Underwriting with Prescription Histories Across the Mental ... · How Medications Treat Insomnia...
Transcript of Underwriting with Prescription Histories Across the Mental ... · How Medications Treat Insomnia...
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Underwriting with Prescription HistoriesAcross the Mental Health ContinuumScott Coller, Pharm.D. – Pharmacy Consultant
Midwestern Underwriting Conference
21 September 2016
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Psychotropic Medications
Rule Results, UW Guidelines and Decisions
Rule Engines Interpret Psych Meds
Drug Combinations and Mortality
Medications and Disease Progression
Agenda
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Drug therapies impact many neurotransmitters.
Drug NameDopamineHistamineNorepinephrineSerotoninAcetylcholineGlutamateGABA
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Dopamine & Histamine
Cognition(Mental Alertness)
Norepinephrine & Acetylcholine
Vigilance(Sustained Concentration)
Serotonin & Glutamate
Perception(Sensory Satisfaction)
Appetite Intuition
Attention
MOOD
GABA
Neurotransmitters influence a wide range of mental states.
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There are a few key categories of psychotropic meds.
Antidepressants and Anxiolytics
Antipsychotics
Mood Stabilizers
Others
Stimulants
Cognitive Enhancers
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Doctors prescribe by condition.Depression
Anxiety
Insomnia
Nausea
Neuropathy
Migraine Prevention
Tourette’s
Obsessive/Compulsive
Bipolar
Schizophrenia
ADHD
Benzodiazepines
SSRI’s, SNRI’s
Tricyclics, Tetracyclics, Modified Cyclics
Antipsychotics
Anticonvulsants
Stimulants
GABA Analogs
Bupropion
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Epilepsy
Benzodiazepines
SSRI’s, SNRI’s
Tricyclics, Tetracyclics, Modified Cyclics
Antipsychotics
Anticonvulsants
Stimulants
GABA Analogs
Depression
Anxiety
Insomnia
Nausea
Neuropathy
Migraine Prevention
Tourette’s
Obsessive/Compulsive
Bipolar
Schizophrenia
ADHD
Smoking Cessation
Bupropion
Underwriters use Rx histories to interpret conditions.
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Rules engines can be used to map drugs to likely conditions.
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A Sesame Street Mnemonic for Mental Disorders
Insomnia
Depression
Obsessive Compulsive Disorder (Anxiety)
Bipolar Disorder
Schizophrenia
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Fall asleep or stay asleep as long as desired Symptom of another disorder
Functional impairment while awake
< 3 hrs or >10 hrs increases mortality by 50-100%. 7 hours per night: lowest mortality†
Insomnia
†Kripke DF, et al. Arch Gen Psychiatry. 2002;59(2):131-136.
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How Medications Treat Insomnia
Benadryl
Trazodone & Seroquel
Melatonin
Rozerem
Temazepam & Ambien
Belsomra
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Major Depressive Disorder (MDD)
Low mood, low self-esteem, loss of interest
Targets:Norepinephrine, Serotonin, Dopamine
SSRI, SNRI
Bupropion
Tricyclic
MAO-I
Antipsychotic
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Estimating MDD Progression
Single agentSSRI or SNRI
Multiple agents, non-concurrentTrial and transition
Multiple agents, concurrentAD + BZD
Multiple AD
AD + AP
AD + AC
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How Medications Treat AnxietyGAD, Panic, Social Anxiety, Phobias, OCD, PTSD
Targets:GABA Serotonin
SSRI, SNRI, TCA
Benzodiazepines
GABA analogs
Buspirone
Antipsychotic
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Estimating Anxiety ProgressionSSRI for maintenance with benzodiazepine for breakthrough / symptomatic relief
Benzodiazepine monotherapy
Pregabalin or buspirone monotherapy
Multiple agents, concurrent
Combinations of aboveAnticonvulsantsAntipsychotics
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Bipolar Disorder
Periods of mania/hypomania alternating with depression
Bipolar I, Bipolar II, Cyclothymia, Mixed, Rapid Cycling
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Estimating Bipolar ProgressionStarting therapy:Lithium and/or Depakote +/- antipsychoticLithium and/or Lamictal +/- antidepressant
Maintenance:Lithium, Depakote, Lamictal, Tegretol, Trileptal or Antipsychotics
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Schizophrenia
Suicide Risk
At least 2 symptoms present for six months
Negative: Flat affect, lack of pleasure in daily life, lack of drive, speaks little
Positive: Hallucinations, delusions, thought disorders, movement disorders
Cognitive: Poor executive functioning, trouble focusing, problems with working memory
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Estimating Schizophrenia Progression
Thought disorder, mood disorder, and anxiety disorder
Antipsychotics are first line but others may be added onClozaril is probably most effective
Three-quarters of all patients stop taking their medications
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Rule engines can manage relative mortality.
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What is RxRules?
RxRulesData Input Rx info Application data Other (MIB, MVR)
UW Guidance Conditions Severity Decisions
Rule Variables Indication / Therapeutic class Drug combinations Fill timing(date or duration ranges) Fill counts / patterns Dosage / quantity Physician specialty / count Gender / Age Other variables
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Insomnia Treatment
Possible
Treatment-resistantDepression
PossibleBipolar
Treatment Likely
Schizophrenia Treatment
Likely
RxRules
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Underwriting expertise remains critical.
Accept
Decline
ReviewRxRulesData Input
Rx info App data Other (MIB, MVR)
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Interpreting a long list of psych meds? Yikes!
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Fill details provide insight to conditions and severity.
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A rule engine supports easy decision-making.
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Summary
There is a wide range of psychotropic medications used to treat a wide range of mental health disorders.
It is difficult to reverse engineer medications to determine likely conditions and severity.
A rule engine can bring consistency and efficiency to a very challenging job!