Pharmacy

Despite systemic challenges in caring for stroke patients, a care program developed by the American Stroke Assn. has shown promise in improving outcomes.

PITTSBURGH?Healthcare leaders need to be well-versed in leading change as healthcare delivery changes, according to industry experts.

About 60 million Americans a year experience insomnia often, or for extended periods of time, leading to problems in job performance and other activities. Insomnia affects about 40% of women and 30% of men.

Are pharmacy benefits managers (PBMs) that rely onrevenue-generating mail-order prescription service going to get arun for their money as 90-day retail programs hit the marketplace?Walgreen Health Initiatives (WHI), a PBM headquartered inDeerfield, Ill., is not particularly bothered by the new retailproduct. WHI launched Advantage90, a 90-day retail fulfillmentprogram, in late 2003 with more than 26,000 pharmacies nationwidenow participating in the program.

As the Centers for Medicare and Medicaid Services (CMS) tackles a host of start-up problems for the new Medicare prescription drug program, Administrator Mark McClellan, MD, is looking for ways to improve the system for next year. CMS has revised policies and updated information systems for Prescription Drug Plans (PDPs) and Medicare Advantage prescription drug plans (MA-PDs) in preparation for the 2007 contracting process, which begins in June.

The challenges of medical versus pharmacy benefits faced by payers are unique and vary by category, say industry watchers (See Desktop Resource, March 2006). Some of the following drug classes can fall under both benefit arrangements.

Savvy executives note challenges in pharmacy versus medical benefits, say industry experts.

In the United States today, 10 million people have osteoporosis (bone density that's about 25% less than a healthy young adult). In addition, 34 million more people have low levels of bone mass, placing them at increased risk. Osteoporosis is responsible for more than 1.5 million fractures annually, including 300,000 hip fractures, approximately 700,000 vertebral fractures, 250,000 wrist fractures, and more than 300,000 other fractures. About 68% of those affected by osteoporosis are women.

If misery loves company, then Beverly Thomas of Carbondale, Ill.,isn't alone. She is one of thousands of dual eligibles(beneficiaries covered by both Medicaid and Medicare) who went tothe pharmacy after January 1, 2006, only to find that it would notfill their prescriptions. Unfortunately, her medication for mentalillness is so critical that if she misses even a day, she could behospitalized. With the help of Southern Illinois Regional SocialServices, Thomas got squared away, but admits she still is confusedabout how the new Medicare Part D benefit operates.

WASHINGTON, D.C. -- Some pharmaceutical companies are dropping Patient Assistance Programs (PAPs) for seniors who enroll in the Medicare drug benefit program. They fear they'll be hit with fraud charges by the Office of the Inspector General (OIG) at HHS if they provide free or low-cost drugs to Medicare beneficiaries enrolled in prescription drug plans.

New molecular entities

Government, Employers, medical associations, payers, and many others are part of a nationwide momentum toward making electronic health records (EHRs) a reality. President Bush has cited the necessity to create EHRs, leading politicians of both parties have issued joint statements, and some states have accelerated activities. A number of initiatives by the Department of Health and Human Services (HHS), standards development organizations, and other groups are moving several issues ahead.

New molecular entities

When cultures enter Renaissance periods, new learning and ideas create transition. Heightened interest in the workings of pharmacy benefit management and subsequent changes in business philosophy represent a Renaissance for managed care. All key stakeholders will feel the ripples of change: payers, physicians, pharmacists, patients and pharmaceutical companies.

The Food and Drug Administration's (FDA) steps to advance the earliest phases of clinical research in the development of innovative medical treatments will have little short-term impact on managed care plans.

Medical registries have been used for many different purposes, including surveillance of rates of different diseases, rates of adverse events associated with medical interventions, rates of short-and long-term outcomes associated with medical interventions, quality improvement activities, post-marketing pharmaceutical intervention outcomes, diffusion of medical interventions and regional, racial and gender disparities.

The Medicare Payment Advisory Commission (Medpac) is conducting a survey to find out what factors have prompted Medicare beneficiaries to join or not join a Medicare drug plan. The aim is to learn more about what information and educational strategies are most useful in choosing a specific plan—including what may influence the selection of a stand-alone prescription drug plan (PDP) or a Medicare Advantage plan (MA-PD).

Total outlays for U.S. healthcare did not rise as fast as expected in 2004, primarily because private payers held the line on insurance premiums and outlays for prescription drugs. Overall spending on healthcare still increased by 7.9%—much faster than the rate of inflation—but below the 8% to 9% growth rates of the two previous years. Even with slower growth, though, U.S. healthcare expenditures amounted to almost $2 trillion, or more than $6,000 per person in 2004, and accounted for 16% of the nation's gross domestic product, about the same as the previous year.

If the united states' healthcare trend continues on its current course, in 20 years the number of people with diabetes will more than double to 50 million. This dismaying prediction comes from a new report from the Yale Schools of Public Health and Medicine in conjunction with the Institute for Alternative Futures. If the current trend continues, by 2025

A value-based formulary enables the payer and pharmacy benefit partner achieve lower net cost.

On a national level, the Medicaid population has grown by 11 million since 1996 and has increasingly spread into managed care. Ten years ago, 40.1% of the 33 million Medicaid enrollees were covered by managed care plans, and as of June 2004, 60.6% of 44 million enrollees were covered by managed care, according to the Centers for Medicare and Medicaid Services.

Seattle—With pharmaceutical costs being the fastest increasing component of healthcare costs, it is important that managed care executives adopt policies that use the best-available evidence to compare the benefits, risks and costs of drugs to include in their health plan formularies.

Washington, d.c.—The advent of Medicare prescription drug coverage for seniors is not prompting large employers to abandon retiree drug benefits, at least not for this year. Most large businesses are accepting federal government subsidies for retiree drug coverage in 2006, although there are signs that this could change over the next five years.

Today's Approach to interventions that address chronic disease and conditions is both broader and deeper than ever before. But there is another group of patients who rarely, if ever, directly benefit from these programs. According to Alan Wright, MD, former chief medical officer of TheraCom, these are patients who might use more than $100,000 a year in pharmaceutical spending and/or resources, patients who have a disease that is progressive with no known cure. These are the patients who have a rare disease, such as pulmonary arterial hypertension (PAH), a rare blood vessel disorder characterized by increased pressure in the pulmonary artery.

For some insurers, television ads have taken center stage.