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Epocrates, an athenahealth service. Affordability Intelligence
Affordability Intelligence
By: Anne Meneghetti, MD

How many times have you experienced the angst of finding out that a patient never filled a prescription because of personal finances? How many times have your patients gone without treatment while prior authorization hurdles were being worked out? Practices are spending more time than ever before on affordability issues.

We did a quick pulse check and surveyed 70 clinicians about their biggest affordability challenges. Topping their list was the lack of available information on actual drug or procedure costs for patients, cited by 43% of respondents, while patient inability to afford care came in second at 28%.

In his provocative new book, "Where Does It Hurt? An Entrepreneur's Guide to Fixing Health Care," CEO of athenahealth Jonathan Bush advocates for greater freedom to choose one's own care options based on cost-effectiveness and personally meaningful differentiators. However, to make appropriate value-based choices, clinicians and patients need greater insight into specific healthcare costs at the patient level.

Thankfully, guidance is emerging from multiple sectors. A viewpoint piece in June's issue of JAMA calls upon specialty societies—such as the American Academy of Family Physicians and the American College of Physicians—to create and disseminate specialty-specific tools and guidelines to assist clinicians in making complex value-based decisions. The American Board of Internal Medicine's Choosing Wisely® Campaign encourages professional organizations to spark conversations between providers and patients about the value of various tests and treatments.

Epocrates is doing its part to bring clinical intelligence to the exam room by supporting clinicians in value-based prescribing decisions. Hundreds of health plan and retail pharmacy formularies are available within the core app – more details are provided in the "Tips and Tricks" section. Select "Alternatives" to compare affordability of other options in the same therapeutic subclass. In some cases, retail pricing may be the best choice. By searching our "Manufacturer/Pricing" section, you can compare retail cost to formulary coverage. Epocrates also supports the popular NeedyMeds program, which offers discounts that anyone can use outside of insurance coverage. In these small ways and more, we hope to ease the burden of finding affordable options for patients, and bring relevant insight to complex value-based care decisions.

Make sure you have the latest information. Update now.

Noteworthy New Drugs
By: Nancy Hwang, PharmD

Spring signaled the start of allergy season, and the arrival of three new sublingual allergen immunotherapies: Grastek, Oralair, and Ragwitek. Other notable monographs added to Epocrates this quarter include oncology drugs Cyramza (ramucirumab) for gastric cancer and Zykadia (ceritinib) for metastatic non-small cell lung cancer, as well as pain medications Xartemis XR (oxycodone/acetaminophen) and the controversial single-entity hydrocodone product Zohydro ER.

More high-profile drugs continued to fall off the patent cliff, with generics now available for Avelox (moxifloxacin), Lunesta (eszopiclone), Xeloda (capecitabine), Lovaza (omega-3-acid ethyl esters), and Evista (raloxifene).

Along with the crop of new generics, several innovative drugs launched, including Hetlioz (tasimelteon), the first FDA-approved drug for non-24-hour sleep-wake disorder in blind patients, Impavido (miltefosine), an oral treatment for leishmaniasis, Otezla (apremilast), a PDE4 inhibitor for psoriatic arthritis, and Alprolix (coagulation factor IX recombinant, Fc fusion protein), a long-acting therapy for hemophilia B.

See more »

FDA MedWatch Alerts

Eszopiclone - Lower starting dose (1 mg) now recommended

Epidural Corticosteroid Injections - Rare but serious neurologic risk

Laparoscopic Power Morcellation - Use discouraged in hysterectomy and myomectomy

Revatio (sildenafil) - Use in pediatric patients clarified

Doribax (doripenem) - Higher risk of death and lower cure rate in ventilator-associated pneumonia

Captomer and Captomer-250 - Contain chelating agents

Male Sexual Enhancement Products; African Black Ant, Black Ant, and Mojo Risen; MV5 Days; and S.W.A.G - Contain PDE-5 inhibitors

Super Arthgold - Contains chlorzoxazone, diclofenac, and indomethacin

La Jiao Shou Shen, Zi Xiu Tang Bee Pollen Capsules and New Life Nutritional Center Dietary Supplements - Contain sibutramine and phenolphthalein

Reumofan Plus - Contains methocarbamol and diclofenac

NeedyMeds: Patient Drug Discount Program

To help ease the burden of high drug costs, Epocrates is pleased to offer the NeedyMeds program to its members. This free drug discount card is accepted at >60,000 pharmacies nationwide, where it can save your patients up to 80% off the price of some medications.

No income, insurance, or residency requirements apply; and, no registration is required. Anyone can use the card, but it cannot be combined with insurance. Plus, we have made the NeedyMeds formulary accessible on Epocrates.

Sign in to "My Account online" and select "Edit Formularies." Choose the "Other Groups" category, highlight "NeedyMeds," and select "Add."

Download the free discount card for your patients »

Disease Focus: Deep Vein Thrombosis
By: Walt Hadikin, MD

DVT: Patient Factors Affecting Choice of Initial Anticoagulation

Patient characteristics Choice of initial anticoagulation
Normal renal and hepatic function Choose any of:
IV or SC unfractionated heparin (UFH)
Direct factor Xa inhibitor (rivaroxaban or apixaban)
Increased risk of bleeding IV UFH is preferred due to short half-life & reversibility
Active cancer LMWH is preferred for initial and long-term tx
Renal impairment
(CrCl <30 mL/min)
IV or SC UFH (Fondaparinux, rivaroxaban, and apixaban not recommended)
Obesity LMWH preferred (use actual body weight to calculate dose)
Pregnancy LMWH (preferred) or SC UFH (Rivaroxaban and apixaban not recommended)

For more patient-specific tx recommendations, see DVT monograph.

Disease Updates
Selected by: Walt Hadikin, MD

Gonorrhea infection – Patient Resources from CDC (View)

Acute prostatitis – Patient Resources from NIA (View)

Celiac disease – Patient Resources from FDA (View)

Diaper rash – Patient Resources from AAP (View)

Autism – Patient Resources from NIMH, CDC (View)

Alopecia areata – Patient Resources from NIAMS (View)

Overview of infant care – Patient Resources from JAMA, FDA, NIDDK (View)

Acute headache in children (Evaluation of) – Patient Resources from JAMA (View)

Hearing loss (Evaluation of) – Patient Resources from CDC, NIA, FDA (View)

Absence seizures – Patient Resources from JAMA (View)

CDC Vital Signs: Getting Patients Moving
By: Walt Hadikin, MD

Increasing Activity in Adults with Disabilities
When providers speak, patients listen. At least that's the case according to a recent CDC Vital Signs report. Working-age adults with disabilities are 82% more likely to be physically active if their clinicians recommend it. Unfortunately, that still leaves nearly half of adults (ages 18-64) with disabilities getting no aerobic physical activity.

CDC Director Tom Frieden, MD, MPH, says that can change "if doctors and other healthcare providers take a more active role helping their patients with disabilities develop a physical fitness plan that's right for them."

Ask disabled patients about their physical activity, discuss barriers, and recommend options based on patients' abilities. When needed, refer patients to outside resources or programs.

Explore more at CDC »

DocAlert Editor's Picks for OB/Gyns
By: Walt Hadikin, MD

FDA MedWatch Alert: Laparoscopic Power Morcellation Use Discouraged
View FDA MedWatch alert

Extended Use of IUDs: A Literature Review
View abstract

Endometriosis Management: A Cochrane Overview
View abstract

Chlamydia and Gonorrhea Lab Testing Recommendations: A CDC Update
View MMWR article

Protective Effect of Oophorectomy in BRCA Mutation Carriers
View PDF

DocAlert Editor's Picks for Cardiology
By: Walt Hadikin, MD

Medical Therapy of Heart Failure: Ten Things to Remember From Updated ACCF/AHA Guidelines
View PDF

Decompensated Heart Failure: Ten Things to Remember From Updated ACCF/AHA Guidelines
View PDF

NEJM Journal Watch: Prehypertension Increases Stroke Risk
View abstract

Management of Atrial Fibrillation: 2014 AHA/ACC/HRS Guidelines
View PDF

Digoxin Use in Patients With Worsening Heart Failure: A Review
View abstract

DocAlert Editor's Picks for Pediatrics
By: Walt Hadikin, MD

Atopic Dermatitis Diagnosis and Assessment Guidelines From AAD
View abstract

Easily Missed Pediatric Diagnosis: Intestinal Malrotation and Volvulus
View PDF

Probiotics for the Prevention of NEC in Preterm Infants: A Cochrane Review
View abstract

Acute Epiglottitis: Key Points to Remember
View PDF

Management of Wheeze in Preschool Children: BMJ Clinical Review
View PDF

DocAlert Editor's Picks
By: Walt Hadikin, MD

NEJM Journal Watch: Comparison of 3 IV Therapies for Acute Migraine
View abstract

Digoxin Use in Patients With Worsening Heart Failure: A Review
View abstract

Protective Effect of Oophorectomy in BRCA Mutation Carriers
View PDF

Atopic Dermatitis Diagnosis and Assessment Guidelines From AAD
View abstract

How Sleep Loss Can Affect Metabolic Traits: Five Points to Remember
View abstract

Tips and Tricks-Formularies on the Go
By: Leslie Ungs, PharmD

Q: Dr. E asks, "How do I add Oregon formularies to my Epocrates app?"

A: Epocrates hosts drug plan formularies for private and public health insurers, chain pharmacies, and other entities. We even host a formulary for NeedyMeds.com. The formularies that appear on your Epocrates app can be managed on www.epocrates.com under "My Account." After logging in, click on "Edit Formularies." Select your state of practice from the drop-down menu to view the formularies in your area. You may add as many as you like, free of charge.

Update your Epocrates content to view the latest formulary information.

Reimbursements: How Does Your Practice Measure Up?
By: Anne Meneghetti, MD

Ever wonder how your reimbursement rates for visits and procedures compare to those of your peers? athenahealth's CodeView tool gives you access to average payments for common procedures derived from athenahealth's network of more than 52,000 providers. Search reimbursement rates by specialty, procedure, or geographic region to find out how your reimbursement measures up.



The Epocrates Rx monograph dosing section for Xartemis XR has been revised to correct the indication to acute pain.

In the Treatment Options section of the Epocrates Disease monograph Intra-abdominal abscess, the dose of micafungin was corrected to 100 mg IV qd.

Perform frequent Epocrates content updates for access to the most current information.

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