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The formulary below provides coverage information about some of the drugs covered by Health First. If you have trouble finding your drug in the list, turn to the Index that begins on page 14. The first column of the chart lists the drug name. Brand-name drugs are capitalized e.g., CRESTOR ; and generic drugs are listed in lower-case italics e.g., verapamil ; . The information in the Requirements Limits column tells you if Health First has any special requirements for coverage of your drug. The comments that will appear in the Requirements Limits section are as follows: Prior Auth: Prior authorization is required your doctor must obtain prior authorization for this drug. ST: Step Therapy is required treatment with certain drugs is required before these drugs will be approved for coverage. Quantity Limits e.g., 7 180 days ; : Quantity Limits apply you may only obtain coverage for a limited amount of this drug. Drug class and name Tier Req. limits Analgesics acetaminophen codeine 2 ANEXSIA 2 buprenorphine hcl 2 co-gesic 2 dolacet 2 dolagesic 2 dolorex forte 2 ENDOCET 4 fentanyl patch 2 hydrocet 2 hydrocodone acetaminophen 2 hydrocodone bitartrate 2 acetaminophen hydrocodone ibuprofen 2 hydromorphone hcl 2 margesic-h 2 methadone hcl 2 morphine sulfate 2 oxycodone hcl 2 oxycodone apap 2 propoxyphene 2 acetaminophen tramadol hcl 2 ULTRACET 5 vanacet 2 Antibacterials amoxicillin 1 amoxicillin clavulanate potassium 2 amoxicillin potassium 2 H1099 EL644 25606A26606 Page 5 Drug class and name clavulanate azithromycin BACTROBAN NASAL cefpodoxime proxetil cefuroxime axetil cephalexin monohydrate ciprofloxacin hcl clarithromycin CLEOCIN clindamycin hcl dicloxacillin sodium doxycycline hyclate erythromycin ethylsuccinate FACTIVE FORTAZ GEOCILLIN GENTAK KETEK LEVAQUIN LORABID MAXIPIME METROGEL VAGINAL NEGGRAM nitrofurantoin macrocrystalline OMNICEF penicillin v potassium polymixin b sulfate trimeth RANICLOR sulfadiazine sulfamethoxazole Tier Req. limits 2 3 2 Drug class and name Tier Req. limits desipramine 2 doxepin hcl 2 EFFEXOR XR 3 fluoxetine hcl 1 fluvoxamine maleate 2 imipramine hcl 2 LEXAPRO 3 MARPLAN 3 maprotiline hcl 3 mirtazapine 2 NARDIL 3 nefazodone 2 NICOTROL INHALER 3 nortriptyline 2 PARNATE 3 paroxetine hcl 2 sertraline 2 SURMONTIL 3 tranylcypromine sulfate 2 trazodone hcl 1 venlaxifine 2 VIVACTIL 3 WELLBUTRIN XL 3 Antiemetics EMEND 3 Prior Auth meclizine hcl 2 metoclopramide 2 ZOFRAN 3 Prior Auth Antifungals ANCOBON 3 BIO-STATIN 3 clotrimazole betamethasone 2 dipropionate fluconazole 2 GRIFULVIN-V 3 itraconazole 2 LAMISIL 3 Prior Auth nystatin 2 Antigout Agents allopurinol 2 colchicine 2 Anti-inflammatories anucort 2 CELEBREX 3 ST cortisone acetate 2 dexamethasone 2 diclofenac sodium 2 Page 6 Employer Groups and nordette!
3.4 Applications of the insoluble Kollidon grades and Crospovidone M 3.4.1 General application properties The insoluble grades of Kollidon and Crospovidone M possess a series of properties that are used in the manufacture of different pharmaceutical products.
National Science Foundation NSF ; 117. 329, 388, Ndzana, Innocent 75 Neal, Phil 331 Necropsy Service 342 Nei, M. 209 Neural Tube Defect NTD ; Resource 280, 285 neurobiology 9 neurodegeneration 14, 15, 137 neurodegenerative diseases 15, 16, 139 neurological disorders 7, 166 neuroprotection 139 Neuroscience Mutagenesis Facility NMF ; 47, 108, 191, Ni, Li 34, 94 Nicholson, Anthony 359 night blindness 181 Nikitin, Alexander 265 Nishina, Patsy M. 61, 186199, 252, Nixon, Farr 99 Noben-Trauth, Konrad 143 North American Hair Research Society 263, 270 Northwestern University 288 Norton, Christine 118 Norwood, Kathy W. 368 Nossov, Igor 44, 287, 288 Notch signaling pathway 119 Novartis Pharmaceutical 206, 324 Nusinowitz, Steven 58, 61, 78 and ocuflox.
The prescriber and the patient should agree on the health outcomes that the patient desires and on the strategy for achieving them `concordance' ; . Taking the time to explain to the patient and relatives ; the rationale and the potential adverse effects of treatment may improve compliance. Advising the patient of the possibility of alternative treatments may encourage the patient to seek advice rather than merely abandon unacceptable treatment. Simplifying the drug regimen may help; the need for frequent administration may reduce compliance although there appears to be little difference in compliance between once-daily and twice-daily administration. Combination products reduce the number of drugs taken but this may be at the expense of the ability to titrate individual doses.
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Porter et al., Cardiovascular Research, February 2004 ; . By discovering how fibroblast movement is triggered, and how statins stop this process, will help professionals to better understand heart failure. Over the past several years, statins have become important preventives in the management of heart health. With this new study, the range of benefits associated with statins has been broadened to tackle major risk factors in maladies of the heart: High cholesterol, adverse remodeling after a cardiac episode, and lowering of the inflammatory marker, C-reactive protein CRP ; . Systemic enzymes also have been shown to help promote heart health. In fact, several studies are underway to determine the preventive role of systemic enzymes in good heart health.
Twenty-three women of postmenopausal status as determined by the absence of menses for at least 12 months or a hysterectomy with bilateral oophorectomy were recruited from outpatient clinics at the University of Michigan Medical Center between 1995 and 1996. Subjects were eligible for participation if they had not been on hormone replacement therapy within the previous 6 months and had a nonsuspicious Pap smear and mammography within the past year. Exclusion criteria were current smoking, history of diabetes mellitus, abnormal hepatic or renal function, an acute medical condition within the previous 3 months, fasting triglycerides 3.95 mmol L 350 mg dL ; on the initial screening laboratory test, or a contraindication to estrogen replacement therapy. All subjects were required to give informed consent, and the protocol was reviewed by the University of Michigan Institutional Review Board and prednisolone.
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For example, the follow-on may provide enough information about its active moiety to rely on the innovator's data, but not enough to be blocked by the innovator's exclusivity. In fact, such a situation occurred with hyaluronidase. FDA considered each product to be a member of the same general class of hyaluronidase products, which allowed the products to rely on FDA's previous safety and effectiveness determinations regarding hyaluronidase. However, for exclusivity purposes, FDA treated each product as a new chemical entity. As such, each product received its own exclusivity and was not blocked by the other product. B. Three-Year Exclusivity The Hatch-Waxman Act also provides three years of market exclusivity to certain applications involving old chemical entities. Under the Act, three years of market exclusivity is awarded to an application for a product containing an active moiety that had been previously approved when the application contains new clinical studies that are essential to approval.52 Three-year exclusivity is typically awarded for new indications, new formulations, and other label changes the approval of which requires and is based on reports of new clinical investigations. During the three-year exclusivity period, FDA may not approve a generic application for the change or condition of approval that received exclusivity. Similar to five-year exclusivity, the application of three-year exclusivity to biological products raises unique and complicated issues. For example, a biologic with the same formulation as a previously approved product may perform differently due to manufacturing or other inherent differences. Would such a product, which contains a previously approved active moiety, be eligible for three-year exclusivity based on its different performance? Generally, if a new formulation requires additional clinical evidence to be approved, the additional exclusivity should be provided. Furthermore, would a biological product that is seemingly similar to another product that received three-year exclusivity be able to avoid the other product's exclusivity by performing differently e.g., clinically superior as with orphan drug exclusivity ; ? As noted earlier, the manufacturing process is extremely important to approvability of biological products. Although most manufacturing processes are kept confidential as trade secrets, would important manufacturing processes that are publicly available be eligible for exclusivity? Furthermore, as with five-year exclusivity, the application of three-year exclusivity to biologics may be difficult because it is not always possible to characterize the scope of the exclusivity. Would a hyaluronidase product described above ; that received three-year exclusivity for a new indication block another hyaluronidase product from receiving approval for the new indication? C. Patent Linkage As was the case in the Hatch-Waxman Act, it will be important to consider patent exclusivity, along with market exclusivity provided through the regulatory approval mechanism, as an integral part of the follow-on biologic approval framework. The Hatch-Waxman Act provides for the early resolution of patent issues when the generic application is filed and theo-dur.
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Courtesy of Don S. Baim, MD, B&W Hospital, Harvard Medical School, Boston MA.
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V. DEFICIENCY CATEGORIZATION Part V, Appendix P ; Once the survey team has completed its investigation, analyzed the data, reviewed the regulatory requirements, and determined that non-compliance exists, the team must determine the severity of each deficiency, based on the resultant effect or potential for harm to the resident. The key elements for severity determination for F431 are as follows: 1. Presence of harm negative outcome s ; or potential for negative outcomes because of failure to meet the pharmacy requirements. Non-compliance related to an actual or potential harm negative outcome for F431 may include, but is not limited to: Failure to lock medications, increasing the likelihood of accidental ingestion by residents. Inaccurate or incomplete labeling, creating the potential for one or more residents to receive the wrong medication or dose or the correct medication by the wrong route.
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Not recognized or appreciated by drug staff? Pain complaints drug seeking attributed to addiction? Complaints minimized ignored due to limited or no access to specialized pain care?.
Members who have had a prescription for one of the brand medications filled within the past four months will be sent a letter informing them of the availability of the generic alternative and that they may save on their copayment by switching. If the member decides to continue to use the brand product, the member is informed that they may be responsible for the higher copayment on the effective date indicated above and mobic.
| IDENTIFYING AND REDUCING SOURCES OF POTENTIAL ERROR FOLLOWING IMPLEMENTATION OF A POINT OF CARE BAR CODE MEDICATION ADMINISTRATION SCANNING SYSTEM. Joshua M. DeSilvey * , Brad C. Ludwig, Steven S. Rough University of Wisconsin Hospital and Clinics, 600 Highland Ave, F6 133-1530, Madison, WI, 53792 jm silvey hosp.wisc Point of care bar code medication administration technology has been identified as one solution to reduce medication administration errors. The potential benefit of this technology to make medication administration safer has resulted in proposed federal regulations mandating all pharmaceutical manufacturers package their products with standardized bar codes. A point of care bar code system has been implemented housewide and has dramatically reduced medication administration errors and improved nurses' satisfaction with the medication use process. With new technology, its impact on the work environment is often not fully appreciated until after the technology is implemented. New sources of error are being identified that were previously not detected. The purpose of this project is to identify and eliminate new potential sources of error related to the point of care bar code system. A multidisciplinary team of pharmacists, physicians, nurses, and other health care professionals will work together to flowchart the medication use process, including medication purchasing, repackaging, preparation, distribution, administration, and monitoring. The team will then apply the Healthcare Failure Mode and Effects Analysis principles to select potential sources of error with the greatest likelihood and potential for patient harm, and implement changes to reduce or eliminate their occurrence. Measurement techniques will be identified and used to determine the effectiveness of the improvements, if deemed necessary. The task force will also create strategies to ensure that the improvements will be maintained. Results will be presented. Learning Objectives: Describe the potential benefits of implementing a point of care bar code medication administration technology in an acute care setting. Identify three potential sources of error related to the use of point of care bar code medication administration technology. Self Assessment Questions: True or False: Reducing medication administration errors will allow other medication errors to become more apparent. True or False: Healthcare Failure Mode and Effects Analysis is an adaptation of an engineering process to be used retrospectively to evaluate a system or new technology.
Trends in the Cost of Drugs Two-Year Enrollment and Cost Projections As required by legislation, enrollment and cost projections for the next two years are presented in Figure 17. These projections reflect the January 1, 2001 program enhancements that will significantly expand enrollment, and lower fees and copayments. The lower copayments will increase the program's share of drug costs. These program changes are expected to increase pharmacy payments to 4 million in the 2000-2001 program year and 6 million in the 2001-2002 program year. These costs will be significantly offset by manufacturers' rebates, which will be increased by the additional rebate based on the changes in prices compared to inflation as measured by the Consumer Price Index. The collection of additional rebate revenue will begin in February of 2001. Another offset to pharmacy payments is fee revenue, which will increase only slightly with enrollment due to the reduction in fees as of January 1, 2001. Both of these changes in offsetting revenue were required by the 2000 legislative changes. As a result, the net State costs based on current law are projected to be 6 million in program year 20002001 and 7 million in 2001-2002.
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Cournan, M., & Kautz, D.D. 2007 ; . Physical healthcare patterns and nursing interventions. In K.L. Mauk Ed. ; The specialty practice of rehabilitation nursing: A core curriculum. 5th ed. ; . Glenview, IL: Association of Rehabilitation Nurses. Enzlin, P., Mathieu, C., & Demytteanere, K. 2003 ; . Diabetes and female sexual functioning: A state-of-the-art. Diabetes Spectrum, 16 4 ; , 256259. Forsberg-Warleby, G., Moller, A., & Blomstrand, C. 2002 ; . Spouses of first-ever stroke patients: Their view of the future during the first phase of stroke. Clinical Rehabilitation, 16, 506514. Johnson, B. K. 2004 ; . Sexuality and heart disease: Implications for nursing. Geriatric Nursing, 25 4 ; , 224226. Kamel, H. K., & Hajjar, R. R. 2003a ; . Sexuality in the nursing home, part 1: Attitudes and barriers to sexual expression. Journal of the American Medical Directors Association, 4, 152156. Kamel, H. K., & Hajjar, R. R. 2003b ; . Sexuality in the nursing home, part 2: Managing abnormal behavior--Legal and ethical issues. Journal of the American Medical Directors Association, 4, 203206. Kaplan, H. S. 1990 ; . Sex, intimacy, and the aging process. Journal of the American Academy of Psychoanalysis, 18, 185205. Kautz, D. D. 2001 ; . Alterations in human sexuality. In C. Stewart-Amidei & J. A. Kunkel Eds. ; , AANN's neuroscience nursing: Human responses to neurologic function 2nd ed., pp. 675702 ; . Philadelphia: Saunders. Kautz, D. D. 2006 ; . Appreciating diversity and enhancing intimacy. In K. L. Mauk Ed. ; , Gerontological nursing: Competencies for care pp. 619643 ; . Sudbury, MA: Jones and Bartlett. Kellogg-Spadt, S. 2004 ; . Sex Rx. Valuable resources for female sexual dysfunction. American Journal for Nurse Practitioners, 8 9 ; , 7576. Korpelainen, J. T., Nieminen, P., & Myllyla, V. V. 1999 ; . Sexual functioning among stroke patients and their spouses. Stroke, 30 4 ; , 715719. Lemieux, L., Cohen-Schneider, R., & Holzapfel, S. 2001 ; . Aphasia and sexuality. Sexuality and Disability, 19 4 ; , 253266. Levy, A., & Freyberg, Z. 2004 ; . Sexual dysfunction and aging: Building a bridge between genders. Clinical Geriatrics, 12 11 ; , 3642. Lewis, J. H., Rosen, R., & Goldstein, I. 2005a ; . Erectile dysfunction. Nursing, 35 2 ; , 64. Lewis, J. H., Rosen, R., & Goldstein, I. 2005b ; . Erectile dysfunction in primary care. Nurse Practitioner, 29 12 ; , 4255. Lewis, J. H., Rosen, R., Goldstein, I., and the Consensus Panel on Health Care Clinician Management of Erectile Dysfunction. 2003 ; . Erectile dysfunction: A panel's recommendation for management. American Journal of Nursing, 103 10 ; , 4857. Melnyk, B. M., & Fineout-Overholt, E. 2005 ; . Evidence-based practice in nursing and healthcare. Philadelphia: Lippincott. Messinger-Rapport, B. J., Sandhu, S. K., & Hujer, M. E. 2003 ; . Sex and sexuality: Is it over after 60? Clinical Geriatrics, 11 10 ; , 4553. Milner, V. S., & Kiser, J. D. 2002 ; . Sexual information and Internet resources. Family Journal, 10, 234240. Murray, C. D., & Harrison, B. 2004 ; . The meaning and experience of being a stroke survivor: An interpretative.
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Providers were not informed of the assessment results. In Maryland and Missouri, health risk assessment forms were developed by the state Medicaid agencies and administered as part of the initial enrollment process. Responses to health status questions either were given directly by families who mailed in their applications or obtained by enrollment brokers. In Utah, the plans themselves were required to conduct a health risk assessment within ten days of plan enrollment using their own forms, but only one of the two Utah plans we interviewed had actually implemented this requirement.
Many breast cancer patients report benefits from their cancer diagnosis and treatment. Benefit finding is a patient's recognition of positive life changes attributed to cancer. The validity of benefit-finding measures in breast cancer populations is unclear. Moreover, some measures that investigators might choose to use were validated with other populations or studies of other circumstances [e.g., Perceived Benefits Scale PBS ; McMillen & Fisher, 1998; Posttraumatic Growth Inventory PTGI ; Tedeschi & Calhoun, 1996]. These measures neglect important benefits experienced specifically by breast cancer patients. The current study compared items of the PBS and PTGI to patient-generated thoughts regarding breast cancer. Sixty-nine women with regional breast cancer mean age 51 years, 91% Caucasian ; listed thoughts associated with changes occurring in their lives during the 24 months since diagnosis. They also rated each change in terms of its valence positive, neutral, negative ; and importance very important, important, somewhat important, not important ; . Three independent raters categorized the 2320 changes listed using the open-coding techniques of Strauss & Corbin 1998 ; , yielding 89% inter-rater agreement. Results suggest that 23 categories were required to capture the range of changes listed. Focusing on the benefits positive-valenced changes ; listed by patients, the most frequent and important categories of benefits were identified. Several of these, including health behavior changes and altruism, are not addressed by the PBS or PTGI, suggesting that these scales are inadequate for comprehensive assessments of benefit finding among breast cancer patients. Implications for developing content-valid measures of benefit finding in breast cancer patients are discussed. CORRESPONDING AUTHOR: Abbey J. Damon, N A, Psychology, The Ohio State University, 154 East Woodruff, S, Columbus, OH, USA, 43201; damon.7 osu.
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Each case in this Report represents an individual tragedy. In some, a woman died despite exemplary care but in others the fatal outcome might have been avoided. The `Maternal Mortality Reports' represent a sustained effort by professionals to learn lessons from sad case-histories which may otherwise go unreported or even unexamined. It is not an easy task for those personally involved in a maternal death to describe it to us detail and to comment on how they might have done better. Nor is it pleasant for the local and national assessors to imagine themselves at the scene and then to make a judgement on whether or not care was substandard. The large numbers of professionals involved in producing these Reports are driven by a desire to improve care. Fifty years ago, when this project began as a collaboration between the Royal College of Obstetricians and Gynaecologists RCOG ; and the Ministry of Health as it then was ; , doctors knew that some women were dying unnecessarily. Today, the authors of this Report can still feel anger at the way the system continues to fail some vulnerable young women. As well as highlighting problems the Report also illuminates successes. Great improvements have taken place over the years in, for example, the safety of obstetric anaesthesia and the treatment of hypertensive disease. The present Report records a remarkably low death rate from obstetric haemorrhage and a dramatic fall in deaths from thromboembolism after caesarean section, following publication of RCOG guidelines. After a decade in which further reduction of maternal mortality seemed elusive, the latter breakthrough shows how improvements in practice can still be made and can still save lives. The scope of the Enquiries continues to broaden. The new and wider public health focus shows starkly what many of us have long suspected but never proved: that maternal mortality rates are higher among the most disadvantaged groups of our society. What we did not expect was to find a twenty-fold difference in the risk of death. This finding alone underpins our recommendations for changes in the delivery of antenatal care. Also, the number of women who had self-disclosed domestic violence points to another, hidden, issue of concern for maternal and child health. Indirect deaths now outnumber Direct deaths and this Report reveals, for the first time, a distressing number of suicides within the first year after childbirth. While it is essential to continue scrutinising the well-known Direct causes of maternal death, it is also important to take a fresh look at emerging problems. Only such an observational study as this can do this. In the UK, as in other developed countries, maternal mortality rates are low. Globally, however, over 600, 000 women die each year of pregnancy-related causes. The authors of this Report frequently discuss its findings with colleagues from other countries and we are repeatedly reminded that these Maternal Mortality Reports have an importance well beyond the UK. For nearly five decades these Reports have underpinned obstetric practice in the UK. In this Report we make far-reaching recommendations for the provision of sensitive, flexible antenatal care which should not only help reduce the maternal mortality rate but also improve the quality of care for pregnant and recently.
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