News

Provider acceptance, administrative hassles, program design remain the important challenges

Department of Labor files suit against a fraudulent plan

CIGNA and Aetna both involved in ERISA cases

Outcome of ERISA interpretation will affect care management programs including drug utilization review

Healthcare today is about choices

Two mergers might put a new spin on the PBM market

It only takes two clicks to vote for the thought leader who provided you with the most insight in 2003

New molecular entities and new formulations, FDA actions and generic approvals

Source: Atlantic Information Services, Drug Cost Management Report

Bea Leopold knows only too well how traumatic and potentially life-altering genetic testing can be. Having a sister with ovarian cancer and a mother who died of breast cancer convinced Leopold to be tested three-and-a-half years ago for the BRCA gene, which is predictive of both kinds of cancer.

All too often, the fundamentals of a sport, industry or discipline are learned at the early stages but then forgotten as an individual advances in knowledge and sophistication. And that, according to Joe Anderson, is the problem that has caused so many healthcare headaches over the years.

The continuing rise of resistance rates among bacteria today has led to the need for the development of new antibiotics with the ability to circumvent current resistance mechanisms. Daptomycin (Cubicin, Cubist Pharmaceuticals) is an injectable novel lipopeptide antibiotic shown to have excellent in vitro bactericidal activity against gram-positive organisms, including resistant isolates. First in the new class of lipopeptide antibiotics, daptomycin possesses a unique mechanism of action. Daptomycin was recently approved by FDA for the treatment of complicated skin and skin structure infections caused by susceptible strains of specific gram-positive microorganisms. Daptomycin may offer an alternative in the treatment of gram-positive infections, especially when resistance is suspected.

The continuing rise of resistance rates among bacteria today has led to the need for the development of new antibiotics with the ability to circumvent current resistance mechanisms. Daptomycin (Cubicin, Cubist Pharmaceuticals) is an injectable novel lipopeptide antibiotic shown to have excellent in vitro bactericidal activity against gram-positive organisms, including resistant isolates. First in the new class of lipopeptide antibiotics, daptomycin possesses a unique mechanism of action. Clinical studies in patients with complicated skin and skin structure infections have shown daptomycin to be similar in clinical cure rates compared to standard therapy. Daptomycin was recently approved by FDA for the treatment of complicated skin and skin structure infections caused by susceptible strains of specific gram-positive microorganisms. Daptomycin may offer an alternative in the treatment of gram-positive infections, especially when resistance is suspected.

The direct and indirect healthcare costs associated with multiple sclerosis are high. In the managed care setting, before treatment is initiated, these costs must be reconciled with other factors such as the epidemiological and clinical features of MS and current recommendations for pharmacologic management. Managed care organizations (MCOs) have the opportunity to improve the outcomes of MS through a system of care. MCOs can also manage the costs of the 2 first-line therapies (glatiramer and agents from the interferon class) used to treat MS by using stepped care and preferred formulary designations. In addition, improved outcomes can be achieved by establishing a disease management approach to treat MS.

For publicly traded managed care firms

Hosptial program aligns high-cost clinical areas and financial strategies to realize benefits of the latest innovations

Avoid the want-book trap

HAP CEO CLevel Killingsworth seeks a savings plan, but only if it reduces overuse and misuse of care

Stock options are an important form of executive compensation

Tools for each moment in care appeal to members who want to make smarter decisions

Uninsured workers need coverage, but opponeents say law is preemted by ERISA

There are inherent challenges and opportunities for DM

Any bill paid on time means good news for an MCO, right? Not so fast. What if it wasn't paid properly? What if the provider or hospital facility was under- or overpaid? When processing medical claims, it pays-literally-for managed care organizations and providers to get it right the first time.

The devil might be in the details, but that's where the hope for redemption is, too. Money-saving strategies are nothing new in the healthcare industry, but ones that can save more than $11 million a year-without a single budget cut, no less-are a little more difficult to generate.

An important annual survey finds that employers see few options beyond tearing some holes in the vaunted consumer insulation against the cost of health care.

A recent "Dear Healthcare Professional" letter issued by Wyeth outlines the potential risks associated with the company's antidepressant venlafaxine (Effexor and Effexor XR) when the drug is administered in the pediatric population. The letter, dated August 22, 2003, cites data from clinical studies in pediatric patients (aged 6­17 y) and details changes that have been made to the labeling for venlafaxine. Venlafaxine has been prescribed off-label in the pediatric population despite never being approved by FDA for use in children or adolescents.

As patient-based strategies promote acceptance and wider use of generic drugs, managed care organizations' (MCOs's) tools now include aggressive voucher programs that go so far as to provide preprinted prescription blanks for patients to take to their doctors.

Benzodiazepines are the gold standard for the treatment of insomnia. However, because of their potential for pharmacologic dependence and withdrawal reactions upon discontinuation, they are neither recommended or FDA-approved for chronic use. The novel cyclopyrrolone eszopiclone (es zoe pik? lone) (Estorra, Sepracor) is a stereoselective isomer of the agent zopiclone, which has been available in Europe for more than a decade. Clinical trials in patients with chronic insomnia suggest the medication may help manage both transient and chronic insomnia with minimal side effects. The most commonly reported side effect with the agent is a bitter taste. The apparent efficacy and favorable side effect profile together with its potential for obtaining the first indication for the management of chronic insomnia in the United States make eszopiclone an attractive therapeutic option. If the drug is approved by FDA, a key issue for formulary decision-makers will be whether to make it openly available or through prior authorization for specific clinical situations. Eszopiclone?s pricing may ultimately determine its use by clinical psychiatrists and reimbursement by insurers.

One of the primary goals in today?s medical environment is to find treatments that provide positive clinical outcomes but also satisfy pressures on healthcare professionals and hospitals to deliver care as cost effectively as possible. To attain this goal, a hospital must have a pharmacy and therapeutics committee that is both scientifically and economically sound. Based on the experience of over 25 years each of the former chairman of the pharmacy and therapeutics committee (R. Quintiliani) and the director of Drug Information Services (R. Quercia) at Hartford Hospital, a large tertiary hospital in Connecticut, this article addresses ways to accomplish this goal, with particular attention given to anti-infective agents.

No matter what happens outside the industry, we provide a vital service that will endure whatever else society must contend with. In this respect at least, some might argue that healthcare is recession-proof.