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Chronic obstructive pulmonary disease (COPD) is a disease state characterized by the progressive development of airflow limitation that is not fully reversible. The airflow limitation is associated with an abnormal inflammatory response of the lungs to noxious particles or gases. It affects approximately 15 million Americans and is associated with high morbidity and mortality. Previously, pharmacologic therapeutic options were limited by relatively short durations of action in the first-line medications and limited efficacy data and/or a high rate of adverse effects in the second-line medications. Today, there are several new and emerging medications to treat this disease state, and new guidelines have been published for disease management. This review examines current therapeutic options, compares efficacy data, and highlights the recommendations from international guidelines.

Nebivolol is a beta-blocker under FDA review for the treatment of hypertension. Nebivolol has unique pharmacologic properties, including high specificity for the beta-1 receptor and a nitric oxide-mediated vasodilatory effect. The agent provides significant blood pressure reduction from baseline values and as compared to placebo. Clinical trials have demonstrated that nebivolol reduces blood pressure similarly to atenolol, bisoprolol, amlodipine, nifedipine, lisinopril, and hydrochlorothiazide. The tolerability of nebivolol is similar to or better than that of these agents. If approved, nebivolol would likely be a viable alternative therapy for hypertension; however, additional studies are needed in patients with heart failure and coronary artery disease.

Suit alleges FDA overstepped jurisdiction in regulating compounding pharmacies; Report lists steps to improve product quality regulatory system; ASHP, AMCP recommend criteria for Medicare formulary design, formulary decision-maker responsibilities; Illinois, Wisconsin specify safeguards, provisions in state-sponsored WWW prescription drug pharmacy

Medicare Fraud: The OIG IS Watching

In 2001, with annual healthcare inflation in the double-digits nationwide, Humana CEO Michael McCallister formulated the plan's new strategy to put more information and choice in the hands of employees and healthcare consumers.

One of the biggest drains on productivity is presenteeism, a term used to describe "the working sick"-employees who are at work but who aren't as productive as usual.

PHCS President and CEO Joe Driscoll takes on healthcare's Big 3 with a proprietary PPO network.

The practice of medicine continues to become more effective, and all of the players in managed care seem to have found a way to (somewhat) peacefully coexist.

November DTR Chart: Top States by Medicare HMO enrollment

November DTR Analysis: Medicare HMO enrollment varies dramatically

As the spiraling cost of healthcare continues to strain federal and state budgets, state Medicaid agencies are looking for powerful, workable solutions to the crisis.

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.

Unfortunately, many providers can't squeeze much more money out of cost reductions.

PHCS President and CEO Joe Driscoll takes on healthcare's Big 3 with a proprietary PPO network.

For 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.

There 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.

Secondary 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.

FDA 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

There is a chronic problem with the healthcare system in the United States and no shortage of rhetoric and theory on how to fix it. In the end, it comes down to a matter of focus.

Months before my grandmother moved into a nursing home, she called me over to her house to help in the kitchen.

Since 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.

Specialty drugs falling under pharmacy benefit

Medicare’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.

On 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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Specialty pharmaceutical coverage by managed care plans

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.

Managed care organizations, hospitals and providers evolve, responding to market influences, but some key issues still command attention.

A unique social HMO for Medicare eligibles, SCAN goes beyond medical benefits and is able to offer its members access to community-based services such as transportation, housecleaning and home-delivered meals-dessert included.

Months before my grandmother moved into a nursing home, she called me over to her house to help in the kitchen.