Pharmacy

JUST A FEW YEARS AGO, a three-tier formulary was a novelty; now more and more health plans and employers have introduced the design into their pharmacy benefits. The growth in the number of workers covered under a three-tier design has grown from 27% to 63% between 2000 and 2003.

New approvals and actions in brief

With Injectable Claims, the root problem in the submission process is that payers cannot read NDC numbers on CMS 1500 forms, and there is no process in place to require providers to include such a data element.

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 19% to 23% Annual Drug cost trend during the past three years was a wake-up call for Virginia Premier Health Plan, a Medicaid HMO in Richmond, Va. Relying on the services of the same pharmacy benefits manager (PBM) since the plan's inception in 1995, Virginia Premier sought a new PBM to bring costs into control. That role was filled by PerformRx, a PBM product offered by Philadelphia-based AmeriHealth Mercy Health Plan.

Consumers more and more are trying to take control of their own healthcare destinies. They are looking for more therapy alternatives so they can better manage their healthcare dollars.

New molecular entities

Migraine headaches can be so painful that patients want to stay in a dark, quiet room until the pain subsides. They have a throbbing or pulsating quality, and they're often only on one side of the head.

Although The U.S. Pharmacopeia's (USP) interim Medicare Prescription Drug Benefit Draft Model Guidelines recommend a drug classification system, CMS will consider other alternatives as long as the formularies provide preferred access to a broad range of widely used drugs.

The Vioxx debacle is providing ample fodder for critics of direct-to-consumer advertising.

In evaluating and approving proposals from Medicare prescription drug plans (PDPs), CMS says it will examine a plan's formulary list, pharmacy and therapeutics (P&T) committee operations, and benefit management tools, such as prior authorization and appeals and exceptions policies.

FDA new indications and the latest generics

Coromary heart disease (CHD) is the leading cause of death for men and women in the United States. There's a direct relationship between cholesterol levels and the risk of death due to CHD. Statin medications inhibit cholesterol synthesis and reduce cholesterol levels substantially.

The Sept. 30 Voluntary Recall of Vioxx (rofecoxib) by Merck is just another in a long list of headline-making news for the industry. The action was based on the results of a three-year, randomized double-blind trial that indicated that after taking Vioxx for 18 months, patients had twice the risk of heart attack compared with a placebo.

Recent scares about suicidality linked to antidepressants and painkillers intensifying interest in policies to ensure the safe use.

The managed care backlash is easing up, probably because consumers are feeling the pinch of rising costs.

By withholding information about some antidepressant medications that cause an increase in suicidal tendencies among teenagers, the Food and Drug Administration (FDA) created heightened public concern about the value of antidepressants.

Vioxx liability claims could run well over $10 billion.

New indications

Several drug regimens are available for asthmatics, but the key to asthma control is to reduce airway inflammation, and therefore limit the need for short-term rescue medications.

The study indicates HRA products can induce positive health behavior changes.

Lincolnshire, Ill.- Healthcare cost increases, while high, are moderating because of decelerating cost trends, according to Hewitt Associates.

The National Institutes of Health's new research strategy aims to address obesity on several fronts.

Specialty drugs falling under pharmacy benefit

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Specialty pharmaceutical coverage by managed care plans

FDA actions and new molecular entities

Everyone's familiar with nonsteroidal anti-inflammatory medications (NSAIDs). These are household names, sold in every drugstore, and consumers use them for headaches, athletic injuries, and other minor aches and pains.