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For payers struggling with unmanageable cost increases in the business of delivering care, however, price cannot be overlooked. Insurers don't necessarily deny coverage of a treatment just because it's expensive, but they would be remiss if they didn't take cost into consideration, as well as safety and effectiveness.

Perhaps it's no coincidence that former historian Jon Kingsdale, PhD, finds himself overseeing one of the most progressive healthcare initiatives in the country, the Massachusetts Commonwealth Health Insurance Connector Authority. The Connector facilitates the purchase of health insurance for individuals and small businesses across New England.

Choice of law issues arising from coverage disputes of both individual and group insurance policies many times determine which party will prevail on the merits of a particular case. Also, in today's mobile economy, insurance transactions frequently cross state boundaries.

Change was in the wind as the Medicare Part D open enrollment period began last month. Most seniors who belong to stand-alone prescription drug plans (PDPs) face premium increases.

Medicare is a difficult market to be in and is going to get even more challenging in the next few years, experts say.

A recent survey by the Employee Benefit Research Institute found that 70% of those enrolled in consumer-directed health plans (CDHP) say that they consider costs when deciding to see a doctor or filling a prescription as compared with fewer than 40% of those in a comprehensive plan. However, the survey also found that CDHP enrollees were twice as likely to avoid, skip or delay healthcare services.

Increased insurance coverage should boost demand for medical services which would highlight concerns about access to medical care, particularly outside of Boston.

Groups such as WellPoint are turning specialty pharmacy into a highly beneficial business model for everyone from the non-clinician to physicians.

Primary care physicians and pediatricians who do not measure childhood body mass index (BMI) are missing a prime opportunity to prevent cardiovascular disease later in life.

Persistence with statins is only approximately 50% by 12 months after therapy is started, with Spanish-speaking patients at highest risk of discontinuing therapy, said Michael H. Davidson, MD, during the American Heart Association Scientific Sessions, Nov. 3-7, 2007, in Orlando.

Therapeutic choices in interventional cardiology are often complicated by factors, such as gastrointestinal (GI) bleeding, left anterior descending coronary artery stenosis, thrombocytopenia, and uncontrollable angina.

A leading expert on global inequalities in cardiovascular healthcare challenged the American Heart Association to take the lead in reducing the burden of cardiovascular disease worldwide.

Antihypertensive treatment that works in the summer may not be sufficient for wintertime blood pressure (BP) control.

Ranolazine extended-release significantly reduced the level of hemoglobin (Hb) A1c in patients with diabetes, allowing more of them to achieve the clinical HbA1c treatment target of less than 7.0%.

Two new studies presented during the American Hospital Association Scientific Sessions, Nov. 3-7, 2007, in Orlando, could speed the replacement of abciximab by eptifibatide in cardiac patients. EVA-AMI showed similar outcomes between the two drugs when used in percutaneous coronary intervention (PCI) and BRIEF-PCI showed that a two-hour infusion of eptifibatide can be as effective as the standard 18-hour course following uncomplicated PCI procedures.

Bystanders and automated external defibrillators (AEDs) are a life-saving combination.

Prasugrel, a new antiplatelet agent in Phase 3 clinical trials, is superior to clopidogrel in preventing major adverse cardiac events in patients undergoing percutaneous coronary intervention (pCI), but is associated with an increase in the risk of major bleeding.

Real-time pharmacogenetic-guided dosing of warfarin does not lead to a reduction in prothrombin time international normalized ratios (INRs) out of the therapeutic range compared with standard warfarin dosing, although it did lead to smaller and less frequent warfarin dosing changes, reported Jeffrey L. Anderson, MD.

In older patients with advanced systolic heart failure, rosuvastatin added to standard heart failure medications failed to significantly reduce incidence of a composite of cardiovascular death, nonfatal myocardial infarction (MI), and nonfatal stroke compared with placebo, although it did reduce the incidence of all-cause and cardiovascular-related hospitalizations.

Asymptomatic peripheral artery disease (PAD) is becoming more prevalent, and at least among women, is associated with a significantly higher prevalence of obesity, Andrew D. Sumner, MD, said.

Parkinson disease (PD) is a chronic, progressive neurodegenerative disorder affecting approximately 1% of people aged >60 years. Levodopa has long been the cornerstone of PD treatment, but many patients receiving long-term levodopa therapy experience dyskinesia and motor fluctuations. Dopamine agonists act directly on dopamine receptors and are associated with a lower incidence of dyskinesias. There are 2 subclasses of dopamine agonists: ergot-derived and nonergot-derived. The use of ergot-derived dopamine agonists has declined in recent years due to the agents' association with valvular heart disease. Nonergot-derived dopamine agonists such as ropinirole and pramipexole are used more widely in the treatment of PD. Rotigotine is a nonergot-derived dopamine agonist that was approved by FDA on May 9, 2007, for the treatment of early-stage idiopathic PD. Rotigotine is the first approved nonergot-derived dopamine agonist that is delivered continuously through a transdermal silicone-based patch that is replaced..

A summary of agents in late-stage development for the treatment of Alzheimer's disease (November 2007).

An investigational drug that combines niacin extended-release (ER) and laropiprant, a prostaglandin D2 receptor antagonist, reduces the flushing that often leads to niacin ER discontinuation while preserving the agent's beneficial effects on lipids, according to lead author Darbie Maccubbin, PhD, Merck Research Laboratories, Rahway, New Jersey, et al. The results of this research were presented at the European Society of Cardiology Congress 2007 in Vienna, Austria, September 1 to 5, 2007. The drug is pending FDA approval.

In a randomized, controlled, open-label trial in patients with peripheral arterial disease (PAD), it was demonstrated that antiplatelet therapy plus an oral anticoagulant was no better at preventing major cardiovascular complications than antiplatelet therapy alone. The combination therapy was also associated with a significant increase in life-threatening bleeding complications compared with monotherapy.

In a prespecified secondary analysis of the Metabolic Efficiency with Ranolazine for Less Ischemia in Non-ST Elevation Acute Coronary Syndromes (MERLIN)-TIMI 36 trial, ranolazine was associated with a reduction in the number of episodes of ventricular tachycardia and supraventricular tachycardia. The results of the analysis were presented at the European Society of Cardiology Congress 2007 in Vienna, Austria.

Questions about the safety of drug-eluting stents (DES) versus bare metal stents (BMS) persisted after 2 studies presented at the European Society of Cardiology (ESC) Congress 2007 in Vienna, Austria, demonstrated varying effects of DES and BMS on long-term mortality.

In the Blue Mountains Eye Study published in the American Journal of Ophthalmology, statin use was demonstrated to be protective against the development of cataracts, reducing a patient's risk by nearly half.

In 2 large, case-control studies published in the New England Journal of Medicine (NEJM), researchers demonstrated that, overall, a woman's use of a selective serotonin-reuptake inhibitor (SSRI) in early pregnancy was not associated with significantly increased risks of congenital heart defects or most other types of birth defects.