Formulary Watch |

Medicare encourages more drug effectiveness information

The Medicare Prescription Drug Plan, which began January 1, 2006, makes the federal government the largest purchaser of pharmaceuticals in the United States, and probably in the world. It is projected that the Centers for Medicare and Medicaid Services (CMS) will spend more than $1 trillion on medications over the next decade, a volume that will influence the pharmaceutical market more broadly and generate new initiatives to encourage utilization of more cost-effective treatments.

A growth hormone conversion program and patient outcomes at a not-for-profit HMO

Although experience tells us that formulary conversion programs are commonplace, they are discussed fairly infrequently in the literature. A recent MEDLINE search did not identify any conversion programs similar to a human growth hormone (HGH) program implemented at HIP Health Plan of New York (HIP-NY).

Influence of a UTI empiric treatment pathway on physician prescribing in an academic medical center

In an attempt to improve patient outcomes and control costs, a guide to empiric antimicrobial therapy, including a urinary tract infection (UTI) algorithm, was distributed to hospital physicians at an academic medical center. A retrospective study was conducted to assess the impact of the guide on physician prescribing of empiric antimicrobial therapy for UTIs. Prior to the implementation of the guide, 45% (n=55) of patients with UTIs were treated consistently with the algorithm. Although not statistically significant, consistency increased to 51% (n=45) after implementation of the guide. The initial publication of a guide to empiric antimicrobial therapy did not significantly influence physician prescribing patterns regarding UTIs. Educational sessions at the time of implementation along with reinforcement of the guidelines may further impact prescribing habits and influence algorithm compliance.

Focus On: Dalbavancin A novel long-acting lipoglycopeptide antibiotic

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Approvable designations, Fast-track designations

FDA actions in brief

FDA approved ranolazine extended-release tablets (Ranexa, CV Therapeutics) on January 31, 2006, for the treatment of chronic angina. A more thorough review of the agent will appear in the FDA Drug Approvals section of Formulary's March issue.

Exubera

New inhalable insulin formulation approved

Sutent

Kinase inhibitor approved for GIST and advanced renal cell carcinoma

Drug Watch: Agents in late-stage development for the treatment of ophthalmic disorders (February 2006) (PDF)

A review of agents in late-stage development for the treatment of ophthalmic disorders (January 2006)

First-time generic approvals

Hydromorphone tablets 2, 4, and 8 mg (equiv to Dilaudid tablets)

Retrospective analysis demontrates that switching statins hinders treatment compliance, persistence

Patients who have switched statins should receive special care as they are substantially less likely to be compliant and remain on the treatment long enough to obtain its full benefits, researchers reported in the American Journal of Managed Care.

Drug Watch: Agents in late-stage development for the treatment of multiple sclerosis (January 2006) (PDF)

A review of agents in late-stage development for the treatment of multiple sclerosis (January 2006).

Economic analysis of a medication assistance program for ambulatory care patients at an urban teaching clinic

Objective: Pharmacy-managed medication assistance programs (MAP) have the potential to recoup losses incurred by the pharmacy department, but whether this offsets the personnel cost of the program has not been well-established. The purpose of this study was to conduct a cost-benefit analysis of the pharmacy-managed MAP at an urban teaching clinic at Hartford Hospital in Hartford, Conn.

First-time generic approvals

Hydromorphone tablets 2, 4, and 8 mg (equiv to Dilaudid tablets)

FDA actions in brief

Oxcarbazepine (Trileptal, Novartis) was approved as adjunctive therapy to treat partial seizures in children aged 2 years or older with epilepsy.

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Methylphenidate transdermal patch (Daytrana, Shire/Noven) to treat attention-deficit/hyperactivity disorder (ADHD)

Avelox

Moxifloxacin

Nexavar

Sorafenib tablets

Formulary policy to be shaped this year by Medicare, IT, and push for drug development

The number-one health policy issue for the new year is to find ways to keep healthcare costs under control. An aging population and more costly medical technology could increase current spending trends. These developments could have an impact on efforts to reduce the number of uninsured people in the United States and could prompt initiatives to make consumers more aware of treatment costs and options.

Chest 2005: Sitaxsentan more effective than bosentan as PAH therapy

Sitaxsentan, a highly selective endothelin-A (ET-A) receptor antagonist undergoing FDA review as an alternative to bosentan for pulmonary arterial hypertension (PAH) treatment, demonstrated improved efficacy over bosentan in a recent study.

Chest 2005: Combination drug therapies may improve efficacy, reduce side effects in PAH

Because several molecular pathways are relevant in the pathogenesis and progression of pulmonary arterial hypertension (PAH), combinations of therapies are being explored to better manage the disease.

Chest 2005: Heparin antibodies, independent of HIT, common in patients undergoing cardiac surgery

The presence of antibodies to heparin is an independent risk factor for potentially serious complications following cardiac surgery, even in patients who do not develop heparin-induced thrombocytopenia (HIT), said David Kress, MD, at the 71st international scientific assembly of the American College of Chest Physicians in Montreal, Quebec, Canada.

Monoclonal antibody demonstrates efficacy in postmenopausal osteoporosis

A pivotal phase 3 trial of a fully human monoclonal antibody, denosumab, that prevents bone destruction is under way and includes 7,800 postmenopausal, osteoporotic women aged 60 to 90 years. The primary endpoint is new vertebral fractures versus placebo and secondary end points are safety and tolerability of the new agent. Phase 2 clinical trials have demonstrated that denosumab is superior to aldendronate in preserving bone mineral density (BMD), reported researchers during the American College of Rheumatology Annual Scientific Meeting in San Diego, Calif.

Study diminshes value of beta blockers in treatment of hypertension

Beta blockers, touted for 3 decades as first-line drugs in the treatment of hypertension, are less than optimum in comparison to other antihypertensive drugs and raise the risk of stroke, according to a meta-analysis published online by The Lancet.

Early invasive stategy no better than selectively invasive approach for acute coronary syndromes

Early invasive strategy, recommended by the current guidelines in the treatment of patients with acute coronary syndromes (ACS), did not excel when compared with its more conservative alternative in a randomized study published in the New England Journal of Medicine.

Retrospective analysis demontrates that switching statins hinders treatment compliance, persistence

Patients who have switched statins should receive special care as they are substantially less likely to be compliant and remain on the treatment long enough to obtain its full benefits, researchers reported in the American Journal of Managed Care.

Lower incidence of CHD, other vascular events observed with absolute reductions in LDD-C

Utilizing statin therapy, researchers have provided further evidence that absolute reductions in LDL-C reduce the incidence of coronary heart disease (CHD) and other major vascular events.

2005 AHA Scientific Sessions: EURIDES/ADONIS

Dronedarone, a class III multichannel blocker developed for maintenance of sinus rhythm and ventricular rate control, reduces the risk of all-cause hospitalizations and death in patients with atrial fibrillation/flutter (AF/AFl), according to a post-hoc analysis of 2 randomized, placebo-controlled clinical trials.

2005 AHA Scientific Sessions: REVIVE II/SURVIVE trials

The calcium sensitizer levosimendan was associated with an improvement in the clinical course of patients compared with placebo when used for the treatment of acute decompensated heart failure (ADHF), but the drug failed to reduce 6-month mortality when compared with dobutamine in a similar set of patients.

2005 AHA Scientific Sessions: CAF? trial

Drugs that reduce brachial blood pressure similarly can have different effects on central blood pressure. This finding may explain differences in clinical end points between antihypertensive drugs that lower blood pressure similarly, said Bryan Williams, MD, lead investigator of the Conduit Artery Function Evaluation (CAF?) trial, a substudy of the Anglo-Scandinavian Cardiac Outcomes Trial (ASCOT).