PACE Case: Cyclobenzaprine Alternatives for Parkinson's?
An 81 y/o male with a history of Parkinson's disease, currently being treated for tremors with carbidopa/levodopa CR 25/100mg ER three times daily and rasagiline 1mg daily, was complaining of muscle spasms and pain. The physician contacted his CareKinesis clinical pharmacist, inquiring about initiating cyclobenzaprine (Flexeril) as a muscle relaxant, however the pharmacist cautioned against this therapy addition due to a significant drug-drug interaction.
"You and your team have been great to work with - a real asset to the PACE community, patients, and providers. I will miss my frequent chats with [CK staff]."
- Terence McCormally, MD (former) Medical Director, InovaCare PACE
Low-Dose Quetiapine Use in the Elderly
In 2005, the Food and Drug Administration (FDA) issued a public health advisory regarding the usage of atypical antipsychotic medications. Quetiapine (Seroquel) is an atypical antipsychotic that acts through several different mechanisms. A more recent article called into question some of the current practices used for treating behavioral problems and sleep problems with low doses of quetiapine (≤ 25 mg/day). The authors concluded that other agents should be used instead of quetiapine at these low doses, due to a large side effect profile. Possible alternatives include trazodone, mirtazapine, and melatonin.
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E-Prescribing of Controlled Substances
CareKinesis partnering clinicians who are authorized to prescribe controlled substances can now do so electronically in EireneRx, which complies with
DEA regulations for use of technology for controlled substance prescription management.
Come see us at booth #14 to learn how 2016 is the CareKinesis Year of Measured Outcomes - we hope to see you there!!
CMS Medicare Enrollment - Are You Ready?
By June 1, 2016, any professional who prescribes Part D drugs must either enroll in the Medicare program or opt out in order to prescribe drugs to patients with Part D plans. Medicare Part D may no longer cover drugs that are prescribed by individuals who are not validly enrolled, or who opted out of Medicare. This regulation applies to physicians, nurse practitioners, physician's assistants, and even pharmacists in some states. Some PACE organizations contract with specialists (dentists, podiatrists, etc.), who may need to prescribe for a PACE participant and therefore must complete the enrollment process. This CMS website allows you to check the status of any prescriber.
Prescriber enrollment will requires ongoing attention, post-launch. CareKinesis is happy to assist clients with policies/procedures to ensure that new employees or contractors have completed the CMS enrollment process. Contact your client liaison for a list of EireneRx prescribers who are currently not enrolled.