dissertation on drug utilization

• Fact sheets
• Facts in pictures
• Publications
• Questions and answers
• Tools and toolkits
• Endometriosis
• Excessive heat
• Mental disorders
• Polycystic ovary syndrome
• All countries
• Eastern Mediterranean
• South-East Asia
• Western Pacific
• Data by country
• Country presence 
• Country strengthening 
• Country cooperation strategies 
• News releases
• Feature stories
• Press conferences
• Commentaries
• Photo library
• Afghanistan
• Cholera 
• Coronavirus disease (COVID-19)
• Greater Horn of Africa
• Israel and occupied Palestinian territory
• Disease Outbreak News
• Situation reports
• Weekly Epidemiological Record
• Surveillance
• Health emergency appeal
• International Health Regulations
• Independent Oversight and Advisory Committee
• Classifications
• Data collections
• Global Health Observatory
• Global Health Estimates
• Mortality Database
• Sustainable Development Goals
• Health Inequality Monitor
• Global Progress
• World Health Statistics
• Partnerships
• Committees and advisory groups
• Collaborating centres
• Technical teams
• Organizational structure
• Initiatives
• General Programme of Work
• WHO Academy
• Investment in WHO
• WHO Foundation
• External audit
• Financial statements
• Internal audit and investigations 
• Programme Budget
• Results reports
• Governing bodies
• World Health Assembly
• Executive Board
• Member States Portal
• Publications /

Introduction to drug utilization research

The ultimate goal of drug utilization research must be to assess whether drug therapy is rational or not.  History has taught us that successful research in drug utilization requires multidisciplinary collaboration between clinicians, clinical pharmacologists, pharmacists and epidemiologists. Without the support of the prescribers, this research effort will fail to reach its goal of facilitating the rational use of drugs.

• My Shodhganga
• Receive email updates
• Edit Profile

Shodhganga : a reservoir of Indian theses @ INFLIBNET

• Shodhganga@INFLIBNET
• Uttarakhand Technical University
• Department of Pharmacy

Items in Shodhganga are licensed under Creative Commons Licence Attribution-NonCommercial-ShareAlike 4.0 International (CC BY-NC-SA 4.0).

An official website of the United States government

The .gov means it’s official. Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

The site is secure. The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

• Publications
• Account settings

Preview improvements coming to the PMC website in October 2024. Learn More or Try it out now .

• Advanced Search
• Journal List
• v.13(8); 2021 Aug

Drug Utilization Study of Antidiabetic Drugs in Patients Attending Geriatric Outpatient Department at a Tertiary Care Hospital

Abdul hannan.

1 Department of Pharmacology, Grant Government Medical College and Sir Jamshedjee Jeejeebhoy Group of Hospitals, Mumbai, IND

Shyamal R Sinha

Mohammad arfat ganiyani.

2 Department of Internal Medicine, Grant Government Medical College and Sir Jamshedjee Jeejeebhoy Group of Hospitals, Mumbai, IND

Manas Pustake

Introduction.

Diabetes has increased in prevalence from 108 million individuals in 1980 to 463 million individuals in 2021. As people's life expectancies have risen, it's become increasingly necessary to be worried about diseases that affect the elderly. To focus and manage these diseases effectively, the illumination of current knowledge about the pattern of anti-diabetic drug utilization in the elderly is important. As a result, it is necessary to evaluate the pattern of anti-diabetic medication use among diabetes patients of the geriatric age group and determine if there is room for improvement in light of current knowledge. With this information, we intend to provide feedback and suggestions for the health care providers. This research aimed to study and analyze the drug utilization of antidiabetic medications in patients attending the geriatric outpatient department.

The data of 600 patients visiting the geriatric outpatient department from January 1, 2016 to September 30, 2017 were collected from the electronic medical record (EMR) database. The protocol was designed using Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) guidelines. Subjects were grouped according to gender, age, drug combination use, and underlying co-morbidities. Indicators of drug usage and the total number of drugs prescribed and prescription patterns were analyzed. Then, the recorded data were classified according to the anatomical therapeutic chemical (ATC) - daily defined dose (DDD) classification. Prescribed daily dose (PDD) values and PDD/DDD ratio of antidiabetic drugs prescribed to a sample of patients (n=600) were calculated. Cost analysis of the prescribed drugs was analyzed and the cost index for each drug is described.

A total of 600 diabetic patients (286 males) were recruited in the study. In the study, the average age of participants was 69.30±11.34 years. The most common comorbidity associated with diabetes mellitus (DM) was hypertension followed by hypertension along with chronic heart disease. Glibenclamide and pioglitazone (thiazolidenediones) had PDD/DDD ratio equal to 1. The ratios for glimepiride (sulfonylurea), metformin (biguanides), sitagliptin (sodium-glucose cotransporter 2 inhibitor), insulin glargine, insulin lispro, insulin aspart, were 1.85, 1.29, 1.66, 1.63, 1.42, and 1.21, respectively, whereas the premixed insulin had a ratio of 0.83. The average cost per prescription was USD 3.36 and around 87.72% of the cost per prescription was due to the prescribed antidiabetics. Metformin + glibenclamide was the most commonly prescribed combination followed by metformin + glimepiride.

On the whole, the principles of rational prescription were followed in accordance with the different WHO drug usage indicators. Many of the drugs prescribed by generic name were supplied from hospital pharmacy thus reducing the burden to some extent.

Diabetes mellitus (DM) is becoming an important public health problem in developing countries, especially in India. The number of people with diabetes has risen from 108 million in 1980 to 463 million adults in 2021 [ 1 ]. Type 2 DM is very common among the elderly [ 2 ]. Various classes of anti-diabetic drugs including insulin and oral hypoglycemic agents (OHAs) are currently being used in the treatment of diabetes, which acts by various mechanisms to reduce the blood glucose levels in order to maintain optimal glycemic control. The utilization study of these medications is important in clinical practice because it serves as the foundation for implementing changes to drug dispensing policies at the local and national levels. Irrational drug use can lead to adverse outcomes including an increase in the risk of hypoglycemia, a decline in medication adherence, the risk of drug-drug interactions, all of which can invariably lead to an increased risk of hospitalization, fatality rate, and healthcare costs [ 3 ]. Drug Utilization Research (DUR) was defined by the WHO in 1977 as “The study of the marketing, distribution, prescription, and use of drugs in a society, with special emphasis on the resulting medical, social and economic implications” [ 4 ]. The main implication of such studies is to promote rational medication usage. Drug utilization studies help in developing strategies to utilize health resources most efficiently, they are particularly needed in a developing economy like India where age-standardized disability-adjusted life-years (DALY) for diabetes is increased by 39.6% since 1990, the largest rise among major non-communicable diseases [ 5 ].

World Health Organization (WHO) has projected that diabetes will be the seventh leading cause of death in 2030 in the world [ 6 ]. With the enhancement of diagnostic and treatment facilities, with better healthcare facilities and awareness, we now have a growing population of elderly people [ 7 ]. As this demographic group expands, the disease burden increases as well, putting an additional strain on an already overloaded healthcare system. Proper evaluation of their problems, correct diagnosis, and suitable treatment are the key factors in reducing this disease burden. This aids in the improvement in the patients' quality of life, which is extremely important.

Without knowledge of how drugs are being prescribed and used, it is difficult to suggest measures to change prescribing habits for the better [ 8 ]. It, therefore, becomes important to assess the pattern of the usage of anti-diabetic drugs among the diabetic patients of the geriatric age group and to see to what extent there may be scope for improvement in the light of current knowledge. A previous drug utilization study for OHA done in India was by Sultana et al. in 2010 [ 8 , 9 ]. In their study, the majority of type 2 diabetic patients were treated with multiple antidiabetic drug therapy. The most commonly prescribed antidiabetic drug class was biguanides followed by sulphonylureas, thiazolidinediones, insulin, and alpha-glucosidase inhibitors. They have reported that the metformin was most commonly prescribed monotherapy followed by insulin. They had emphasized the need for patient education for promoting rational use of medications to promote drug adherence. This study has also recommended drug utilization studies should be carried out in a large population and at different locations in India so that the utilization patterns may be compared and diabetes management improved, thus suggesting a need for a longer-term study on a larger sample size [ 9 ]. Although many similar studies were done previously, no studies particularly were done in the geriatric population. We plan to use these data to offer feedback and suggestions to healthcare professionals. Thus, this study was designed.

Materials and methods

The study was done in Geriatric Outpatient Department, Sir JJ Group of Hospitals, Mumbai, one of the largest government tertiary health centre in Western India.

Study design and ethical considerations

A retrospective drug utilization study was conducted after the approval of the institutional ethics committee (IEC Document number: IEC/Pharm/445/2014). The guidelines for Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) were used in the designing of the protocol and the manuscript [ 10 ].

Selection criteria

Inclusion Criteria

Prescriptions of both the sexes of the geriatric population (defined as age >60 years) diagnosed with DM since at least five years and started on either OHA or insulin that were selected for the study.

Exclusion Criteria

Patients with other coexistent causes of hyperglycemia (e.g., Cushing's syndrome, pancreatic cancer, or hormone-secreting tumors) were excluded from the study.

Sample size

Six hundred prescriptions were assessed from medical databases/registries as per WHO standards [ 8 ] for performing retrospective drug utilization studies.

Study procedure

The data of patients visiting the geriatric outpatient department (OPD) from January 1, 2016 to September 30, 2017 were collected from the electronic medical record (EMR) database, avoiding Hawthorne's bias, and was documented in a systematic case record form. During the period of the study, the sample frame was set at three prescriptions a day, three days a week. Three prescriptions were chosen as follows: on day one, all three prescriptions were picked at the start of the day; on day 2, three prescriptions were picked in the middle of the day; on day 3, three prescriptions were selected at the end of the day, and so on. In the event of an OPD holiday, the prescriptions for that day were allocated to the next working day. This method was adopted because of three fixed geriatric OPD days per week in our hospital and also to eliminate potential bias.

Data collection and analysis

Data were collected relating to participant demographics and clinical characteristics. The demographic data collected included: medical records department number, gender, age, smoking status, marital status, education level, employment status, income, and occupation. The clinical characteristics data obtained were: length of time since diagnosis with DM, body mass index (BMI), and any relevant medical history or co-morbidities in the records, of any diabetes complications. Prescription details like date, number of drugs, names of individual drugs (generic/brand), any fixed-dose combination (FDC) prescribed, and whether the prescribed drugs were available from the hospital pharmacy, dose, dosage form, dosing schedule, and duration of treatment were all recorded. The medicines that were dispensed by the hospital pharmacy were documented. Those who were not distributed from hospital pharmacies were considered to be purchased from outside pharmacy outlets.

Data analysis

Prescription patterns were assessed as defined by the World Health Organization-International Network of Rational Use of Drugs (WHO-INRUD) drug usage indicators [ 11 ]. The prescription medications were categorized using the anatomical therapeutic chemical (ATC) - defined daily dose (DDD) system [ 12 ]. The Prescribed Daily Dose (PDD) was derived by averaging the daily dosage of the antidiabetic medicines [ 13 ]. The PDD/DDD ratio was then computed by using appropriate values.

Cost analysis

The cost of medications prescribed from the hospital schedule was calculated based on the rate contract available in the hospital drug store. The cost of the drugs prescribed from pharmacies outside the hospital was obtained from the Drug Index (DI): February 2017 [ 14 ]. The cost parameters calculated were average total cost per prescription, percentage of average cost due to antidiabetic drugs average cost borne by the hospital, average cost borne by the patient. We estimated the price per 10 tablets/capsules (minimum and maximum, as per DI), average monthly cost (minimum and maximum), which was equal to (PDD/dose per tablet) × price per 10 tablets × 3 and cost index (CI) (maximum price/minimum price) for pharmaceuticals prescribed from outside pharmacies. The cost of each drug was modeled in the USD.

Statistical analysis

The descriptive data were reported in percentages for categorical variables and mean(\pm\)SD for continuous variables. All statistical calculations were done using IBM Statistical Package for the Social Sciences (SPSS) version 24 (IBM Corp., Armonk, NY).

Demographic characteristics

Comorbidities associated with DM

The most common comorbidity associated with DM was hypertension (56.33%) followed by hypertension along with chronic heart disease (23.16%); details of which are presented in Figure ​ Figure1 1 .

Utilization of anti-diabetic drugs

Metformin (biguanide antidiabetic class) was the single most commonly prescribed antidiabetic agent (585 (97.5%) of 600 study participants). It was followed by the sulfonylureas group, which was used by 53.66% of patients. Glibenclamide was the most commonly prescribed sulfonylurea in 263 (43.83%) patients followed by glimepiride in 59 patients (9.83%). The percentage distribution of antidiabetic drugs is shown in Table ​ Table1 1 .

DPP-4: dipeptidyl peptidase-4, TZD: thiazolidinedione, NPH: neutral protamine Hagedorn.

Insulin was prescribed to 42 patients (7%) out of 600 in three types of regimens. The most often prescribed regimen (regular insulin + NPH insulin) was split mixed in 32 patients (76.19%), followed by the basal-bolus regimen (glargine + aspart) in 8 patients (19.04%). Figure ​ Figure2 2 provides a more detailed description.

The percentage of the study population who were prescribed monotherapy was 40.49, of which metformin in 233 (38%) of patients was the most commonly prescribed drug followed by glibenclamide as shown in Figure ​ Figure3. 3 . Metformin + glibenclamide was the most commonly prescribed combination in 201 (33.5%) of patients followed by metformin + glimepiride in 44 (7.33%) of patients others combinations are described in Figure ​ Figure3 3 .

The most commonly prescribed drug for the comorbid condition was aspirin in 431 (71.83%) patients followed by enalapril for hypertension in 307 (51.16%) patients. Other drugs and their distributions are elaborated in Figure ​ Figure4 4 .

Analysis of prescription patterns according to the WHO drug use indicators

Table ​ Table2 2 shows the analysis of prescription patterns according to the WHO drug use indicators.

Drug utilization patterns as per ATC/DDD Classification

ATC/DDD categorization, PDD values, and PDD/DDD ratio of antidiabetic medications are depicted in Table ​ Table3 3 .

DDD: defined daily dose, PDD: prescribed daily dose, ATC: anatomical therapeutic classification, NPH: neutral protamine Hagedorn.

The average cost per prescription was USD 3.36 out of which, the cost borne by the hospital was USD 0.81 and that borne by the patient was found to be USD 2.55. Around 87.72% of the cost per prescription was due to the antidiabetics prescribed. Table ​ Table4 4 below summarizes the cost analyses of the drugs.

IU: international unit, USD: United States dollar, NPH: neutral protamine Hagedorn.

Diabetes mellitus (DM) is a rising public health concern in developing countries. Several anti-diabetic drug utilization studies have been published in the healthcare setting from various parts of the world that can aid the rational drug use in patients with diabetes [ 17 , 18 ]. This study has concentrated on trends in anti-diabetic medication prescription and usage. Drug utilization study is important in clinical practice because it serves as the foundation for implementing changes to drug dispensing policies at the local and national levels. Also, since it helps in developing strategies to utilize health resources most efficiently, it is particularly needed in a developing economy like India where 72% of all health care burden is borne by the patients [ 19 ].

In our study, we observed that glibenclamide and pioglitazone had a PDD/DDD ratio of 1. Whereas glimepiride, metformin, sitagliptin, insulin glargine, insulin lispro, and insulin aspart had ratios higher than 1 and premixed insulin had a ratio less than 1. When the PDD/DDD ratio is less than or higher than one, it may suggest inadequate use or overuse of drugs, respectively. However, it is important to keep in mind that the PDD may vary depending on the patient and disease variables. PDDs may also vary significantly across nations; for example, PDDs are often lower in Asian people than in Caucasian ones. Additionally, the DDDs acquired from the WHO ATC/DDD website are applicable to moderately severe diseases and are based on worldwide data. As a result, the WHO encourages nations to compile their own DDD list using local data. Our study is contributing to this data, particularly for India.

We found that premixed insulin is underutilized in our settings. In contrast to this, Kalra et al. found in a review that premixed insulin is the most commonly prescribed and used insulin in Asia [ 20 ]. This may be attributable to the fact that physicians often have a difficult task in evaluating the contradictory recommendations and deciding which to adopt between basal and premixed insulin [ 20 ]. However, the present study justifies the need for prescribing more premixed insulin. Additionally, the present study included individuals in the elderly age range, who may have a preference for non-insulin regimens, resulting in underutilization of premixed insulin.

Pioglitazone is utilized optimally, which may be attributable to a preference for oral hypoglycemic regimes over insulin by patients. It is not overutilized considering its adverse effects.

Metformin alone and metformin combination was the most commonly prescribed anti-diabetic drug in the present study, in line with Orlando and coworkers [ 21 ], and Das et al. [ 22 ]. They also found that metformin was the most prescribed drug during their study. Interestingly, our results are contrasting to Ramesh and coworkers [ 23 ], Chiang et al. [ 24 ], and Al Khaja et al. [ 25 ], wherein sulfonylureas were the commonly prescribed anti-diabetic drug. This might be attributed to variations in the age groups studied in these studies. In our study, among the second-generation sulfonylureas, glibenclamide was the most commonly prescribed along with metformin which is in line with a study from Nigeria by Jimoh et al. [ 26 ]. The fact that metformin was the most prescribed drug complies with its endorsement as the preferred anti-diabetic agent by current clinical guidelines, for instance, the guidelines of the American Diabetic Association (ADA) [ 27 ].

This study was conducted in the geriatric department of a tertiary care institution, where the consultants are specialists. In many areas of India, however, diabetes patients are managed by general practitioners. When these physicians are confronted in such situations, the phenomenon of “clinical inertia” is evident. It is referred to as “A consultation in which a change in treatment based on a diabetes-related variable was indicated but did not occur” [ 28 , 29 ]. This leads to inappropriate prescribing and improper use of these medications. To avoid this, government entities must develop and strictly enforce policies. While our research uncovered both the patterns of under- and overuse of anti-diabetic medications, such data may be utilized by government and non-government organizations to develop policies and recommendations to reinforce the appropriate use of these medications. While it is not feasible for countries like India to afford specialists at every level of the healthcare system, it may be mandated for existing healthcare personnel to be trained in order to ensure appropriate medication use, especially for the care of chronic diseases like diabetes.

According to intercontinental marketing service (IMS) statistics, the most often used categories of drugs globally are cardiovascular drugs, which are frequently co-prescribed with anti-diabetic drugs due to the association between cardiovascular illnesses and diabetes [ 30 ]. Comorbidities such as hypertension in diabetics make it more difficult to prevent multiple medication usage; as a result, diabetics are more prone to polypharmacy and, in some cases, irrational prescriptions.

While evaluating the rationality, dose strength, and dose schedule that were mentioned in all prescriptions were studied. There was no prescription in which banned drug formulation was prescribed. For instance, pioglitazone which has a black box warning is used in 2.83% of prescriptions which is relatively low. Blood sugar levels were available for all the prescriptions studied. Patients were advised monotherapy as initial therapy and advised dietary restrictions, exercise, and advised eye, cardiovascular, and neurological checkup, which was in adherence with ADA guidelines [ 27 ]. This may be attributed to the fact that the study setting is a tertiary care facility, guidelines were followed, which may not be the case in every hospital in the country. Further studies are needed to assess current treatment patterns for good practice and quality of service.

In our study, around 87.72% of the cost per prescription was due to the antidiabetics prescribed. The reason behind this is expensive newer antidiabetic drugs and different preparations of insulin. The costs of diabetes affect everyone, everywhere, but it is not only a financial problem. Unquantifiable costs (pain, inconvenience, anxiety, and overall poorer quality of life, for example) have also been shown to have a significant effect on the lives of patients and their families [ 31 ]. It has also been observed that doctors have suboptimal awareness of the costs of the drug. The situation can be improved if drug cost is given greater emphasis during the medical training program of doctors [ 32 ]. A mention of drug cost is also required in medical literature and drug advertisement. Either cheaper brands with better efficacy or drugs, in general, should be prescribed as far as possible to reduce the cost of treatment for the patient. In a few instances, pharmaceutical companies use their clout to persuade physicians to prescribe costly medicines, resulting in higher-than-usual prescription costs for consumers.

This study has reported the utilization pattern of antidiabetic drugs in the geriatric population and also provided the baseline data regarding the prescribing patterns in diabetic patients. Since diabetes is a common disorder in the geriatric age group, the prescription cost is one of the major reasons for non-adherence to drug therapy. There is a need to prescribe cheaper alternatives for these types of patients for good glycemic control. This study has opened the door to more research in this field.

Strengths and limitations

Because the study was conducted in a government hospital, there may be a sampling bias since the patients who arrived here are usually from a low socioeconomic class. The population in our study was the elderly age group, hence the actual drug usage by the entire population could not be identified, and these data cannot be extrapolated for the entire population. Additionally, we were unable to evaluate patient compliance since patients were not interviewed in person. A more comprehensive study is warranted. Because of the present study design, we faced certain limitations which could be avoided with another well-designed prospective study.

The study's sample size was adequate. Since we used the EMR, Hawthorne bias was obviated. EMR is a component of the national surveillance system making the gathered data more reliable and accurate.

Conclusions

On the whole, the principles of rational prescription were followed in accordance with the different WHO drug usage indicators. Many of the drugs prescribed by generic name were supplied from hospital pharmacy thus reducing the financial burden of the patient to some extent. The incidence of poly-pharmacy is relatively high, suggestive of irrational prescribing; but polypharmacy is quite relevant in geriatric diabetic patients because diabetes is associated with various concurrent diseases and their complications. Apart from this, drugs prescribed by generic names were also high, therefore drug use in this setup is quite rational.

We would like to make the following suggestions: (i) the use of premixed insulin was found to be good but further need to increase premixed insulin in hospital drug schedules; (ii) continue the use of metformin adhering to the ADA guidelines; (iii) need to increase newer expensive antidiabetic drugs in the hospital drug schedule and pharmacy in order to relieve the financial recommendation on the patients; (iv) the practice of prescribing glibenclamide and pioglitazone should be continued.

The content published in Cureus is the result of clinical experience and/or research by independent individuals or organizations. Cureus is not responsible for the scientific accuracy or reliability of data or conclusions published herein. All content published within Cureus is intended only for educational, research and reference purposes. Additionally, articles published within Cureus should not be deemed a suitable substitute for the advice of a qualified health care professional. Do not disregard or avoid professional medical advice due to content published within Cureus.

The authors have declared that no competing interests exist.

Human Ethics

Consent was obtained or waived by all participants in this study. Institutional Ethics Committee, Grant Government Medical College and Sir JJ Group of Hospitals, Byculla, Mumbai, India issued approval IEC/Pharm/445/2014

Animal Ethics

Animal subjects: All authors have confirmed that this study did not involve animal subjects or tissue.

An official website of the United States government

The .gov means it’s official. Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

The site is secure. The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

• Publications
• Account settings
• My Bibliography
• Collections
• Citation manager

Save citation to file

Email citation, add to collections.

• Create a new collection
• Add to an existing collection

Add to My Bibliography

Your saved search, create a file for external citation management software, your rss feed.

• Search in PubMed
• Search in NLM Catalog
• Add to Search

Utilization and cost of non-insulin glucose-lowering drugs in Australia from 2013 to 2023

Affiliations.

• 1 School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia.
• 2 Department of Endocrinology & Diabetes, Alfred Health, Melbourne, Victoria, Australia.
• 3 Department of Endocrinology & Diabetes, Western Health, St Albans, Victoria, Australia.
• PMID: 39219539
• DOI: 10.1111/dom.15893

Objectives: To investigate the utilization and costs of non-insulin glucose-lowering drugs (GLDs) in Australia from 2013 to 2023.

Materials and methods: We conducted a retrospective analysis of the Australian Pharmaceutical Benefits Scheme (PBS) administrative dataset of 118 727 494 GLD prescriptions. The main outcome measures were the annual number of GLD prescriptions dispensed, accounting for type 2 diabetes mellitus (T2DM) prevalence and healthcare system costs, adjusted for inflation.

Results: Utilization of GLDs doubled from 6.4 million prescriptions in 2013 to 15.6 million in 2023. The average annual percent increase in utilization was 8.1%, compared to the average annual increase in prevalence of T2DM of 1.8%. The biggest change was in sodium-glucose cotransporter-2 (SGLT2) inhibitors, for which there was an average annual increase in utilization of 59.4% (95% confidence interval [CI] 51.7%, 68.2%; p < 0.05) from 2014 (first full year of PBS listing), followed by glucagon-like peptide-1 receptor agonists (GLP-1RAs), which showed an increase of 31.4% (95% CI 28.5%, 33.8%; p < 0.05) annually (2013 to 2023). Dipeptidyl peptidase-4 inhibitor utilization tripled, with an average annual increase of 10.9% (95% CI 8.1%, 13.8%; p < 0.05), but this plateaued from 2020. Metformin utilization increased by 4.7% (95% CI 2.0%, 6.9%; p < 0.05) annually. In contrast, sulphonylurea, glitazone and acarbose utilization declined. Total GLD costs increased threefold over the same period. Despite only accounting for 11.7% of utilization, GLP-1RAs contributed to 35% of the costs.

Conclusion: Utilization of GLDs doubled, and associated costs tripled over the past 11 years, with no sign of either utilization or costs plateauing, predominantly due to increased GLP-1RA and SGLT2 inhibitor prescribing.

Keywords: GLP‐1 analogue; SGLT2 inhibitor; antidiabetic drug; database research; observational study; type 2 diabetes.

© 2024 The Author(s). Diabetes, Obesity and Metabolism published by John Wiley & Sons Ltd.

PubMed Disclaimer

• Zinman B, Wanner C, Lachin JM, et al. Empagliflozin, cardiovascular outcomes, and mortality in type 2 diabetes. N Engl J Med. 2015;373:2117‐2128.
• Wiviott SD, Raz I, Bonaca MP, et al. Dapagliflozin and cardiovascular outcomes in type 2 diabetes. N Engl J Med. 2019;380:347‐357.
• Wanner C, Inzucchi SE, Lachin JM, et al. Empagliflozin and progression of kidney disease in type 2 diabetes. N Engl J Med. 2016;375:323‐334.
• Husain M, Bain SC, Jeppesen OK, et al. Semaglutide (SUSTAIN and PIONEER) reduces cardiovascular events in type 2 diabetes across varying cardiovascular risk. Diabetes Obes Metab. 2020;22(3):442‐451.
• Oesterle A, Laufs U, Liao JK. Pleiotropic effects of statins on the cardiovascular system. Circ Res. 2017;120(1):229‐243.

LinkOut - more resources

Full text sources, miscellaneous.

• NCI CPTAC Assay Portal

• Citation Manager

NCBI Literature Resources

MeSH PMC Bookshelf Disclaimer

The PubMed wordmark and PubMed logo are registered trademarks of the U.S. Department of Health and Human Services (HHS). Unauthorized use of these marks is strictly prohibited.

• Supplements

The Forbes Health editorial team is independent and objective. To help support our reporting work, and to continue our ability to provide this content for free to our readers, we receive compensation from the companies that advertise on the Forbes Health site. This compensation comes from two main sources. First , we provide paid placements to advertisers to present their offers. The compensation we receive for those placements affects how and where advertisers’ offers appear on the site. This site does not include all companies or products available within the market. Second , we also include links to advertisers’ offers in some of our articles; these “affiliate links” may generate income for our site when you click on them.

The compensation we receive from advertisers does not influence the recommendations or advice our editorial team provides in our articles or otherwise impact any of the editorial content on Forbes Health. While we work hard to provide accurate and up-to-date information that we think you will find relevant, Forbes Health does not and cannot guarantee that any information provided is complete and makes no representations or warranties in connection thereto, nor to the accuracy or applicability thereof.

I Tried Thesis Nootropics—Here’s My Honest Review

Fact Checked

Have a question for Heidi Borst or our other editors?

Ask here for a chance to be featured in a story.

Send a note to Heidi Borst, Sarah Davis and our other editors. We read every email.

Keep reading Forbes Advisor for the chance to see the answer to your question in one of our upcoming stories. Our editors also may be in touch with follow-up questions.

Table of Contents

Our verdict, thesis nootropics at a glance, how does thesis nootropics work, how much does thesis nootropics cost, the product, my thesis nootropics experience, what experts say about thesis nootropics.

Thesis nootropic blends, which are nutritional compounds often used to boost brain function , are designed to enhance mood and cognitive performance based on your individual needs and goals. The Starter Kit allows users to sample four of Thesis’ nootropics blends to determine which is most effective for them.

While the supplements are pricey, I found the increased productivity and enhanced focus I experienced worth the cost.

• Supports memory, focus, and mental speed
• Helps optimize cognitive function
• Caffeine-free and gluten-free formula
• Sold over 10 million bottles
• Subscribe and you’ll save up to 35% off

Key Features

• Thesis nootropics are designed to enhance cognitive function and optimize brain performance by supporting mood, memory, focus, cognitive processing, creativity and motivation, according to the company.
• Ingredients and blends are third-party tested for quality and potency by an independent lab, according to the company.
• Products are backed by a 30-day money-back guarantee (with a maximum return limit of a one-month supply).

Dan Freed founded Thesis in 2017 after finding inspiration from his personal journey with nootropics. With company headquarters in New York, Thesis offers customized nootropics to support cognitive function and boost productivity.

• Thesis nootropics are sourced from vegan ingredients like saffron, ginkgo biloba, mango leaf and lion’s mane mushrooms that have been studied for their impact on mood and cognitive function.
• A Thesis Starter Kit costs $119; monthly subscriptions are available for $79.
• With the Thesis Starter Kit, you can try four of the six available blends—Motivation, Clarity, Creativity, Energy, Logic and Confidence—for six days each to determine which blend works best for your brain chemistry.

Thesis nootropics are designed to enhance specific elements of brain health, from focus to energy. To get started with Thesis, you can take an online survey or choose your own blends.

If you choose to complete the online quiz (the option recommended by Thesis), you’ll answer questions about the following:

• Your age, weight and identifying gender
• Areas you’d like to focus on, such as energy, motivation or mood
• How much caffeine you drink and how it affects you
• How often you exercise
• Whether you consume excess alcohol (five or more  drinks per day)
• Whether you smoke or vape
• How much sleep you get nightly
• How often you forget things

You’ll also rate your energy, sleep quality, productivity, focus, mood and anxiety levels. Once you finish the quiz, suggested blends based on your specific needs and goals are populated for purchase on the website. You can choose to purchase a one-time or monthly package.

Each Thesis Starter Kit contains four boxes of nootropic blends, each containing six sachets of capsules. Users can try  four recommended blends from the six available through Thesis. Capsules are taken first thing in the morning (on an empty stomach) for six consecutive days, followed by a one-day break to gauge  each blend’s results. You’re encouraged to write down how you feel, including any benefits and side effects you notice.

Customers have free and unlimited virtual access to wellness coaches. Sessions are 15 minutes each and must be scheduled in advance. During your first session, your coach  guides you through each customized blend, goes over the instructions and answers any questions you may have. If there’s a blend that’s not working for you, Thesis coaches can help you make adjustments to your plan.

Monthly subscriptions can be managed in your online profile, so you can choose which blends you’d like to receive after the initial period.

• Contains 1000mg of Organic Lion's Mane in every serving
• Formulated with organic reishi, lion’s mane, and Cordyceps sinensis
• Packed with bioactive constituents that promote overall health and longevity
• Informed Choice Certified for dosage, purity, and safety from banned substances

The Thesis Starter Kit is available on the company’s website for $119. Customers can also sign up for a monthly subscription plan for $79 (a discount of $40). Shipping is free.

My curated sampler kit, based on my survey results, contained the following blends.

This blend contains four capsules and is formulated to promote energy, fight fatigue and increase mental stamina. The key ingredient theacrine, which is a naturally-occurring compound found in plants, has been shown to improve energy levels, motivation and concentration, the company notes. It also contains N-acetyl cysteine (NAC), which research suggests possesses  promise as a supplement for cognitive function. However, clinical trials studying the effects of these two particular ingredients are inconclusive, and more research is needed.

That said, a large body of research supports the combination of caffeine and L-theanine (also contained in the Energy blend) for increased energy and attention, says Umo Callins, a board-certified sports dietitian and fitness coach at Well Rooted Health and Nutrition in Oklahoma City.

Active ingredients of the Energy blend include:

• Citicoline: 300 milligrams
• Mango leaf extract: 300 milligrams
• Indian trumpet leaf extract: 100 milligrams
• Theacrine: 100 milligrams
• N-acetyl L-tyrosine: 300 milligrams
• N-acetyl cysteine: 500 milligrams
• Caffeine: 100 milligrams
• L-theanine: 200 milligrams

This four-capsule blend is designed to spark imagination, maintain confidence and support verbal fluency, according to the company. The focus ingredient, ashwagandha, has been shown to reduce stress and anxiety in clinical trials. The blend also contains L-theanine, which may have relaxing effects, acting as a buffer for stress and anxiety.

Active ingredients of Creativity include:

• Ashwagandha root: 300 milligrams
• Panax ginseng: 200 milligrams
• Sceletium tortuosum: 25 milligrams
• Agmatine sulfate: 250 milligrams
• Alpha GPC: 150 milligrams

This blend, containing three capsules, is designed to help maintain willpower, prevent procrastination and manage stress, notes the company. The featured ingredient, CDT (Dynamine)—which is a patented, standardized form of methylliberine, a compound found in plants—may assist with cognitive control and improve reaction time during mentally challenging tasks, the company claims, but supporting research is limited.

Because the blend also contains caffeine and L-theanine, Callins says it will likely help with productivity, especially in a stressed or anxious state.

Active ingredients of Motivation include:

• Artichoke extract: 450 milligrams
• Vitamin B12 : 1,000 micrograms
• L-phenylalanine: 500 milligrams
• CDT (Dynamine): 100 milligrams
• Forskolin: 250 milligrams

Thesis claims that this three-capsule blend is designed to maintain focus, support attention and help individuals enter a flow state. According to the company, the featured ingredient, alpha-GPC, a compound found in the brain and in trace amounts in food sources like egg yolks and organ meats, supports healthy cognitive function and physical performance, but supporting research is limited. The blend also contains caffeine and L-theanine, which can help boost focus and attention, says Callins.

Active ingredients of Clarity include:

• Alpha-GPC: 500 milligrams
• Lion’s mane mushroom: 500 milligrams
• Camellia sinensis tea leaf: 278 milligrams
• Dihydroxyflavone: 30 milligrams

Elevate Your Mind, Unleash Your Potential

Boost your brainpower and seize every moment with Alpha BRAIN your key to enhanced cognitive performance and focus.

On Onnit's Website

The customized blends I received from Thesis were Energy, Clarity, Creativity and Motivation. For each blend, I followed the instructions as indicated, taking the supplements in the morning on an empty stomach (with a glass of water). I took each blend for six consecutive days, followed by a one-day break.

I didn’t notice much of a difference from my baseline mood or energy from the Creativity blend, and the Motivation blend gave me heartburn, so I stopped using it after a few days. According to Thesis, experiencing negative side effects is a sign the specific blend is not a fit, and you should move on to the next one. When I took the Energy blend before my morning workout, I experienced a mild boost to my mental and physical stamina.

Hands down, my favorite blend was Clarity. I was amazed by how big of an impact this nootropic blend had on my focus, attention and productivity. As someone with inattentive ADHD (a type of attention-deficit/hyperactivity disorder that manifests as distractibility and forgetfulness), tasks requiring sustained attention can be challenging. Clarity’s effects were noticeable immediately (within 30 minutes), and I had an incredible level of focus that lasted. I don’t take ADHD medication because it interferes with my sleep, so this was an exciting find.

I was pleasantly surprised by the effectiveness of Thesis nootropics. For me, Clarity was the most effective blend, but I enjoyed experimenting with different formulas. While it’s pricey, I’ll definitely use Thesis again, thanks to the huge improvement in focus and attention I experienced.

Nootropics, also referred to as cognitive enhancers or “smart drugs,” are natural or pharmaceutical substances used to boost brain activity and cognitive function, explains Callins. Potential benefits include improved memory, focus, thinking, learning and mood management, she says.

Although many nootropics are generally considered safe, Callins says consuming more than the recommended dose can result in mild side effects like dizziness, nausea and headaches. And while some of the ingredients in Thesis products may have cognitive benefits supported by research, she points out that more data on their long-term effects and safety is needed.

The bottom line? “Always consult with your doctor or primary health care practitioner before taking any supplement,” advises Callins, adding that some nootropics are contraindicated with certain medical conditions and medications.

• Kuhman DJ, Joyner KJ, Bloomer RJ. Cognitive Performance and Mood Following Ingestion of a Theacrine-Containing Dietary Supplement, Caffeine, or Placebo by Young Men and Women. Nutrients. 2015;7(11):9618-32.
• Skvarc DR, Dean OM, et al. The effect of N-acetylcysteine (NAC) on human cognition - A systematic review. Neurosci Biobehav Rev. 2017;78:44-56.
• Anas Sohail A, Ortiz F, et al. The Cognitive-Enhancing Outcomes of Caffeine and L-theanine: A Systematic Review. Cureus. 2021;13(12):e20828.
• Ashwagandha: Is it helpful for stress, anxiety, or sleep?. National Institutes of Health. Accessed 2/28/23.
• Wang L, Brennan M. How does the tea L-theanine buffer stress and anxiety. ? Food Science and Human Wellness. 2022;11(3):467-475.
• La Monica MB, Raub B, et al. Methylliberine Ingestion Improves Various Indices of Affect but Not Cognitive Function in Healthy Men and Women. Nutrients. 2023;15(21):4509.
• Parker AG, Byars A, et al. The effects of alpha-glycerylphosphorylcholine, caffeine or placebo on markers of mood, cognitive function, power, speed, and agility. J Int Soc Sports Nutr. 2015;12(Suppl 1):P41.
• Tamura Y, Takata K, et al. Alpha-Glycerylphosphorylcholine Increases Motivation in Healthy Volunteers: A Single-Blind, Randomized, Placebo-Controlled Human Study. Nutrients. 2021;13(6):2091.
• Malík M, Tlustoš P. Nootropics as Cognitive Enhancers: Types, Dosage and Side Effects of Smart Drugs. Nutrients. 2022;14(16):3367.
• Epstein JN, Loren RE. Changes in the Definition of ADHD in DSM-5: Subtle but Important. Neuropsychiatry (London). 2013;3(5):455-458.
• Best Multivitamins For Men
• Best Multivitamins For Women
• Best Protein Powder
• Best Whey Protein Powder
• Best Protein Powder For Weight Loss
• Best Protein Powder For Muscle Gain
• Best Protein Shakes
• Best Greens Powders
• Best Magnesium Supplements
• Best Pre-Workout
• Best Vitamin C Supplements
• Best Zinc Supplements
• Best Iron Supplements
• Best Vitamins For Energy
• Best Vitamins For Hair Growth
• Best Probiotic Supplements
• Best Collagen Powders
• AG1 (Athletic Greens) Review
• Your Guide To The Best Fish Oil Supplements
• I’m A Nutrition Scientist—Here’s Why I Take A Multivitamin
• Your Guide To Vitamin D: Benefits, Best Sources And More

Next Up In Supplements

• Best Pre-Workout Supplements
• Best Protein Powders
• Best Creatine Monohydrate Supplements
• Best Vitamin Brands
• Best Protein Powders For Weight Loss
• Best Vitamin D Supplements

More from  

Support your weight loss and ignite your metabolism with gnc, best vitamin c supplements of 2024, according to experts, 8 best turmeric supplements: expert-reviewed in 2024, best coq10 supplements of 2024, according to experts, a guide to the best vitamins and supplements for dry skin, i tried raw organic whey’s grass fed whey protein: here’s my honest review, bloom whey protein isolate review: tried and tested by a health editor.

Information provided on Forbes Health is for educational purposes only. Your health and wellness is unique to you, and the products and services we review may not be right for your circumstances. We do not offer individual medical advice, diagnosis or treatment plans. For personal advice, please consult with a medical professional.

Forbes Health adheres to strict editorial integrity standards. To the best of our knowledge, all content is accurate as of the date posted, though offers contained herein may no longer be available. The opinions expressed are the author’s alone and have not been provided, approved or otherwise endorsed by our advertisers.

Heidi Borst is a freelance journalist, healthcare content writer and certified nutrition coach with a love of all things health and wellness. Her work has appeared in The New York Times, The Washington Post, National Geographic, Good Housekeeping, MSN, Yahoo and more. Based in Wilmington, North Carolina, Borst is a lifelong runner and general fitness enthusiast who is passionate about the physical and mental benefits of sleep and self-care.

Sarah is an experienced writer and editor enthusiastic about helping readers live their healthiest and happiest lives. Before joining Forbes Health, Sarah worked as a writer for various digital publications including LendingTree, theSkimm, CNBC and Bankrate. When she isn’t writing or editing, you can find Sarah with her nose in a book or enjoying the outdoors with her French bulldog, Honey.

You must have JavaScript enabled in order to access this part of the site. Please enable JavaScript and then reload this page in order to continue.

WARNING: THIS IS A TEXAS HEALTH AND HUMAN SERVICES INFORMATION RESOURCES SYSTEM THAT CONTAINS STATE AND/OR U.S. GOVERNMENT INFORMATION. BY USING THIS SYSTEM YOU ACKNOWLEDGE AND AGREE THAT YOU HAVE NO RIGHT OF PRIVACY IN CONNECTION WITH YOUR USE OF THE SYSTEM OR YOUR ACCESS TO THE INFORMATION CONTAINED WITHIN IT. BY ACCESSING AND USING THIS SYSTEM YOU ARE CONSENTING TO THE MONITORING OF YOUR USE OF THE SYSTEM, AND TO SECURITY ASSESSMENT AND AUDITING ACTIVITIES THAT MAY BE USED FOR LAW ENFORCEMENT OR OTHER LEGALLY PERMISSIBLE PURPOSES. ANY UNAUTHORIZED USE OR ACCESS, OR ANY UNAUTHORIZED ATTEMPTS TO USE OR ACCESS, THIS SYSTEM MAY SUBJECT YOU TO DISCIPLINARY ACTION, SANCTIONS, CIVIL PENALTIES, OR CRIMINAL PROSECUTION TO THE EXTENT PERMITTED UNDER APPLICABLE LAW. ----------------------- AMA/ADA End User License Agreement LICENSE FOR USE OF CURRENT PROCEDURAL TERMINOLOGY, FOURTH EDITION ("CPT® ")

CPT only copyright 2023 American Medical Association. ALL rights reserved. CPT is a registered trademark of American Medical Association.

You, your employees and agents are authorized to use CPT only as contained in materials on the Texas Medicaid & Healthcare Partnership (TMHP) website solely for your own personal use in directly participating in healthcare programs administered by THHS. You acknowledge that AMA holds all copyright, trademark and other rights in CPT.

Any use not authorized herein is prohibited, including by way of illustration and not by way of limitation, making copies of CPT for resale and/or license, transferring copies of CPT to any party not bound by this agreement, creating any modified or derivative work of CPT, or making any commercial use of CPT. License to use CPT for any use not authorized herein must be obtained through the American Medical Association, Intellectual Property Services, 515 N. State Street, Chicago, Illinois, 60610. Applications are available at the American Medical Association website, www.ama-assn.org/go/cpt .

U.S. Government Rights

This product includes CPT which is commercial technical data and/or computer databases and/or commercial computer software documentation, as applicable which were developed exclusively at private expense by the American Medical Association, 515 North State Street, Chicago, Illinois, 60610. U.S. Government rights to use, modify, reproduce, release, perform, display, or disclose these technical data and/or computer databases and/or computer software and/or computer software documentation are subject to the limited rights restrictions of DFARS 252.227-7015(b)(2) (November 1995) and/or subject to the restrictions of DFARS 227.7202-1(a) (June 1995) and DFARS 227.7202-3(a) (June 1995), as applicable for U.S. Department of Defense procurements and the limited rights restrictions of FAR 52.227-14 (June 1987) and/or subject to the restricted rights provisions of FAR 52.227-14 (June 1987) and FAR 52.227-19 (June 1987), as applicable, and any applicable agency FAR Supplements, for non-Department of Defense Federal procurements.

Disclaimer of Warranties and Liabilities

CPT is provided "as is" without warranty of any kind, either expressed or implied, including but not limited to the implied warranties of merchantability and fitness for a particular purpose. Fee schedules, relative value units, conversion factors and/or related components are not assigned by the AMA, are not part of CPT, and the American Medical Association (AMA) is not recommending their use. The AMA does not directly or indirectly practice medicine or dispense medical services. The responsibility for the content of this product is with THHS, and no endorsement by the AMA is intended or implied. The AMA disclaims responsibility for any consequences or liability attributable to or related to any use, non-use, or interpretation of information contained or not contained in this product.

This Agreement will terminate upon notice if you violate its terms. The AMA is a third party beneficiary to this Agreement.

Should the for egoing terms and conditions be acceptable to you, please indicate your agreement and acceptance by clicking below on the button labeled "accept".

These materials contain Current Dental Terminology, Fourth Edition (CDT), Copyright © 2023 American Dental Association (ADA). All rights reserved. CDT is a trademark of the ADA.

THE LICENSE GRANTED HEREIN IS EXPRESSLY CONTINUED UPON YOUR ACCEPTANCE OF ALL TERMS AND CONDITIONS CONTAINED IN THIS AGREEMENT. BY CLICKING BELOW ON THE BUTTON LABELED "ACCEPT", YOU HEREBY ACKNOWLEDGE THAT YOU HAVE READ, UNDERSTOOD, AND AGREED TO ALL TERMS AND CONDITIONS SET FORTH IN THIS AGREEMENT.

IF YOU DO NO AGREE WITH ALL TERMS AND CONDITIONS SET FORTH HEREIN, CLICK BELOW ON THE BUTTON LABELED "DO NOT ACCEPT" AND EXIT FROM THIS COMPUTER SCREEN.

IF YOU ARE ACTING ON BEHALF OF AN ORGANIZATION, YOU REPRESENT THAT YOU ARE AUTHORIZED TO ACT ON BEHALF OF SUCH ORGANIZATION AND THAT YOUR ACCEPTANCE OF THE TERMS OF THIS AGREEMENT CREATES A LEGALLY ENFORCEABLE OBLIGATION OF THE ORGANIZATION. AS USED HEREIN, "YOU" AND "YOUR" REFER TO YOU AND ANY ORGANIZATION ON BEHALF OF WHICH YOU ARE ACTING.

1. Subject to the terms and conditions contained in this Agreement, you, your employees and agents are authorized to use CDT only as contained in the following authorized materials and solely for internal use by yourself, employees and agents within your organization within the United States and its territories. Use of CDT is limited to use in programs administered by Centers for Medicare & Medicaid Services (CMS). You agree to take all necessary steps to ensure that your employees and agents abide by the terms of this agreement. You acknowledge that the ADA holds all copyright, trademark and other rights in CDT. You shall not remove, alter, or obscure any ADA copyright notices or other proprietary rights included in the materials.

2. Any use not authorized herein is prohibited, including by way of illustration and not by way of limitation, making copies of CDT for resale and/or license, transferring copies of CDT to any party not bound by this agreement, creating any modified or derivative work of CDT, or making any commercial use of CDT. License to use CDT for any use not authorized herein must be obtained through the American Dental Association, 211 East Chicago Avenue, Chicago IL 60611. Applications are available at the American Dental Association web site, http://www.ADA.org .

3. U.S. GOVERNMENT RIGHTS. Applicable Federal Acquisition Regulation Clauses (FARS)\Department of Defense Federal Acquisition Regulation Supplement (DFARS) Restrictions Apply to Government Use. This product includes CDT, which is commercial technical data and/or computer data bases and/or commercial computer software and/or commercial computer software documentation, as applicable, which was developed exclusively at private expense by the American Dental Association, 211 East Chicago Avenue, Chicago Illinois, 60611. U.S. Government rights to use, modify, reproduce, release, perform, display, or disclose these technical data and/or computer data bases and/or computer software and/or computer software documentation are subject to the limited rights restrictions of DFARS 252.227-7015(b)(2) (June 1995) and/or subject to the restrictions of DFARS 227.7202-1(a) (June 1995) and DFARS 227.7202-3(a) (June 1995), as applicable for U.S. Department of Defense procurements and the limited rights restrictions of FAR 52.227-14 (June 1987) and/or subject to the restricted rights provisions of FAR 52.227-14 (June 1987) and FAR 52.227-19 (June 1987), as applicable, and any applicable agency FAR Supplements, for non-Department of Defense Federal Procurements.

4. ADA DISCLAIMER OF WARRANTIES AND LIABILITIES. CDT is provided “as is” without warranty of any kind, either expressed or implied, including but not limited to, the implied warranties of merchantability and fitness for a particular purpose. No fee schedules, basic unit, relative values or related listings are included in CDT. The ADA does no t directly or indirectly practice medicine or dispense dental services. The sole responsibility for the software, including any CDT and other content contained therein, is with TMHP or the CMS; and no endorsement by the ADA is intended or implied. The ADA expressly disclaims responsibility for any consequences or liability attributable to or related to any use, non-use, or interpretation of information contained or not contained in this file/product. This Agreement will terminate upon notice to you if you violate the terms of the Agreement. The ADA is a third party beneficiary to this Agreement.

5. CMS DISCLAIMER. The scope of this license is determined by the ADA, the copyright holder. Any questions pertaining to the license or use of the CDT should be addressed to the ADA. End Users do not act for or on behalf of the CMS. CMS DISCLAIMS RESPONSIBILITY FOR ANY LIABILITY ATTRIBUTABLE TO END USER USE OF THE CDT. CMS WILL NOT BE LIABLE FOR ANY CLAIMS ATTRIBUTABLE TO ANY ERRORS, OMISSIONS, OR OTHER INACCURACIES IN THE INFORMATION OR MATERIAL COVERED BY THIS LICENSE. In no event shall CMS be liable for direct, indirect, special, incidental, or consequential damages arising out of the use of such information or material.

The license granted herein is expressly conditioned upon your acceptance of all terms and conditions contained in this agreement. If the foregoing terms and conditions are acceptable to you, please indicate your agreement by clicking below on the button labeled "ACCEPT". If you do not agree to the terms and conditions, you may not access or use the software. Instead, you must exit from this computer screen.

Summary of July 2024 Drug Utilization Review Board Meeting Now Available

The Texas Drug Utilization Review (DUR) Board met on Friday, July 26, 2024, to recommend Medicaid clinical prior authorizations and drugs for the preferred drug list (PDL). A summary of this meeting is now available on the Texas Vendor Drug Program (VDP) website.

Clinical Prior Authorization Reminders

The following are reminders for clinical prior authorizations:

• Clinical prior authorizations for traditional Medicaid and Medicaid managed care organizations (MCOs) may differ. The Pharmacy Clinical Prior Authorization Assistance Chart identifies which MCO uses each prior authorization and how these prior authorizations relate to those used by VDP.
• Use the MCO search to find each MCO’s website with a list of its active clinical prior authorizations.

PDL Reminders

The following are reminders for the PDL:

• All PDL recommendations are pending until the Texas Health and Human Services Commission (HHSC) executive commissioner releases the final decision. HHSC will incorporate the approved decisions from the July and October 2024 board meetings into the PDL that will be published in January 2025.
• Prescribing providers must use the Medicaid formulary and PDL.
• MCOs should adhere to the Medicaid formulary and PDL. Providers should evaluate a drug’s formulary status before its preferred status.

Retrospective DUR Reminders

Retrospective DUR periodically examines claims data and other records to identify patterns of fraud, abuse, gross overuse, or inappropriate or medically unnecessary care made by prescribing providers, pharmacists, and people associated with specific drugs or groups of drugs. The retrospective review also allows for active and ongoing educational outreach to educate prescribing providers on common drug therapy problems to improve prescribing or dispensing practices.

About the Texas DUR Board

The board’s next meeting is scheduled for Friday, October 25, 2024. Board members meet quarterly in Austin to recommend outpatient prescription drugs in the Medicaid program. The schedule of upcoming meetings, instructions on submitting written materials to the board, and directions about publicly testifying in front of the board are available on the VDP website .

Email [email protected] with any comments or questions.