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Iodine.com Drug Information Database

Iodine.com is a new drug information database that is accessible to the public and combines clinical information with patient reviews of medications. Time magazine is quoted as saying the website is “the Yelp of medicine”.

After a thorough review of Iodine.com we have come up with some positives about the website, and some areas for improvement.

Positives:

  1. The information that is presented on the website is clinically accurate.
  2. Information is provided in a patient friendly format at an appropriate reading level.
  3. Stories of encouragement from patients who are currently using the medication are included. An example is patients taking metformin offer clinically appropriate tips to reduce the incidence of GI upset, such as taking the larger dose of medication at night or drinking more water with each dose.

Room for improvement:

  1. When you look up a medication the first screen that comes up says “How people feel about (selected drug name)”. It then goes on to give statistics of surveyed patients in the categories of: Is the drug worth it overall? How well does the drug work for you? Is the drug a hassle? Unfortunately, the website does not offer any comparison to what happens if the disease is left untreated. Drugs with major side effects may have low patient scores even if clinically effective. The way the information is presented seems like a recipe that promotes non-adherence. Without scaring patients it is important to show the clinical benefit offered by drug therapy.
  2. The website lacks information on the disease state each medication is used to treat. Showing the risks and disease progression for untreated patients compared to the benefits of drug therapy would provide a clear message that the drug is helpful and there may be some side effects that must be dealt with.
  3. There seems to always be a “but” associated with statements on the website. For example, it says “metformin is a very effective medicine to lower blood sugar and the risk of complications and death from diabetes, but it’s likely to cause diarrhea for the first few weeks.” Although the part about diarrhea is true, it is another emphasis on reasons patients may not start or stop taking medications.

Pharmacists are the medication experts and patient counseling should be individualized to help patients meet their treatment goals. No website will replace this interaction, but rather help supplement it with medication related information. If a resource causes confusion or potential non-adherence it should direct patients to discuss the information with their pharmacist or physician. Sharing patient experiences with a drug on Iodine.com may better prepare future patients to conquer challenges related to the specific medication. Like any other customer reviews, these need to be carefully considered and not be the primary focus for determining therapy.

Healthcare professionals are always looking for ways to provide their patients with accurate and easy to understand drug information. Iodine.com is on its way to becoming the type of resource physicians and pharmacists can direct patients to, but it cannot be at the risk of non-adherence to essential medications. Iodine.com is a certified National Association of Boards of Pharmacy e-Advertiser program which makes it even more imperative to provide the full scope of medication information.

RxOrange

PHSI was introduced to the RxOrange App through a comment on another post about brand drug patents and generic launch. RxOrange provides details from the FDA Orange Book in the convenience of a mobile app. The App is available for purchase ($3.99) on Apple’s iPhone, iPod touch and iPad.

The home screen of the App starts on a drug search and scroll screen. Any drug in the FDA Orange Book is available. When you find the drug, selecting it displays the drug, manufacturer, and any pharmaceutically equivalent product (both brands and generics). You can continue to drill down to find the strengths and dosage forms, route of administration, therapeutic equivalence code, the approval date, and some information about patents and exclusivity. This information is based on a data file from the FDA that is updated monthly.

The bottom of the screen always offers 5 areas to find information.

1. Drug Search (where you start and find what was described above)
2. Patent Expiration (a list by date of potential brand drug patent expirations when generics may be expected)
3. FDA Approvals (a list by date of FDA approvals that can be searched, or filtered to display only brands or generics)
4. Special Topics (a handful of drugs where substitution or drug classification may be difficult to determine)
5. Info (general info about the App and the supporting sources)

Once you download RxOrange, you do not need an internet connection to access the data because it is stored on your device (19.2mb installed size). You will need an internet connection to update the device with new data. This App is dependent on data from the FDA so new generics and new brands will not be in the App until the next monthly update. There are also some products that are not included in the FDA Orange Book (i.e. Enbrel, Humira) that will not be included in the App. RxOrange does not contain drug information such as side effects, dosing, or drug interactions. PHSI believes that if you find yourself regularly utilizing the FDA Orange Book to find therapeutic equivalence, drugs and their manufacturers, and potential new generics, RxOrange would benefit you with portability of this data.

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Glucose Buddy App Review

The Glucose Buddy App is a data storage utility developed by Azumio Inc. for diabetic patients. This app is available for free on any iPhone, iPad, or iPod touch product with iOS 4.0 or later, as well as all Android devices. This mobile app easily keeps track of the blood glucose readings that are manually recorded from the user’s glucose monitor. It even allows users the option to enter productive notes such as “blood sugar elevated because of high carb lunch” so that their personal health record is more complete.

This diabetic app also gives users the option to record the name and dose of their medications, along with the corresponding time they were taken each day. Once a drug/dosage combination is entered, it is saved so that users must only select the medication from their list of previously entered products. Additional free features provided by this app include daily food, activity, and HbA1c logs, as well as charts that compare weekly and monthly log recordings. Another helpful feature is the ability of the app to send out push notifications in order to provide users with reminders and alarms when it is time for blood glucose testing and/or medication administration. A more advanced “Pro” version of this app is available for purchase at $6.99, which includes additional log options for blood pressure and weight and eliminates in-app advertisements.

Glucose Buddy is an easy-to-use journal app specially individualized with each patient’s diabetic history. Users have the ability to print out their log results to bring with them to their doctor’s office by syncing the logs to their account and then accessing them online. One drawback is that the app relies heavily on the patient to record this data accurately, so failure to do so will result in incomplete data sets. To get started, simply download the app and then go online to create your free account. For more information on this app, please visit www.glucosebuddy.com.

 

Vaccines on the Go App Review

The Children’s Hospital of Philadelphia has released an app called “Vaccines on the Go: What You Should Know” to help parents have quick access to reliable information about vaccinations and the diseases they prevent. Not only does it go into detail about the vaccines, vaccine side effects, diseases, contagiousness of the disease, and timeline of the disease, but it contains a section dedicated to talking about vaccination safety. The vaccination safety section addresses concerns about vaccines such as risk of autism, vaccine components like thimerosal, and egg allergies. The app has videos that discuss the information found within the app, which may be helpful for those parents who have a low health literacy.

The app contains a vaccine schedule for children, teens and adults. For parents worried about the number of vaccines their child is receiving, there’s a section answering those questions. This app would be a great recommendation by the pharmacist or physician to parents who just had their first child, or had questions or concerns about vaccinations. If parents still had questions after using this app, there’s functionality to make a note to bring up to their doctor and the ability to email the Vaccine Education Center with questions.

Vaccines on the Go is full of valuable information, but there are a few limitations of the app. While the app provides a vaccine schedule, it does not provide a place for parents to record the administration date of a vaccine, which might be more useful to parents later on in their child’s life, as many parents lose immunization cards or fail to keep those records accessible.

This app is free for both Apple and Android devices. More information is available on the app’s website at http://www.chop.edu/service/parents-possessing-accessing-communicating-knowledge-about-vaccines/vaccine-mobile-app.html.

 

Brand Drug Patents and Exclusivity –Timed Locks on a Safe Analogy

Brand drugs in the U.S. have two main methods of protection from generic competition. 1) The U.S. Patent and Trademark Office protects innovation by awarding patents. 2) The U.S. Food and Drug Administration offers exclusivity protections.

The following analogy helps to illustrate the difficulty in predicting a generic launch date due to complex brand protections. Think of the brand drug as being protected by a safe. The door to the safe may Safehave one or more locks. Each lock has a timer that is counting down. Once the time runs out on the lock, it opens and remains open. Those locks represent the patents and exclusivities that protect the brand from generic competition.

There are two main scenarios for this analogy. First, without doing anything, all of the locks will open automatically at some point in the future. Generic drug manufacturers could wait for all patents and FDA exclusivity to expire. For the opportunists and/or impatient, actions can be taken to open the safe early instead of waiting.

To open the safe early, you must have certain capabilities in picking locks (proving invalidity or non-infringement in a Paragraph IV challenge). The type of lock (a patent protecting an indication vs. a patent protecting a dosage form) must be taken into consideration. Some locks (exclusivities and patents) are very advanced and essentially unable to be bypassed in the time remaining before it opens automatically (expires). Other locks are easily “picked” once you have the basic knowledge and capabilities.

Each brand drug will have a unique combination of patents and exclusivities that may have varying expiration dates (timed locks). Beating a patent (picking a lock) on one drug may or may not help you with future patent challenges. All of these factors demonstrate why it is so difficult to predict a generic launch date.

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GetMyRx App Review

GetMyRx is a prescription delivery service application that is available for mobile Apple devices. This new App allows retail pharmacy customers to scan and send a new prescription or refill into a local pharmacy and then get their prescription delivered within 4 hours. The App is easy to use, utilizing a step-wise approach for patients to enter necessary information. The App is able to scan the user’s insurance card and the new prescription or refill label using an in-app camera feature. The written prescription must be surrendered to the pharmacy upon delivery of the medication. Then, all the user has to do is enter their patient information, their doctor’s name, and a delivery address, and the pharmacy will do the rest. The delivering pharmacy takes care of transferring the prescription (if necessary) and calling the user to confirm the order and obtain the user’s credit card information. The App is free to download and the delivering pharmacy cannot charge a delivery fee, so the prescription will cost the exact amount it would cost in-store. GetMyRx charges pharmacies a software licensing fee for using its proprietary technology platform.

Currently, this service is only available in the Miami, Florida area, but developers are looking to expand to New York and San Francisco soon. Expansion of the availability of this App will largely depend on state law. In certain states, pharmacies cannot fill prescriptions unless they have the original prescription or the prescription was electronically sent by an authorized practitioner, so the prescription scan option would not be available in those states. Another drawback is that the user cannot choose which pharmacy to get the new prescription from, the App automatically matches the user to the nearest pharmacy using the service. Pharmacies interested in being a part of the GetMyRx network can email the company at info@getmyrx.com. More information about the GetMyRx App is available at http://www.getmyrx.com.

Johnson & Johnson 7 Minute Workout App Review

The Johnson & Johnson Official 7 Minute Workout is a free mobile App by Wellness & Prevention, Inc., a division of Johnson & Johnson. It is available for iPhone, iPad, iPod Touch and Android devices. This App is based on research by the American College of Sports Medicine that suggests a 7 minute, high intensity interval training (HIIT) session can be as effective as longer workouts to build muscle, lose weight and improve cardiovascular health.

The App includes the “7 minute workout”, a workout routine that only requires the user, a chair, and a wall. In the 7 minute workout, the user will perform 12 exercises for 30 seconds each with a 5-10 second break in between each exercise. Exercises include jumping jacks, abdominal crunches, pushups and many others that require minimal to no equipment. The App also includes two additional ways to work out: the “smart workout” is a customized workout based on age and other factors, and the “Workout library” which contains 36 exercises and 12 additional workouts that can be customized by the user. This customization of workouts allows for over 1,000 variations.

The user is able to customize and build their ultimate workout by liking or disliking exercises on the screen during a workout and the App will remember which exercises they do not like. The user is able to set reminders and share their results and accomplishments with friends on social media, to help keep motivated on their fitness goals.

The 7 minute workout is a visual app that can provide a variety of exercises for a quick workout for our time-starved population. This may be an ideal workout while on a business trip. The exercises are straightforward and easy to perform. If you are interested in the Johnson & Johnson Official 7 Minute Workout App, you can obtain more information and download it for free at https://7minuteworkout.jnj.com.

 

Prescription Drug Abuse – Educate Early

Cardinal Health Foundation has teamed up with Edheads, a non-profit organization that specializes in educational web development, to make an educational video game called “Trauma”. This game is designed to help educate and raise awareness of prescription drug abuse for students in middle school, high school, and college.

This free online game can be found at http://www.edheads.org/activities/trauma/index.shtml.

The video game begins with the player being greeted by Dr. Ashner, an ED Physician, and Dr. Bennett, an ED Pharmacist. The player is a resident starting their emergency medicine rotation and will help to stabilize an automobile accident victim.

The video game takes the player through many activities and tests that would be conducted in stabilizing a patient in the emergency room. Throughout the game the player is educated on the dangers of prescription drug abuse, the effect it can have on parents, and the consequences that come from abusing prescription medicine.

Overall, this game is a useful tool in educating middle and high school students on the dangers of abusing and misusing prescription medication. Healthcare providers need to promote the safe and effective use of prescription medications everyday to patients. Pharmacists can advocate the use of the “Trauma” game to schools, community groups, and churches to spread awareness of prescription drug abuse not just to students or patients, but to the whole community.

Monitoring Price Changes

Price changes are a fact of life in pharmacy. PHSI monitors many prices that affect all stakeholders in pharmacy.

Pharmaceutical manufacturers monitor the price changes of products in therapeutic categories where they compete. Conclusive and up-to-date monitoring of a drug’s wholesale acquisition cost (WAC) and corresponding average wholesale price (AWP) provides insights into both the reimbursement of prescriptions at the pharmacy and manufacturer strategies. Pricing data can help you analyze and forecast prices for pharmaceutical products in the pipeline and factor into decisions concerning future target drugs.

Pharmacy Benefit Management companies (PBMs) closely monitor generic pricing to establish and maintain appropriate maximum allowable cost (MAC) prices. Published prices play a role in payer reimbursement to the pharmacy and rebates from manufacturers.

Retail pharmacies need current WAC and/or AWP prices to track expected reimbursement results. Plus, monitoring the fluctuating costs in the generic marketplace can ensure pharmacies establish their usual and customary cash price at a competitive and profitable level.

PHSI is an expert in monitoring price changes with valued partners in all 3 stakeholder segments and assists clients navigate the changing competitive landscape.

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CMS FUL Finalization Announced

The Centers for Medicare & Medicaid Services (CMS) announced on November 27, 2013 that the new Federal Upper Limit (FUL) for multi-source generic drugs will be finalized in July 2014.  The new FUL is at least 175% of weighted Average Manufacturer Price (AMP) for multi-source products with at least two A-rated generics available to retail pharmacies nationwide.  This is a significant change from the previous FUL calculation (150% of the lowest Wholesale Acquisition Cost [WAC]).  The new FUL is expected to decrease prices for most drugs while a select few drugs may see FUL increases.

Many states have implemented their own Maximum Allowable Cost (MAC) list (also known as SMAC) for Medicaid to achieve savings greater than the previous FUL.  If the state uses a SMAC list, a review and adjustment may be required to comply with the new FUL.  The SMAC list must deliver the same or more savings to the state when compared to the new FUL.

States may also use the National Average Drug Acquisition Cost (NADAC) similar to the AAC implementation in Alabama, Oregon, and other states.  If States decide to use NADAC pricing, they must submit state plan amendments (SPAs) to CMS to clarify and gain approval to update their pharmacy reimbursement methodology.

PHSI constantly works with payers, pharmacies, and pharmaceutical manufacturers to explain how FUL and NADAC impact each organization.  Do not delay in preparing for these changes.  It will be important to monitor your state(s) to determine if they will be adjusting the SMAC list or changing to NADAC as the basis for reimbursement.

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