-
Federal Register Apr 2017This document revises Department of Veterans Affairs (VA) medical regulations to reflect the codification of the authority for the VA Dental Insurance Program (VADIP), a...
This document revises Department of Veterans Affairs (VA) medical regulations to reflect the codification of the authority for the VA Dental Insurance Program (VADIP), a program through which VA contracts with private dental insurers to offer premium-based dental insurance to enrolled veterans and certain survivors and dependents of veterans. The VA Dental Insurance Reauthorization Act of 2016 codified the authority of the VADIP, and this final rulemaking accordingly revises the authority citation in the VA medical regulations that implement VADIP.
Topics: Contract Services; Dental Health Services; Eligibility Determination; Government Programs; Humans; Insurance, Dental; United States; Veterans Health
PubMed: 28375593
DOI: No ID Found -
MMWR. Morbidity and Mortality Weekly... Dec 2015A high blood level of low-density lipoprotein cholesterol (LDL-C) remains a major risk factor for atherosclerotic cardiovascular disease (ASCVD), although data from 2005...
A high blood level of low-density lipoprotein cholesterol (LDL-C) remains a major risk factor for atherosclerotic cardiovascular disease (ASCVD), although data from 2005 through 2012 has shown a decline in high cholesterol (total and LDL cholesterol) along with an increase in the use of cholesterol-lowering medications. The most recent national guidelines (published in 2013) from the American College of Cardiology and the American Heart Association (ACC/AHA) expand previous recommendations for reducing cholesterol to include lifestyle modifications and medication use as part of complete cholesterol management and to lower risk for ASCVD. Because changes in cholesterol treatment guidelines might magnify existing disparities in care and medication use, it is important to describe persons currently eligible for treatment and medication use, particularly as more providers implement the 2013 ACC/AHA guidelines. To understand baseline estimates of U.S. adults on or eligible for cholesterol treatment, as well as to identify sex and racial/ethnic disparities, CDC analyzed data from the 2005-2012 National Health and Nutrition Examination Surveys (NHANES). Because the 2013 ACC/AHA guidelines focus on initiation or continuation of cholesterol treatment, adults meeting the guidelines' eligibility criteria as well as adults who were currently taking cholesterol-lowering medication were assessed as a group. Overall, 36.7% of U.S. adults or 78.1 million persons aged ≥21 years were on or eligible for cholesterol treatment. Within this group, 55.5% were currently taking cholesterol-lowering medication, and 46.6% reported making lifestyle modifications, such as exercising, dietary changes, or controlling their weight, to lower cholesterol; 37.1% reported making lifestyle modifications and taking medication, and 35.5% reported doing neither. Among adults on or eligible for cholesterol-lowering medication, the proportion taking cholesterol-lowering medication was higher for women than men and for non-Hispanic whites (whites) than Mexican-Americans and non-Hispanic blacks (blacks). Further efforts by clinicians and public health practitioners are needed to implement complementary and targeted patient education and disease management programs to reduce sex and racial/ethnic disparities among adults eligible for treatment of cholesterol.
Topics: Adult; Black or African American; Aged; Anticholesteremic Agents; Eligibility Determination; Female; Health Status Disparities; Humans; Hypercholesterolemia; Male; Mexican Americans; Middle Aged; Prevalence; United States; White People; Young Adult
PubMed: 26633047
DOI: 10.15585/mmwr.mm6447a1 -
Blood Jun 2018Patients may be deemed ineligible for a clinical trial for reasons that do not directly impact efficacy or safety. We identified reasons for ineligibility and compared...
Patients may be deemed ineligible for a clinical trial for reasons that do not directly impact efficacy or safety. We identified reasons for ineligibility and compared outcomes of ineligible with eligible patients treated on Southwest Oncology Group (SWOG) Leukemia Committee protocols. Patients enrolled in SWOG phase 2, 2/3, or 3 protocols open since 2005 were analyzed for eligibility status, reasons for ineligibility, baseline characteristics, Eastern Cooperative Oncology Group (ECOG) performance status (PS), serious adverse events (SAEs), complete remission (CR) status, and overall survival. A total of 2361 patients were enrolled in the 13 included studies. Of these, 247 (10%) were deemed ineligible; 78 were excluded from analyses, and 169 were included. Of the 169 included in analyses, 60% (101/169) were excluded due to missing baseline documentation. Baseline characteristics comparing ineligible to eligible patients were similar, with the exception of ECOG PS for S0325 ( = .02) and S0530 ( = .002). In multivariable analyses, neither the proportion of patients with ECOG PS ≥ 2 ( = .12) nor the rate of grade 5 SAEs ( = .62) differed between groups. There was no difference in survival between eligible and ineligible patients ( = .25), and CR rates were similar, with the exception of S0325 ( < .001) and S0703 ( = .004). The findings of this study suggest that nonessential eligibility criteria can be less restrictive, thus expanding patient enrollment and avoiding protocol deviations. The clinical trials included in this study were registered at www.clincialtrials.gov as #NCT00085709, #NCT00066794, #NCT00070499, #NCT00109837, #NCT00093418, #NCT00492856, #NCT00337168, #NCT00352365, #NCT00658814, #NCT00792948, #NCT00945815, #NCT00840177, and #NCT01522976.
Topics: Adolescent; Adult; Aged; Aged, 80 and over; Clinical Trials, Phase II as Topic; Clinical Trials, Phase III as Topic; Eligibility Determination; Female; Humans; Leukemia; Male; Middle Aged; Survival Analysis; Treatment Outcome; Young Adult
PubMed: 29618479
DOI: 10.1182/blood-2018-01-826693 -
Characterizing Gender Eligibility Descriptions for Clinical Trials Registered on ClinicalTrials.gov.JAMA Nov 2023
Topics: Eligibility Determination; Registries; Research Design; Sex Factors; Clinical Trials as Topic
PubMed: 37948067
DOI: 10.1001/jama.2023.19517 -
Journal of Managed Care Pharmacy : JMCP 2007Upon signing the Medicare Prescription Drug, Improvement, and Modernization Act (MMA) on December 8, 2003, President Bush set in motion the greatest change in the... (Review)
Review
BACKGROUND
Upon signing the Medicare Prescription Drug, Improvement, and Modernization Act (MMA) on December 8, 2003, President Bush set in motion the greatest change in the Medicare program since its inception in 1965. MMA was implemented on January 1, 2006, and established the Medicare prescription drug benefit, also known as Medicare Part D. Community and managed care pharmacists were essential to the success in 2006 of this new benefit program with 33 million beneficiaries. Pharmacists will continue to be an essential and integral part of the continued success of the Medicare prescription drug benefit in 2007, in part by being informed about the policies and regulations.
OBJECTIVE
To review policy statements released by the Centers for Medicare & Medicaid Services (CMS) for the Medicare prescription drug benefit in 2006 and to compile an abridged version of the highlights from the policy statements that may affect pharmacists and their interaction with Medicare beneficiaries.
METHODS
We reviewed all policy statements that were released publicly via the CMS Web site (www.cms.gov) policy guidance section between January 1, 2006, and September 30, 2006. We read through approximately 100 guidance statements and summarized approximately 50 that were determined to be relevant to beneficiaries and pharmacists in various practice settings.
RESULTS
Policy statements that may impact beneficiaries of the Medicare prescription drug benefit in 2007 include the timeline for the annual coordinated election period, managed care open enrollment period, and distribution of annual notices of change to beneficiaries. Changes have also occurred in the standard benefit and cost sharing for low-income subsidy (LIS) or extra help that some beneficiaries are eligible to receive based on their current financial status. Discontinuation of coverage of erectile dysfunction drugs is a noteworthy coverage change. For all health care providers, the National Provider Identification (NPI) number will be used beginning May 23, 2007. Once the system using NPI numbers is required, no other provider identification number will be valid for billing Medicare and Medicaid.
CONCLUSION
Important policy updates to the Medicare prescription drug benefit in 2007 include the subject areas of: (1) beneficiary enrollment, (2) transition medication fills, (3) standard benefit, (4) cost sharing, particularly for those who qualify for LIS, (5) enhancement of the Medicare Prescription Drug Plan Finder, (6) beneficiary complaints, (7) discontinuation of coverage for erectile dysfunction drugs, (8) vaccine coverage by the Medicare prescription drug benefit, (9) syringes in long-term care, (10) donation of unused medications by beneficiaries, (11) implementation of the NPI, and (12) preventive services covered by the Medicare program.
Topics: Centers for Medicare and Medicaid Services, U.S.; Drug Prescriptions; Eligibility Determination; Humans; Insurance Benefits; Insurance, Pharmaceutical Services; Medicare; Pharmacists; United States
PubMed: 17269838
DOI: 10.18553/jmcp.2007.13.1.59 -
Journal of Health Economics Mar 2022While a large share of Disability Insurance recipients in OECD countries are expected to recover, outflow rates from temporary disability schemes are typically...
While a large share of Disability Insurance recipients in OECD countries are expected to recover, outflow rates from temporary disability schemes are typically negligible. We estimate the disincentive effects of disability benefits on the response to a (mental) health improvement using administrative data on all Dutch disability benefit applicants. We compare those below the DI eligibility threshold with those above and find that disincentives significantly reduce work resumption after health improves. Approximately half of the response to recovery is offset by benefits. Estimates from a structural labor supply model suggest that disincentives are substantially larger when the worker's earnings capacity is fully restored.
Topics: Disabled Persons; Eligibility Determination; Humans; Income; Insurance, Disability; Social Security; United States
PubMed: 35184012
DOI: 10.1016/j.jhealeco.2022.102593 -
Blood Jun 2018
Topics: Clinical Trials as Topic; Eligibility Determination; Humans; Leukemia
PubMed: 29930149
DOI: 10.1182/blood-2018-04-844704 -
JAMA Health Forum Feb 2023
Topics: United States; Medicaid; Eligibility Determination
PubMed: 36800193
DOI: 10.1001/jamahealthforum.2022.5407 -
Journal of Managed Care & Specialty... Jul 2016Erectile dysfunction (ED) medications are therapeutically effective and associated with satisfaction. Medicare Part D included ED medications on the formulary during...
BACKGROUND
Erectile dysfunction (ED) medications are therapeutically effective and associated with satisfaction. Medicare Part D included ED medications on the formulary during 2006 and inadvertently in 2007-2008.
OBJECTIVE
To characterize phosphodiesterase-5 inhibitor (PDE-5) medication use among veterans who were dually eligible for Veterans Affairs (VA) and Medicare Part D benefits.
METHODS
Veterans aged > 66 years who received PDE-5 inhibitors between 2005 and 2009 were included. Veterans were categorized by PDE-5 inhibitor claims: VA-only, Part D-only, or dual users of VA and Part D-reimbursed pharmacies. T-tests and chi-square tests were applied as appropriate.
RESULTS
From 2005 to 2009, the majority (85.2%) of veterans used VA benefits exclusively for their PDE-5 inhibitors; 11.4% used Medicare Part D exclusively; and 3.4% were dual users. The Part D-only group was older, more frequently not black, had a VA copay, and had a higher income (P < 0.03). The VA group was more likely to have comorbidities, smoke, and have a history of substance abuse (P < 0.001). With the inception of Medicare Part D in 2006, the number of patients filling prescriptions for PDE-5 inhibitors (-68%) and total number of PDE-5 inhibitor 30-day equivalents dispensed (-86.7%) from the VA decreased. Part D prescriptions increased through 2006 (full coverage period) and 2007 (accidental partial coverage) and decreased in 2008. While Part D accounted for only 10% of PDE-5 inhibitor 30-day equivalents, it equaled 29.2% of dispensed tablets. In October 2007, VA PDE-5 inhibitor use returned to 2005 levels.
CONCLUSIONS
Implementation of Medicare Part D reduced VA PDE-5 inhibitor acquisition. However, after removal of PDE-5 inhibitors from the Part D formulary, use of VA pharmacies for PDE-5 inhibitors resumed. Medication policies outside the VA can affect medication use. Veterans with access to non-VA health care may obtain medications from the private sector because of VA restrictions. This may be especially true for nonformulary and lifestyle medications.
DISCLOSURES
The authors received funding support for this research project from the Department of Veterans Affairs, Veterans Health Administration, Health Services Research and Development Service as grant IIR 07-165-2. The views expressed in this article are those of the authors and do not necessarily represent the views of the Department of Veterans Affairs or Health Services Research and Development Service. Study concept and design were contributed by Smith and Stroupe, assisted by the other authors. Huo, Bailey, and Stroupe took the lead in data collection, assisted by the other authors. Data interpretation was performed by Spencer and Suda, along with Smith and Stroupe and assisted by Huo and Bailey. The manuscript was primarily written by Spencer and Suda, with assistance from the other authors, and revised by Spencer, along with the other authors.
Topics: Aged; Aged, 80 and over; Cohort Studies; Eligibility Determination; Erectile Dysfunction; Humans; Male; Medicare Part D; Phosphodiesterase 5 Inhibitors; Retrospective Studies; United States; United States Department of Veterans Affairs; Veterans
PubMed: 27348283
DOI: 10.18553/jmcp.2016.22.7.818 -
RoFo : Fortschritte Auf Dem Gebiete Der... Sep 2018
Topics: Eligibility Determination; Germany; Humans; Insurance, Health, Reimbursement; Magnetic Resonance Imaging; National Health Programs; Radiology
PubMed: 30134484
DOI: 10.1055/a-0654-3394