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Physician Pharmaceutical Review (PPR) Case Study
Jurisdiction: Florida PRIUM Case ID: Review Date: 02/04/2010
The patient is a 64-year-old female who has a long history of chronic low back pain with a date
of industrial injury on 08/15/92. According to her treating physician there are multiple non-related medical issues for which he is treating her. As late as 2009 her pain rating remained at 8-9 out of 10. The patient has been verbally abusive in the past when asked for a urine drug
screen and results have been inconsistent at times, and in the opinion of the treating physician the patient was trying to dictate her own care. Because of these facts, the treating physician
has been frustrated with this case. Pharmacotherapy:
1. Ambien CR 12.5mg ($185.72 monthly cost) 2. Arthrotec 75/200mg ($170.64 monthly cost) 3. Buspar 15mg ($250.14 monthly cost)
4. Clonazepam 1mg ($75.40 monthly cost) 5. Fentanyl patches 50mcg/hr ($395.40 monthly cost) 6. Hydrocodone/Acetaminophen 10/500mg ($30.36 monthly cost)
7. Lidoderm patches 700mg ($231.58 monthly cost) 8. Lyrica 75mg ($485.77 monthly cost) 9. Neurontin 600mg ($127.83 monthly cost)
10. Pristiq 50mg ($135.08 monthly cost) 11. Promethazine HCL 25mg ($54.12 monthly cost)
12. Tizanidine 4mg ($351.65 monthly cost) 13. Topamax 200mg ($292.38 monthly cost) 14. Tramadol HCL 50mg ($149.90 monthly cost)
This drug regimen incurs a monthly expense of $2,935.97. PRIUM’s reviewing physician discussed the current and potentially future treatment regimen
with the treating physician on 02/02/10. They agreed the patient should be weaned from the majority of her work-related medications because the treating physician cannot determine what is providing benefit. He has not had success in the past in convincing the patient to make
changes but committed to using the reviewer’s clinical recommendations to address them again. It was agreed that Buspar and Clonazepam and Pristiq were not related to the WC
claim, use of Arthrotec could be continued, and all other drugs should be discontinued. As of 10/31/11 (20 months after the discussion), the drug regimen as evidenced by drugs filled
1. Ambien CR 12.5mg ($175.48 monthly cost)
This document, in part or entirety, is considered Confidential and Privileged information to PRIUM Copyright 2011 – PRIUM.- All Rights Reserved
3. Hydrocodone/Acetaminophen 10/500mg ($45.82 monthly cost) 4. Lyrica 75mg ($557.31 monthly cost)
5. Tizanidine 4mg ($126.95 monthly cost) 6. Tramadol HCL 50mg ($96.95 monthly cost)
PRIUM’s intervention resulted in a decrease of monthly costs from $2,935.97 to $1,077.84. Since the date of the review, total savings accrued are $32,626.04 and will continue to accrue
at least $1,486.53 per month. This document, in part or entirety, is considered Confidential and Privileged information to PRIUM Copyright 2011 – PRIUM.- All Rights Reserved
A Paranoid’s Guide to HistoryINRECO doc #2Section 818.08pgPsychology DivisionSchizophrenia and its Neurological ConnectionsSchizophrenia is a multi-symptom, neural-psychologicaldisease with an elusive pathology. There have beenincreasing discussions as to the accuracy and functionalityof the term schizophrenia applied to such a wide rangesymptoms (Andreasen, 1999; Walters). One reason for
Sleep Medicine Reviews (2008) 12, 153–162aSleep Disorders and Research Center, Henry Ford Hospital, 2799 W Grand Blvd, CFP-3, Detroit,MI 48202, USAbDepartment of Psychiatry and Behavioral Neuroscience, School of Medicine, Wayne State University,Detroit, MI, USACaffeine is one of the most widely consumed psychoactive substancesand it has profound effects on sleep and wake function. Laborat