Non-profit insurers follow the conversion trend
November 1st 2004For the past several years, non-profit health plans and insurers have been converting to for-profit corporations (or have been acquired by for-profit enterprises) in an effort to gain access to capital markets, to expand their service area, and/or to add to their product lines. In most states, the Blue Cross Blue Shield plans are no longer non-profit.
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Vancomycin resistance: Means of prevention, control, and treatment revisited
October 1st 2004There has been a nationwide increase in the incidence of vancomycin-resistant Enterococcus (VRE) reported over the last decade and a half. The heightened concern caused by VRE and the possibility of vancomycin resistance gene transfer to other gram positive organisms, especially methicillin-resistant Staphylococcus aureus (MRSA), led the Centers for Disease Control and Prevention (CDC) and the Hospital Infection Control Practices Advisory Committee (HICPAC) to publish recommendations for the prevention and control of vancomycin resistance. However, in 2002, the first documented case of vancomycin-resistant S aureus (VRSA) was reported in Michigan in an immunocompromised patient with a history of diabetes, peripheral vascular disease, and renal failure. Since then, 2 other cases have been reported: 1 in Pennsylvania in October 2002 and 1 in New York in March 2004. The limited availability of effective antimicrobial agents against vancomycin-resistant strains of Enterococcus and Staphylococcus species and the morbidity, mortality, and cost associated with resistance represent serious reasons for concern. This article presents a general overview of the current literature on the prevention and control of vancomycin resistance and a review of potential antimicrobial agents used in the treatment of VRE, vancomycin intermediate S aureus (VISA), and VRSA infections.
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Cinacalcet: The first calcimimetic approved for secondary hyperparathyroidism
October 1st 2004Secondary hyperparathyroidism is a common sequelae of chronic kidney disease. Treatment of this condition with traditional agents such as phosphate binders and vitamin D analogs is often complicated by the development of hypercalcemia and hyperphosphatemia. Cinacalcet (Sensipar, Amgen) is the first agent in a new class of drugs called calcimimetics. The agent sensitizes the calcium-sensing receptors in the parathyroid gland to extracellular calcium and directly lowers arathyroid hormone levels. Cinacalcet is FDA-approved for the treatment of secondary hyperparathyroidism in patients with chronic kidney disease on dialysis. In this patient population, cinacalcet reduces plasma intact parathyroid hormone (iPTH) levels, serum calcium and phosphorus levels, and the calcium-phosphorus product without associated hypercalcemia and hyperphosphatemia. Cinacalcet appears to be well-tolerated, with nausea, vomiting, and hypocalcemia as the main adverse events. The drug is also approved for the treatment of hypercalcemia in patients with parathyroid carcinoma and holds promise for the treatment of primary hyperparathyroidism.
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FDA combats illegal WWW drug sales
October 1st 2004FDA combats illegal WWW drug sales; Electronic database allows greater public access to studies; ‘Roadmap’ developed to prepare for and respond to pandemic; Government seeks posting of clinical trial results online; Purchasing pools yield more options, savings for states; New efforts to increase antimicrobial research gain momentum
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Web Exclusive: Contact Center Outsourcing
October 1st 2004Since the mid-1990s, most U.S. industries have begun to outsource inbound customer care as a cost control measure. The experience and sophistication of many outsourced service providers allow clients to achieve substantial cost savings, including minimizing capital expenditure for new technologies while maintaining the same or improved service levels.
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On Finance: Managing Medicare's Mess
October 1st 2004Medicare’s announcement of a 17% increase in premiums precipitated a more recent report that found that overall health care insurance costs jumped more than 11% in the last year, according to a survey by the Kaiser Family Foundation and the Health Research and Educational Trust. It didn’t take long for the pundits to take a direct shot at Medicare’s financing and, of course, that other easy prey-managed care.
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FTC and DOJ encourage industry competition
October 1st 2004On July 23, a joint report on the role of competition in healthcare was issued by the Federal Trade Commission and the Department of Justice. Covering a range of issues dealing with the cost, quality and accessibility of healthcare, the report was produced as the result of a two-year project conducted by the two agencies, which included over five weeks of joint hearings held in 2003.
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New pain relievers may lower gastrointestinal problems but at increased cost
October 1st 2004Everyone'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.
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Study evaluates aspirin comedication rates among long-term COX-2 inhibitor users
September 1st 2004A telephone survey investigating comedication rates of aspirin, acetaminophen, or nonaspirin NSAIDs (ibuprofen and naproxen) among long-term cyclooxygenase 2 (COX-2) inhibitor users (at least a 90-day supply of a COX-2 inhibitor) (N=325, mean age 71, 67% female) revealed that 50% used aspirin concurrently despite its apparent GI adverse effects. Aspirin use was higher for those aged ?56 years (50%) than for those aged 37 to 55 years (25%) (P=.03).
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Higher-dose rofecoxib linked to 3x greater risk of acute cardiac events compared to other NSAIDs
September 1st 2004A study presented on August 25 at the 20th International Conference on Pharmacoepidemiology & Therapeutic Risk Management in Bordeaux, France, revealed that higher-dose rofecoxib (>25 mg/d) was associated with a greater risk of acute myocardial infarction (AMI) and sudden cardiac death (SCD) compared to other NSAIDs. The risk of AMI and SCD was also increased with lower-dose rofecoxib (25 mg/d) when compared with celecoxib. The maximum recommended daily doses of rofecoxib in the management of pain associated with osteoarthritis, rheumatoid arthritis, primary dysmenorrhea, and migraine attacks with or without aura are 25, 25, 50, and 50 mg/d, respectively.
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Higher-dose rofecoxib linked to 3x greater risk of acute cardiac events compared to other NSAIDs
September 1st 2004A study presented on August 25 at the 20th International Conference on Pharmacoepidemiology & Therapeutic Risk Management in Bordeaux, France, revealed that higher-dose rofecoxib (>25 mg/d) was associated with a greater risk of acute myocardial infarction (AMI) and sudden cardiac death (SCD) compared to other NSAIDs. The risk of AMI and SCD was also increased with lower-dose rofecoxib (25 mg/d) when compared with celecoxib. The maximum recommended daily doses of rofecoxib in the management of pain associated with osteoarthritis, rheumatoid arthritis, primary dysmenorrhea, and migraine attacks with or without aura are 25, 25, 50, and 50 mg/d, respectively.
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Atorvastatin associated with modest but clinically apparent improvement in RA symptoms
September 1st 2004Investigators in the Trial of Atorvastatin in Rheumatoid Arthritis (TARA) assessed whether statins would reduce inflammatory symptoms in patients with RA. Patients with RA (N=116) were randomized in the double-blind, placebo-controlled trial to receive 40 mg of atorvastatin or placebo in addition to their current disease-modifying antirheumatic drug (DMARD) therapy.
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Drug-eluting stents: A pharmacy management perspective
September 1st 2004Current treatment options for acute coronary syndromes as well as chronic stable angina often include the use of percutaneous coronary intervention (PCI) with routine stenting. The clear benefits of stents have lead to their routine use for prevention of restenosis. However, the benefits of stenting demonstrated on some aspects of restenosis are compromised by the induction of restenosis by neointimal hyperplasia that is stimulated by standard bare metal stents. FDA has approved 2 drug-eluting stents (DES). DES create a local delivery system at the vascular site to reduce restenosis by neointimal hyperplasia. Multiple clinical trials have demonstrated the safety and efficacy of the use of DES. This article reviews the use of PCI in coronary artery disease, the evolution and pathophysiology of restenosis, and multiple aspects of DES technology. While DES may not be a direct pharmacy and therapeutics committee responsibility, committee members are being called upon to provide insights into pathway processes for medical technology review committees evaluating DES since these products contain a key pharmacologic component. There are also important adjunctive antiplatelet therapy protocols that need to be developed and adhered to in conjunction with DES in order to ensure optimal outcomes.
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Ezetimibe/simvastatin: A combination product for the treatment of hyperlipidemia
September 1st 2004Although statins have been shown to reduce LDL-C and coronary heart disease (CHD) morbidity and mortality, it is not uncommon for patients to fail to reach the treatment goals recommended by the National Cholesterol Education Program (NCEP) guidelines. Some statins cannot lower LDL-C sufficiently in FDA-approved doses; other statins cannot be titrated optimally due to potential drug interactions and adverse effects. Ezetimibe/simvastatin(Vytorin, Merck/Schering-Plough) is an intestinal cholesterol absorption inhibitor and statin combination product that received FDA approval in July 2004. The combination has been found to reduce LDL-C and triglycerides by an additional 22% and17%, respectively, and to increase HDL-C by up to 5% compared to statin monotherapy. The 40 mg simvastatin/10 mg ezetimibe dose of the combination product is one of onlya few cholesterol-lowering regimens that can reduce LDL-C >55% and is also one of the most economical. Adding ezetimibe to a statin does not reduce tolerability. Since ezetimibelacks cytochrome P450 isoenzyme interactions, the additional drug interaction risk with combination therapy is low.
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