Most patients and providers were satisfied with the services provided by the pharmacist-managed lipid clinic. The clinic helped improve patients' LDL cholesterol, total cholesterol, and triglyceride levels.

Background:Hyperphosphatemia is a common problem in patients with chronic kidney disease (CKD). Calcium-containing phosphate binders are typically used as first-line therapy, primarily due to cost considerations. Non-calcium phosphate binders such as sevelamer and lanthanum may be considered in the appropriate setting. It is hypothesized that lanthanum is less costly and has a lower pill burden compared to sevelamer carbonate. Objective: Determine the difference in cost (outcome 1) and tablet burden (outcome 2) between sevelamer carbonate and lanthanum within the Veteran population. Methods: Patients with an active prescription for lanthanum or sevelamer carbonate on October 22, 2014 were evaluated. Chi-square analysis was used to analyze categorical data, and 2-sided t test was used for continuous data. An α of 0.05 determined significance. Results: One hundred fifty patients were included in the evaluation. Patients were predominately male (96%) and had a diagnosis of end stage renal disease (ESRD; 78%). The combined rate of non-dialysis CKD (ND-CKD) stage 5 and ESRD was similar between lanthanum and sevelamer carbonate groups. Both groups achieved similar phosphorus control (56% vs 65%, with phosphorus level less than or equal to 5.5 mg/dL, respectively; P = .23). Lanthanum prescriptions required significantly fewer tablets per day (4 lanthanum tablets daily vs 7 sevelamer carbonate tablets daily; P < .001). A potential prescription cost savings of approximately $4,500 monthly or $54,000 annually was seen when considering conversion of patients in this study population from sevelamer carbonate to lanthanum therapy, with appreciable savings beginning at sevelamer daily doses of at least 4,800 mg. Conclusions: Compared to sevelamer carbonate, lanthanum use was associated with reduced pill burden and lower absolute drug cost while maintaining similar phosphorus control.

Approximately 25% of Veterans have diabetes. Both the American Diabetes Association (ADA) and Department of Veterans Affairs/Department of Defense (VA/DoD) guidelines recommend treatment with glucagon-like peptide-1 (GLP-1) agonists, such as liraglutide, as second line options after metformin. In May 2016, the Pharmacy Benefits Management Services, Medical Advisory Panel, and VISN Pharmacist Executives updated criteria for use of GLP-1 agonists, increasing prescribing of this drug class. This coincided with recent data demonstrating cardiovascular benefit of liraglutide and led to increased usage at the Louis Stokes Cleveland Veterans Affairs Medical Center (LSCVAMC). A medication use evaluation was conducted to assess adherence to the criteria for use and to describe the characteristics of liraglutide usage at LSCVAMC. Sixty-two patients with T2DM and a prescription for liraglutide initiated between July 1, 2016 and January 30, 2017 were included. Patients were predominantly male (97%), had a baseline hemoglobin A1c (HgbA1c) of 9.2% and were prescribed metformin (82%). Adherence to the criteria for use was 90%. Follow-up HgbA1c after three to six months was obtained in 87% of patients. Average HgbA1c reduction of 0.76% was achieved in 72% of patients, while 28% were without improvement. Given the less than expected reduction in HgbA1c seen with liraglutide and the pharmacoeconomic impact of this medication, facility changes were implemented to ensure more appropriate prescribing of liraglutide at the LSCVAMC. Disclosure R.L. Rychel: None. M. Low: None. S.A. Watts: None. C. Falck-Ytter: None. K.M. Pascuzzi: None. A. Lyman: None.