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Managed care coverage for specific drug classes

BREAST CANCER is the most common cancer found in women, and the second leading cause of cancer deaths in women. More than 200,000 new cases of invasive breast cancer are diagnosed in the United States each year, approximately 77% of them in women over 50 years of age.

WHEN HUMANS WALKED on the moon during the Apollo era, visionaries were foretelling the development of colonies in outer space. Meanwhile, Earthbound communities experienced explosive growth, producing the modern suburb with its housing developments and urban sprawl.

You don't have to be in the healthcare industry for long before it becomes obvious that change is the only constant. Late in 2004, Christopher Koller conducted an interview with MANAGED HEALTHCARE EXECUTIVE and talked about his job as CEO of Providence-based Neighborhood Health Plan of Rhode Island (NHPRI), which was created in 1993 by the state's 14 Community Health Centers.

LAST FALL, THE CENTERS for Medicare and Medicaid Services (CMS) and the National Association of Insurance Commissioners (NAIC), published a memorandum providing guidance to state regulators regarding the licensure and regulation of Medicare Advantage (MA) organizations.

EVERY SO OFTEN, something in healthcare really captures my imagination. I am frequently amazed by the innovation, intelligence and dedication of the people who work in this industry, but once in a while something special will happen and I'll think, "I'm going to remember this for the rest of my life."

First prescription sleep aid not limited to short-term use

First inhaled prostacyclin approved for pulmonary arterial hypertension

If approved, cilansetron (Calmactin, Solvay Pharmaceuticals) would be the second selective 5-HT3 antagonist introduced for the treatment of irritable bowel syndrome (IBS). Based on 2 main clinical trials, cilansetron 2 mg orally 3 times daily appears to be effective in the relief of IBS-D symptoms (abdominal pain/discomfort) and abnormal bowel habits in both male and female patients. Adverse effects were minor, with constipation being the most commonly reported adverse effect. No information is currently available on cilansetron's potential for drug interactions, need for dose adjustments in renal or hepatic insufficiency, long-term safety, or cost. Cilansetron was granted priority review status by FDA on September 1, 2004, for the treatment of diarrhea-predominant IBS in men and women. Currently marketed agents for the treatment of IBS are only approved for use in female patients.

Medicaid: Top 20 States by Enrollment

Recent Acquisitions of companies specializing in consumer-driven health plans (CDHPs) may lead to further product innovation and competition in the managed care market.

Politics are a very strange animal. The vehemence brought to the table by the extreme left and right, and just about everyone in between, strikes me as both frightening and encouraging.

Medicaid enrollment is up in 18 of the top 20 states

At a minimum, healthcare organizations must show an ongoing effort to assess their level of compliance. And for many, compliance is uncharted territory where processes, costs and solutions are unknown.

From a compliance standpoint, one medical center wanted to make sure that none of its personal health information (PHI) was leaving the network.

For those healthcare providers and payers who still believe large claims clearinghouses are the only way to reduce administrative costs, it may be time to think again.

Medicaid: Top 20 States by Enrollment

Paying physicians for performance is one of managed care's hottest trends.

New entities and actions in brief

Sexually Transmitted infections (STIs) such as syphilis, gonorrhea, herpes and chlamydia are a major health concern in the United States.

A possible hospice barrier is the requirement that patients forego further curative care.

As George Bernard Shaw once said, "Nothing is ever done in this world until men are prepared to kill one another if it is not done." While accidental fatalities, even those caused by preventable mistakes and human errors, are a far cry from murder, Don Berwick, MD, has seen enough death. He's also heard enough rhetoric about ways to improve healthcare quality.

The American Heart Association (AHA) Scientific Sessions comprise the largest meeting of its kind held in the cardiovascular field, with several thousand presentations given each year. The recently concluded 2004 AHA Scientific Sessions, which took place in New Orleans, included presentations of trials that evaluated potential therapeutic compounds, as well as widely used and accepted compounds in new dosages or combinations, for the treatment of cardiovascular disorders. The compilation of clinical news that follows focuses on the cardiovascular pharmacotherapy trials of greatest interest to formulary decision-makers, including: CREATE, PEACE, A-HeFT, PROTECT, CLEAR Platelets, DIPOM, GEMINI, SHIELD, and RIO-NA.

Secretary Tommy G. Thompson resigns, EPA administrator Michael Leavitt nominated replacement; HHS purchases 1.2 million doses of flu vaccine

A review of select agents in late-stage development for the treatment of arrhythmia, congestive/chronic heart failure, and pulmonary hypertension (PDF) (January 2005)

Serious infections due to the Aspergillus and Candida species and other filamentous fungi have emerged as an increasing cause of infectious morbidity and mortality in the United States and globally. The most notable explanation for this increase is a rise in the number of immunocompromised patients due to advances in transplantation, the emergence and prevalence of Acquired Immunodeficiency Syndrome (AIDS), and an increase in the number of invasive surgical procedures. 1-3 Treatment of these infections with currently available standard antifungal agents such as amphotericin B, itraconazole, and fluconazole still results in an unacceptably high associated mortality. 3. Furthermore, many of these antifungal agents have limitations, including dose-limiting toxicity, drug-drug interactions, and fungal resistance. 4-10

Transparency among PBMs continues to be an important strategy that should be approached openly.

Small business has its own distinct list of needs for health benefits.