Pharmacy

WellPoint supports putting gold-standard generics in most drug classes on the first tier.

One hundred fifty billion dollars is a staggering figure. Combine it with the phrase, "in losses," and the number becomes a nightmare. That nightmare-$150 billion in losses-is one estimate of the cost of health insurance fraud and abuse in America.

Through its research correlating copayments with utilization, Express Scripts, a pharmacy benefits manager (PBM) in St. Louis, found that a three-tier structure can control prescription drug costs without causing any unintended consequences, such as visits to the emergency room or hospitalizations.

While plan managers have been doing it for nearly two decades with oral medications that are paid on the pharmacy benefit, the product-preferencing process is relatively novel for injectable medications. The next natural discussion is the role of benefit designs in the management of the cost of injectable products, since this is closely tied to product preferencing.

MORPHINE, the first and best-known of the opioid analgesics, is a natural substance produced from the opium poppy, papaver somniferum. It's been used to relieve pain since ancient times; Hippocrates prescribed poppy juice as a narcotic. Today many different semisynthetic opioid analgesics are used to relieve moderate to severe pain, but morphine remains the standard of comparison used to describe their effectiveness.

New combinations

Workers’ comp pays 74% more than group health for the same drugs, due to lack of control over AWP and limited purchasing power.

Executives will need to ... craft a whole-person care plan.

Cholesterol Limbo...How low can you go? *Obsesity Limbo:...In the middle ground, how much coverage? * Obesity drugs * Weight loss programs * Concierge services at work * JCAHO hospital ratings * The co-pay ripple effect...

The Medicare health plan marketplace has stabilized and is poised foranother period of growth, although some experts don't know whether thatgrowth curve will be modest or steep.

Because of external demands for quality information, the ability to utilizetechnology to compile and analyze data is an important task for organizations.As is often noted, these quality demands are particularly important undernew pay-for-performance (P4P) initiatives. Last year, a large health planin California became one of the first in the nation to award P4P bonusesto physician groups in its provider network. It paid a total of $28 millionin bonuses to 80 physician groups.

In the past 15 years, with the introduction of largemolecule, biologically engineered therapies, the treatment of multiple sclerosis (MS) has been revolutionized. While still not curable, today MS is eminently treatable.

The objective of this supplement is to alert managed care decision makers nationwide to how the evolution of biologics will affect both their organizations and the health and well-being of their patient populations.

If diagnosing IBS is difficult, managing it can be even trickier because there’s no protocol.

One driver involved in managing injectables is the product selection process. Historically, injectable products were introduced into the market as new innovations for previously untreated or undertreated diseases. While manufacturers continue to introduce products that are therapy class innovations, there has been a recent trend to release injectable products that serve as secondary or tertiary biotech additions to a particular therapy class.

FDA actions and new molecular entities

With the drug spend for Blue Cross and Blue Shield of Nebraska (BCBSNE) previously at less than 10% of total medical costs, the Omaha-based insurer didn't put too much energy into controlling costs. But when the 1990s started driving drug costs skyward-drug spend for the Blues plan is 15%, or $23 million per month today-BCBSNE looked for solutions to keep costs at bay.

The human immunodeficiency virus (HIV) attacks the immune system, particularly white blood cells known as CD4 T-cells. As a result, the immune system becomes less able to fight off infection and disease. The final stage of HIV infection is acquired immunodeficiency syndrome (AIDS), but some people live with HIV for years or even decades before the disease progresses to AIDS.

After almost two years of disputes and delay, the House overwhelmingly approved legislation last month to fund private-sector development of vaccines and countermeasures to biological and chemical warfare. The Project BioShield bill had passed the Senate last May and provides $5.6 billion over 5 years to purchase counter-terrorism therapies for national stockpiles.

Washington, D.C. - Last month, the House approved legislation that would make it easier for Americans to obtain prescription drugs from Canada and other countries, similar to action it took last year. This time the legislators voted overwhelmingly to add to FDA's 2005 budget bill a provision that blocks FDA from enforcing a ban on drug reimportation. The drug import language is not expected to survive House-Senate negotiations on a final FDA spending bill, but it allows members of Congress to portray themselves as import advocates at election time.

New molecular entities and FDA news

Everyone joins the fight against fat.

The pain associated with a degenerative hip condition had 37-year-old Gerald Amaral taking several prescription pain tablets on a daily basis to manage his discomfort. It's hard to believe that doctors say this former competitive mountain bike racer has the hip of a 70-year-old man.

Sulfonylureas or metformin are reasonable initial-medication choices to slow the progression of diabetes.

THE USE OF technology in the challenge to improve patient safety has become more widespread as technological solutions have improved and their costs have decreased. Healthcare organizations can now see a quick return on investment (ROI), both financially and medically.

WITH THE GROWTH OF specialty pharmacy-therapeutically promising, high-cost, and typically injectable bioengineered drugs-it’s time for plan sponsors to revisit the proven managed care techniques of prior authorization and formulary management.

For health plans to implement a tobacco-reduction intervention, the cost is about 22 cents PMPY.

In an era where the rate of medical advancements is increasing at breakneck speed, it can take up to 17 years for those advances to be integrated into physician practices. Even then, application of such advancements is uneven

NATIONAL REPORTS-MCOs are expected to soon treat pediatric drug costs in a similar manner to which they treat drug spending overall, according to industry experts.

Benefits are many, but healthcare still lags other industries in adoption of wireless integration