2. How to Practice and Teach #HighValueCare Steven R. Brown, MD @SteveBrownMD Ryan Evans, MD University of Arizona College of Medicine – Phoenix Family Medicine Residency

3. High Value Prescribing: The Price is Right

5. High-intensity Statin Therapy There are two “High-Intensity Statins” 1. atorvastatin 80mg 2. rosuvastatin 20mg All prices from goodrx.com 3/30/16 Walgreens Phoenix, AZ

6. $263.73 $15.35 Rx: Atorvastatin 80mg 1 month supply Rx: Rosuvastatin 20mg 1 month supply

7. Neuropathy Pain

8. $15 $362.91 Rx: pregabalin 75mg PO BID 1 month supply Rx: gabapentin 300mg PO TID 1 month supply

9. $381.78 $5 Rx: Metformin 500mg BID 1 month supply Rx: Sitagliptin 100mg 1 month supply

10. Some ways you can become a high value prescriber Be aware of the costs (and cost discrepancies) –goodrx.com –healthcarebluebook.com Know the data –Check your favorite resource—dynamed, uptodate, Cochrane Go through the STEPS

11. STEPS: What you need to know about a drug Safety Tolerability Efficacy Price Simplicity

12. High Value Prescribing Be a healthy skeptic, and be cautious when prescribing new drugs Apply STEPS and know drug prices Use generic medications and compare value Restrict access to pharmaceutical representatives and samples Prescribe conservatively Brown, SR. The why and how of high-value prescribing. Am Fam Phys Feb 15, 2016

13. Resources Choosing Wisely - choosingwisely.orgchoosingwisely.org Healthcare Bluebook - healthcarebluebook.comhealthcarebluebook.com GoodRx - goodrx.comgoodrx.com Teaching Value Project - www.teachingvalue.orgwww.teachingvalue.org ACP High Value Care Curriculum - hvc.acponline.org hvc.acponline.org Costs of Care - www.costsofcare.orgwww.costsofcare.org UCSF Center for Healthcare Value - healthvalue.ucsf.eduhealthvalue.ucsf.edu ABIM Foundation - www.abimfoundation.orgwww.abimfoundation.org RightCare Alliance - rightcarealliance.orgrightcarealliance.org Lown Institute - lowninstitute.orglowninstitute.org American Family Physician STEPS: New Drug Reviews www.aafp.org/afp/viewRelatedDepartmentsByDepartment.ht m?departmentId=4&page=0 www.aafp.org/afp/viewRelatedDepartmentsByDepartment.ht m?departmentId=4&page=0 American College of Radiology Appropriateness Criteria www.acr.org/Quality-Safety/Appropriateness-Criteria www.acr.org/Quality-Safety/Appropriateness-Criteria Consumer Reports Best Buy Drugs www.consumerreports.org/cro/health/prescription- drugs/best-buy-drugs/index.htm www.consumerreports.org/cro/health/prescription- drugs/best-buy-drugs/index.htm Teaching Value and Choosing Wisely Challenge www.abimfoundation.org/News/ABIM-Foundation- News/2015/Winners-of-Teaching-Value-Choosing-Wisely- Challenge.aspx Cooke M. Cost Consciousness in Patient Care — What Is Medical Education's Responsibility? N Engl J Med 2010; 362:1253-1255. Moriates C, Arora V, Shah N. Building A Pipeline of Change: Teaching About Cost Awareness and Evidence- Based Medicine. In: Moriates C, Arora V, Shah N. eds. Understanding Value-Based Healthcare. New York, NY: McGraw-Hill; 2015. JAMA Internal Medicine “Less is More” series

14. #HighValueCare University of Arizona College of Medicine – Phoenix Family Medicine Residency @UAPhxFamilyMed