Formulary Watch |

Specialty drugs will account for 50% of all drug costs by 2018

Health insurers should use both medical and pharmacy data to forecast specialty drug costs, which are predicted to rise to 50% of commercially insured total drug costs by 2018, according to a new study presented at the Academy of Managed Care Pharmacy’s 25th Annual Meeting & Expo in San Diego, in April.

Studies show increase costs, higher use of specialty drugs to treat inflammatory autoimmune conditions

Biologic anti-inflammatory (BAI) specialty medications to treat autoimmune inflammatory conditions-such as rheumatoid arthritis (RA), psoriasis or inflammatory bowel disease (eg, Crohn’s disease, ulcerative colitis)-are among the most commonly used specialty drugs and costs are rising rapidly. Three new studies presented at the 2013 Academy of Managed Care Pharmacy’s 25th Annual Meeting & Expo in San Diego, in April, highlight the use, effectiveness and cost trends for BAIs.

Specialty drug costs now make up half of the total cost of RA and hepatitis C care

Specialty drugs now account for half of the cost of treating patients with rheumatoid arthritis (RA) or hepatitis C (Hep C), according to 2 studies presented by St. Paul-based Prime Therapeutics (Prime) and Blue Cross and Blue Shield of Minnesota at the Academy of Managed Care Pharmacy’s 25th Annual Meeting & Expo in San Diego, in April.

Multidisciplined process redesign: A collaborative approach to system-wide electronic medication reconciliation improvement

Medication errors and adverse drug events (ADEs) pose large threats to patient wellbeing and safety. Medication errors are the most common errors occurring in hospitals. Preventable ADEs are linked with 1 in 5 injuries or deaths. Medication errors occur at key points of transition during the hospital stay. 4-6 At one institution, failure to reconcile medications at transition points accounted for 50% of all medication errors and 20% of ADEs. Medication errors and ADEs are harmful, but also costly to the patient and the healthcare system.7 Complete and accurate medication reconciliation is crucial for reducing medication errors and ADEs

Study shows patient satisfaction with pharmacy program

Implementation of a pharmacy service that provides dosing, monitoring, education, and ensured safe transition from the inpatient to the outpatient setting is associated with improved patient satisfaction with overall care and with care related to anticoagulation management, according to a study published in the Annals of Pharmacotherapy.

Standards of medical care in diabetes: focus on updated recommendations in hospitalized patients

Although the prevalence of diabetes mellitus in hospitalized patients remains unknown, an estimated one-fourth of inpatients experience hyperglycemia.1 Hyperglycemia is linked to poor health outcomes, and there is evidence that intensive glucose control in the hospital reduces mortality, need for dialysis, infections, and length of stay.2 The American Diabetes Association (ADA) publishes clinical practice guidelines annually, which offer clinicians, patients, researchers, and payers current, evidence-based recommendations on all components of diabetes care, general treatment goals, and tools to evaluate the quality of care. The updated guidelines focus on changes in the recommendations for care of the hospitalized diabetes patient.

Specialty drugs are critical focus for payers

The appropriate use of specialty drugs is a major priority for health plans and will become increasingly important for future growth over the next 3 to 5 years, according to a comprehensive survey on payer approaches to specialty drugs. Furthermore, the research finds significant variation in what health plans view as emerging areas of opportunity to manage these drugs.

Efficiency, less utilization fuels US drug spending decline

Total spending on medicines declined by 3.5 percent, according to the IMS Institute for Healthcare Informatics report, Declining Medicine Use and Costs: For Better or Worse?” report. In addition, nominal pharmaceutical spending reached $325 billion in 2012, or real per capita spending of $898, a decline of one percent.

New molecular entity: Canagliflozin

On March 29, 2013, FDA approved canagliflozin (Invokana, Janssen Pharmaceuticals, Inc.), a once-daily tablet, indicated as an adjunct to diet and exercise to improve glycemic control in adults with type 2 diabetes mellitus.

New oral contraceptives increase women’s cardiac risk

Women taking fourth-generation oral contraceptives, which use a progestin that is antiandrogenic, are at increased heart risk. The drugs significantly lengthen the corrected QT (QTc) by 3.6 milliseconds, according to a recent study in the Annals of Noninvasive Electrocardiology.

Newer whooping cough vaccines less effective than older vaccines

Teenagers who received DTaP (acellular pertussis vaccine) in their first 2 years of life had a 6 times higher risk of contracting pertussis compared with those who received DTwP (whole-cell pertussis vaccine) in their first 2 years of life, according to a study online in Pediatrics.

Increased cardiac risks in COPD with new Rx inhalers

Older patients with chronic obstructive pulmonary disease (COPD) may be at increased risk for cardiovascular events with newly prescribed long-acting beta-agonists (LABAs) and long-acting anticholinergics (LAAs) and need to be followed closely by their healthcare providers, according to a study published online May 20 for JAMA Internal Medicine.

Underdosing in obesity-an epidemic: Focus on anticoagulation

Obesity is a growing problem in the United States. Currently, 68% of adult Americans are overweight (BMI >25 kg/m2).1 Of those, 35% are obese (BMI >30 kg/m2) and 6% are morbidly obese (BMI >40 kg/m2). It is estimated that by 2030, 51% of the population will be obese and 11% will be morbidly obese.1 We are often confronted with dosing drugs in an obese patient. Unfortunately, many clinical trials exclude or have limited overweight patients enrolled; thus, optimal dosing for both safety and efficacy in this population is lacking. Pharmacokinetic studies in obese patients have shown that the volumes of distribution of lipophilic drugs and the clearance of hydrophilic drugs can be increased. For this reason, dosing in obesity should be patient- and drug-specific.

FDA actions in brief

FDA pipeline preview

FDA pipeline preview

FDA approves dabrafenib and trametinib for advanced skin cancer

FDA has approved dabrafenib (Tafinlar, GlaxoSmithKline) and trametinib (Mekinist, GlaxoSmithKline) for patients with advanced (metastatic) or unresectable melanoma.

Disinfecting all ICU patients significantly reduces MRSA

Decolonization of all intensive care unit (ICU) patients with antimicrobial soap and ointment significantly reduces all bloodstream infections, including methicillin-resistant Staphylococcus aureus (MRSA), according to a study published in the New England Journal of Medicine.

Targeted screening for C difficile upon hospital admission could potentially identify most colonized patients

Testing patients with just 3 risk factors upon hospital admission has potential to identify nearly 3 out of 4 asymptomatic carriers of C difficile, according to a new study published in the May issue of the American Journal of Infection Control.

Long-term high-dose opioids for pain can result in ED

Men using long-term, high dose prescription opioids for back pain were about 50% more likely to be using medications for erectile dysfunction than men with back pain who were not using opioids, according to a study published in a recent issue of Spine.

USPSTF advises against vitamin D, calcium to prevent fractures in adults

After its recent review, the US Preventive Services Task Force (USPSTF) could not recommend supplementation with vitamin D and calcium for the primary prevention of fractures in healthy adults.

Following CDC protocols reduces dialysis bloodstream infections

Outpatient hemodialysis facilities realized a 32% decrease in overall bloodstream infections and a 54% decrease in vascular access-related bloodstream infections after Centers for Disease Control and Prevention (CDC) guidelines were used, according to a new study.

FDA panel OKs Merck insomnia agent suvorexant at lower doses

Soon after FDA expressed concerns over the higher dosages and safety profile, including daytime drowsiness, of the proposed sleep agent known as suvorexant (Merck), the Agency’s Peripheral and Central Nervous System Drugs Advisory Committee voted 13-3, with 1 abstention, in favor of the safety of 2 proposed starting doses of suvorexant - 15 mg in patients over the age of 65 and 20 mg in patients under the age of 65.

Injectable methotrexate recalled

Sandoz is conducting a voluntary nationwide recall at the U.S. hospital/user level of 2 lots of its injectable methotrexate sodium, USP, 25 mg/mL, 40 mL vials, as a result of the discovery of particulate matter during routine quality examination of vials included among the manufacturer’s retention samples.

Abbott recalls FreeStyle InsuLinx glucose meters

Due to a recurring error that sometimes prompts FreeStyle InsuLinx Blood Glucose Meters to display false test readings, Abbott Diabetes Care has voluntarily recalled the product.

FDA approves first generic Atacand

Sandoz has become the first company to gain the FDA approval to produce a generic version of Atacand (candesartan cilexetil), the popular heart drug that generated an estimated 120 million in domestic sales last year.

Managed care approach to substance abuse treatment

An examination of people’s behaviors as they relate to drug use in the 20th century has shown that people will expend a large amount of energy to acquire any agent that has the ability to alter their minds, bodies, or behaviors in order to achieve a euphoric effect.

FDA concerned about higher doses of investigational sleep agent

The proposal of the investigational sleep agent called suvorexant (Merck), is believed to target sleep disturbances and insomnia through a different mechanism compared to the agents that are currently on the market, but FDA has concerns over the higher dosages of the drug and its safety profile.

Actavis to buy Warner Chilcott for $8.5 billion in stock transaction

Actavis Inc. announced May 20 its plans to acquire Warner Chilcott in a stock transaction deal, which is worth approximately $8.5 billion. The merger is expected to create a global specialty pharmaceutical company serving the women’s health, gastroenterology, urology, and dermatology therapeutic sectors, according to a joint company release.

Senators introduce revised draft compounding bill

Senators from the Health, Education, Labor and Pensions (HELP) Committee have introduced a revised version of its draft compounding bill to help improve the safety of compounded human and animal drugs, following feedback earlier this month from stakeholders, including the American Society of Health-System Pharmacists (ASHP).

FDA approves Bayer’s Xofigo for treatment of prostate cancer

FDA has approved radium Ra 223 dichloride (Xofigo, Bayer) for the treatment of patients with castration-resistant prostate cancer (CRPC), symptomatic bone metastases, and no known visceral metastatic disease. It is intended for men whose cancer has spread after receiving medical or surgical therapy to lower testosterone.