Many residents WITH OAB could benefit from TREATMENT1
These considerations may help you identify residents with OAB who could benefit from treatment
- Has been diagnosed with OAB (N32.81*)2
- Consistently expresses the need to urgently urinate3
- Has had a “triggering event” (such as a fall, fracture, UTI, or complaint regarding UI)4-6
- Rated incontinent based on the MDS 3.0 assessment7†
- Has been using or is scheduled to use absorbent products regularly8
- Currently uses (or has previously used) an OAB medication that is not (or was not) achieving treatment goals3
*The ICD-10 code is the standard diagnostic tool for epidemiology, health management, and clinical purposes.
†MDS 3.0 is a resident assessment and care screening criteria for nursing homes.
Nothing in this site is intended to serve as reimbursement advice.
The decision about which code to report must be made by the provider/physician considering the clinical facts, circumstances, and applicable coding rules.
Factors to consider when evaluating OAB medications for long-term care residents
Before choosing a medication, assess the following:
- Symptom reduction
GEMTESA provides urgency improvement.
Safety & Tolerability
- Side effect profile
- Drug-drug interactions (DDIs)
- Long-term complications
- Contraindications, warnings, and precautions
GEMTESA has proven safety and tolerability.
Dosing & Administration
- Number of doses per day
- Titration requirements
- Crushable vs non-crushable
- Can be taken with or without food
GEMTESA is a crushable dose. In adults, GEMTESA tablets may be crushed, mixed with a tablespoon (~15 mL) of applesauce and taken immediately with a glass of water.
After choosing a medication, patient access may be a factor
- Insurance coverage
GEMTESA provides support to help facilitate the PA/appeal process.
References: 1. Willis-Gray MG, Dieter AA, Geller EJ. Evaluation and management of overactive bladder: strategies for optimizing care. Res and Rep Urolo. 2016;8:113-122. 2. 2021 ICD-10-CM Codes for other diseases of the urinary system (N30-N39). ICD-10 Index. Accessed January 27, 2021. https://icdlist.com/icd-10/index/other-diseases-of-the-urinary-system-n30-n39 3. Gormley EA, Lightner DJ, Burgio KL, et al. Diagnosis and treatment of overactive bladder (non-neurogenic) in adults: AUA/SUFU guideline. J Urol. 2012;188(suppl 6):2455-2463. 4. Jayadevappa R, Chhatre S, Newman DK, Schwartz JS, Wein AJ. Association between overactive bladder treatment and falls among older adults. Neurourol Urodyn. 2018;37(8):2688-2694. doi:10.1002/nau.23719 5. Szabo SM, Gooch KL, Walker DR, Johnston KM, Wagg AS. The association between overactive bladder and falls and fractures: a systematic review. Adv Ther. 2018;35(11):1831-1841. doi:10.1007/s12325-018-0796-8 6. Perk S, Wielage RC, Campbell NL, et al. Estimated budget impact of increased use of mirabegron, a novel treatment for overactive bladder. J Manag Care Spec Pharm. 2016;22(9):1072-1084. doi:10.18553/jmcp.2016.22.9.1072 7. Centers for Medicare & Medicaid Services. MDS 3.0 frequency report. Accessed January 27, 2021. https://www.cms.gov/Research-Statistics-Data-and-Systems/Computer-Data-and-Systems/Minimum-Data-Set-3-0-Public-Reports 8. Freeman R, Foley S, Rosa Arias J, et al. Mirabegron improves quality-of-life, treatment satisfaction, and persistence in patients with overactive bladder: a multi-center, non-interventional, real-world, 12-month study. Curr Med Res Opin. 2018;34(5):785-793. doi:10.1080/03007995.2017.1419170