New England Quality Care Alliance (NEQCA) - Pharmacy Department

High Cost Medication Utilization Review for Milton Primary Care, LLC

The New England Quality Care Alliance (NEQCA) Pharmacy Department conducted a review evaluating the utilization of high cost medications. The following criterion was used in the report:

  1. General recommendations  when prescribing high cost medications
  2. Alternative recommendations (including applicable price comparisons) to specific high cost medications

Individual provider reports can be created with patient level information for PCP’s whose patients had claims for any of the listed medications.  If you have any questions please contact your NEQCA pharmacist, Tricia Stock, at pstock@neqca.org or 781-664-5714.

Table 1: Recommendations and Suggestions for High Cost Medications

General Recommendations When Prescribing High Cost Medications

  • To ensure more accurate risk scores, recommend to code patients for all disease states
  • Contact patient’s pharmacy if a medication is discontinued or changed in order to cancel remaining refills and ensure patient is not continuing to fill high cost medication
  • Routinely access medication adherence to high cost medications

High Cost Medication

Alternative Medication and Price Comparison*

  • Acetaminophen 300mg products
  • Choose products with 325mg acetaminophen over the products with 300mg acetaminophen                                                                                
  • Hydrocodone 10mg/ acetaminophen 300mg tabs ($209/script)
  • Hydrocodone 10mg/ acetaminophen 325mg tabs ($20/sript)
  • Advair 250/50mcg
  • Symbicort 160/4.5mcg

  • Generic of AirDuo Respiclick (fluticasone/salmeterol) is the low cost alternative
  • Available in three strengths:  54/14mcg, 113/14mcg and 232/14mcg
  • Lower copay for BCBS, HPHC and THP when compared to Symbicort and Advair
  • Erectile Dysfunction Medications
  • Generic Viagra (sildenafil) is now available
  • Consider switching Cialis and Levitra patients to Viagra to capture generic savings
  • Anticipate generic Cialis and Levitra to be available at the end of 2018
  • Vancomycin 250mg caps
  • Consider Firvanq Oral Solution Kit (vancomycin 25mg/mL or 50mg/mL)

*Cost based on Commercial medication claims during identified claims period

                                                                        PTS 5/18