News

Aggressive lipid-lowering with high-dose atorvastatin initiated immediatelyafter hospitalization for an acute coronary syndrome (ACS) significantlyreduces the risk of long-term adverse cardiovascular outcomes compared withlipid-lowering with standard-dose pravastatin. As such, target levels oflow-density lipoprotein cholesterol (LDL-C) may need to be lower than theones currently recommended in patients at risk of cardiovascular events,said Christopher Cannon, MD, at the 53rd annual scientific session of theAmerican College of Cardiology in New Orleans.

Chronic obstructive pulmonary disease (COPD) is a major public health problem, with inhaled anticholinergic agents being the treatment of choice. The disadvantage of currently approved therapies for the treatment of COPD is that agents such as ipratropium (Atrovent, Boehringer Ingelheim) must be administered numerous times daily. Tiotropium (Spiriva, Pfizer/Boehringer Ingelheim) is a new, recently FDA-approved, long-acting anticholinergic drug that requires only once-daily dosing. Tiotropium displays selective receptor kinetics by dissociating more slowly from M1 and M3 receptors than M2 receptors. In patients with COPD, tiotropium 18 mcg inhaled once daily results in significant improvement in lung function. Furthermore, improvements appear sustained for up to 3 weeks after discontinuing tiotropium. Tiotropium is well tolerated with minimal systemic absorption resulting in a favorable adverse effect profile. The most common adverse effect associated with tiotropium is dry mouth. Given the longer duration of action, once-daily dosing, minimal adverse effects, and documented improvements in lung function, tiotropium is poised to replace ipratropium as the inhaled anticholinergic of choice.

One of the most common ophthalmic conditions that directs a patient to a primary-care physician or eye-care practitioner is the red, itchy eye. The highest percentage of conjunctivitis is noninfectious or inflammatory, and frequently these cases are allergic in nature. The ophthalmic armamentarium is now filled with a number of pharmaceutical compounds that act specifically at different points along the inflammatory cascade. Formulary decision-making should be based on sound knowledge of the ocular inflammatory cascade and the pathways through which the various ophthalmic antiallergic preparations exert their anti-inflammatory effects.

FDA rolls out new policies on DTC advertising,counterfeit drugs, and bar codes before McClellan departs

McClellan takes over at CMS amidst escalating battle over drug imports

Seniors mount campaign to ensure lower drug prices

AAHP and HIAA become AHIP

Cost resurgence provides plans with an opportunity to prove value

Humble beginnings are often the first step to greatness--as long as we remember our raison d'etre

Analysis of the April DTR chart

Is DM best delivered through traditional FFS Medicare or through competing private plans?

MCOs are familiar with carve-outs and will increasingly use them for transplants and more

Also see this month's Pharmacy Best Practices

Ranked by number of lives with network access

PBMs, associations, pharmacies and plans see discount cards as natural extensions of their service offerings for seniors

Chart

The growth of healthcare spending slowed in 2003-7.8% compared with 9.3% in 2002-but according to the Centers for Medicare & Medicaid Services (CMS), employers are not impressed.

Raised in Trinidad and Tobago, West Indies, Dr. Valerie Beckles, a pediatrician and medical director for Aetna's Southeast Region, graduated from medical school in Jamaica then trained in London and Nassau, Bahamas, before practicing in Texas and transitioning into administration in recent years. Her broad background has allowed her to bring perspective to patient care and the diversity issues that arise in healthcare today.

The most enduring changes are those that come from the inside. Improvements that arise from outside pressure sometimes fade away once that influence is removed, especially when the changes are hard to make.

Fosamprenavir (Lexiva, GlaxoSmithKline/Vertex) is the latest protease inhibitor (PI) approved by FDA for the treatment HIV-1 infection. A prodrug of amprenavir (APV), fosamprenavir has improved solubility and bioavailability over the parent PI, allowing for once- or twice-daily dosing and a decreased pill size and burden. In clinical trials, fosamprenavir was studied alone or boosted with ritonavir (RTV) in both HIV treatment-naïve and -experienced patients. In both patient populations, fosamprenavir decreased HIV RNA, increased CD4 cell counts from baseline, and increased the proportion of patients reaching undetectable viral loads (<400 and <50 copies/mL). Patients who received treatment with fosamprenavir demonstrated protease gene mutations different than those commonly seen with other PIs (except APV). Fosamprenavir appears to have an adverse effect profile similar to that of other PIs.

One of the primary etiologies of acute renal failure (ARF) is nephropathy secondary to the administration of radiocontrast dye. In the United States alone, the cost of ARF-related expenses is estimated at more than $8 billion per year. Since ARF contributes such a substantial burden to the cost of healthcare and may be associated with significant morbidity and mortality, initiatives to educate pharmacists, physicians, and other health-care providers about how to decrease the incidence of radiocontrast-induced ARF are warranted. It is important to identify patients at risk for developing this pathology and to play an active role in disease state prevention. This review covers the pathogenesis, signs and symptoms, and current treatment options for reducing the risk of radiocontrast-induced nephropathy. Current pharmacotherapy focuses on the use of aggressive hydration before and after the administration of a contrast agent. Clinical trials evaluating the application of periprocedural drugs are also reviewed.

For some, an investigational clinical trial can seem like the opportunity for a miracle; for others, it is an altruistic donation to science that might be used to help others. It also can be a means of receiving treatment for people with chronic conditions who have few resources, or it can be viewed cynically by critics of the pharmaceutical industry.

Later this year, U.S. Surgeon General Dr. Richard Carmona will release a report, "The Health Consequences of Smoking," and a new database of medical research, treatment and smoking prevention information. This year's report will come 40 years after Americans first learned there were significant consequences of smoking, thanks to the efforts of then-Surgeon General Dr. Luther Terry, who was appointed during the Kennedy administration.

Organizational, operation review required for building health savings accounts

Consumers who receive guidance from their plans about the pharmacy benefit tend to make wiser choices

New cost estimate rises to $534 billion over 10 years, up from $410 billion

Insurers, PBMS back cards to gain market foothold, Medicare experience

A national health system recognized that its internal process was not improving