 1.6% Alkaline phosphatase 5 x ULN ; 0% 0% ULN Upper limit of normal. Pediatrics: Study ACTG300: Selected clinical adverse events and physical findings with a 5% frequency during therapy with EPIVIR 4 mg kg twice daily plus RETROVIR 160 mg m2 orally 3 times daily compared with didanosine in therapy-naive 56 days of antiretroviral therapy ; pediatric patients are listed in Table 7. Table 7. Selected Clinical Adverse Events and Physical Findings 5% Frequency ; in Pediatric Patients in Study ACTG300 EPIVIR plus RETROVIR n 236 ; Didanosine n 235 ; 32% 11% 7.
EMEND * . 40 EMGEL . 48 EMLA . 14 EMTRIVA . 17 ENABLEX . 42 enalapril . 21 enalapril hydrochlorothiazide . 22 ENBREL . 44 ENJUVIA . 37 ENTOCORT EC . 41 ENULOSE . 41 EPIPEN . 46 EPIPEN JR 46 EPIVIR . 17 EPIVIR-HBV . 18 EPOGEN * . 43 EPZICOM . 17 EQUETRO. 30 ERTACZO . 49 ERYC. 15 ERY-TAB . 15 ERYTHROCIN. 15 erythromycin. 53 erythromycin delayed-rel . 15 erythromycin ethylsuccinate . 15 erythromycin gel 2% . 48 erythromycin solution . 48 erythromycin stearate . 15 erythromycin benzoyl peroxide . 48 erythromycin sulfisoxazole . 15 ESKALITH . 32 estazolam . 31 ESTRACE . 37 ESTRACE CREAM. 37 ESTRADERM . 37 estradiol . 37 estradiol transdermal. 37 ESTRASORB . 37 ESTRING . 37 ESTROGEL . 37 estrogens, esterified methyltestosterone . 37 estropipate . 37 ESTROSTEP FE . 36 ethambutol . 18 ETHMOZINE . 23 ethosuximide. 27 ethynodiol diacetate EE . 36 etodolac . 12 61 and flutamide.
ANTIRETROVIRALS NRTIs- abacavir Ziagen ; , abacavir lamivudine Epzicom ; , abacavir lamivudine zidovudine Trizivir ; , didanosine ddI, Videx ; , efavirenz emtricitabine tenofovir disproxil fumarate Atripla ; , emtricitabine Emtriva ; , lamivudine Epivir, 3TC ; , lamivudine zidovudine Combivir ; , stavudine d4T, Zerit ; , tenofovir Viread ; , tenofovir emtricitabine Truvada ; , zalcitabine ddC, Hivid ; , zidovudine AZT, Retrovir ; . PIs- amprenavir Agenerase ; , atazanavir Reyataz ; , darunavir Prezista ; , fos-amprenavir Lexiva ; , indinavir Crixivan ; , lopinavir ritonavir Kaletra ; , nelfinavir Viracept ; , ritonavir Norvir ; , saquinavir Fortovase, Invirase ; . NNRTIsdelavirdine Rescriptor ; , efavirenz Sustiva ; , nevirapine Viramune ; , tipranavir Aptivus ; . Entry Inhibitorsenfuvirtide Fuzeon ; . OI DRUGS PHS "A1 OI"s- acyclovir Zovirax ; , azithromycin Zithromax ; , cidofovir Vistide ; , clarithromycin Biaxin ; , clindamycin Cleocin ; , fluconazole Diflucan ; , isoniazid INH ; , itraconazole Sporonox ; , pentamidine NebuPent ; , pyrazinamide, pyrimethamine Daraprim ; , rifabutin Mycobutin ; , rifampicin Rifampin ; , sulfadiazine, TMP SMX Bactrim ; , valacyclovir Valtrex ; , valganciclovir Valcyte ; . Other OIs- amoxicillin clavulanate Augmentin ; , atovaquone Mepron ; , ciprofloxacin Cipro ; , clotrimazole Lotrimin, Mycelex ; , dapsone, doxorubicin Doxil ; , ethambutol Myambutol ; , erythropoietin Alpha EpogenProcrit ; , ketoconazole Nizoral ; , ofloxacin Floxin ; , . ALL OTHERS Metformin, glipizide Glucotrol XL ; , atorvastatin Lipitor ; , dronabinol Marinol ; , megestrol acetate Megace ; , oxandrolone Oxandrin ; , acetomenaphine with codeine Tylenol III and Tylenol IV ; , adefovir dipivoxil Hepsera ; , alpha-interferon * , amitriptyline Elavil ; , Berocca Plus generic ; , buproprion Wellbutrin ; , dephenoxylate and atropine Lomotil ; , Doxorubicin Doxil ; , dulozetine Cymbalta ; , fentanyl patch Duragesic ; , fluoxetine HCL Prozac ; , gabapentin Neurontin ; , hydrocortisone cream 1%, ibuprofen 800mg ; , lidocaine patch 5% Lidoderm ; , morphine sulfate MS Contin ; , peg-interferon alpha-2a Pegasys ; * , peg-interferon alfa-2b & ribavirin PegIntron Rebetol ; * , ribavirin and interferon Rebetron ; * , sertraline HCL Zoloft ; , voriconazole Vfend.
Company: glaxowellcome approval status: approved november 2000 treatment for: hiv infection general information trizivir tablets contain three nucleoside analogues; abacavir sulfate ziagen ; , lamivudine epivir or 3tc ; and zidovudine retrovir, zdv or azidothymidine and raloxifene.
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Data in Table 1 are taken verbatim from the VAERS database. The narratives within case reports are frequently truncated mid-sentence. Additionally, data for age, date of vaccination and interval between vaccination and onset of symptoms is sometimes missing.
The Remittance Advice Remark Code list is one of the code lists mentioned in the ASC X12 transaction 835 Health Care Claim Payment Advice ; version 4010A1 Implementation Guide IG ; . This list is maintained by the Centers for Medicare & Medicaid Services CMS ; and is updated three times a year. E lated Change Request #: 3636 MedlearnMattersNumberMM3 March 2005 A-05-1 ; Communiqu Kansas Nebraska Northwestern Missouri 47 and efavirenz.
Our postretirement health care plans are not funded. The following table presents an analysis of the changes in 2002 and 2001 in the benefit obligation of the postretirement plans.
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Failing to disclose such practices to the individual patients and their insurers, the Defendant Drug Manufacturers engaged in a fraudulent and unlawful course of conduct constituting a pattern of racketeering activity. 445. Defendants' racketeering activities amounted to a common course of conduct.
1 in 8 -- are 65 or older, according to the Census Bureau. When the baby boomers retire, the number of elderly will swell to 82 million -- 1 in 5 -- 2050. Today's elders include 1.6 million people 90 and older, including 72, 000 centenarians; by 2050, the Census Bureau expects almost 9 million people over 90, including 1.1 million centenarians. As consumers age, they begin to encounter more serious health conditions that require medication, such as arthritis, high blood pressure and diabetes. They also begin to look to drugs to address issues such as hair loss and impotence.
The U.S. pharmaceutical market is relatively dynamic and complex. In most of the analysis presented in the main text, three median prices are presented, the U.S. FSS price, the U.S. Red Book price and an average price comprised of both prices. The U.S. FSS prices are generally lower than the Red Book prices, and brand prices are generally higher than generic prices. As a result, the U.S. to median international price ratio varies greatly depending on the methodology used to generate it. Table 3-5.
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