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There are inherent challenges and opportunities for DM

Any bill paid on time means good news for an MCO, right? Not so fast. What if it wasn't paid properly? What if the provider or hospital facility was under- or overpaid? When processing medical claims, it pays-literally-for managed care organizations and providers to get it right the first time.

The devil might be in the details, but that's where the hope for redemption is, too. Money-saving strategies are nothing new in the healthcare industry, but ones that can save more than $11 million a year-without a single budget cut, no less-are a little more difficult to generate.

An important annual survey finds that employers see few options beyond tearing some holes in the vaunted consumer insulation against the cost of health care.

A recent "Dear Healthcare Professional" letter issued by Wyeth outlines the potential risks associated with the company's antidepressant venlafaxine (Effexor and Effexor XR) when the drug is administered in the pediatric population. The letter, dated August 22, 2003, cites data from clinical studies in pediatric patients (aged 6­17 y) and details changes that have been made to the labeling for venlafaxine. Venlafaxine has been prescribed off-label in the pediatric population despite never being approved by FDA for use in children or adolescents.

As patient-based strategies promote acceptance and wider use of generic drugs, managed care organizations' (MCOs's) tools now include aggressive voucher programs that go so far as to provide preprinted prescription blanks for patients to take to their doctors.

Benzodiazepines are the gold standard for the treatment of insomnia. However, because of their potential for pharmacologic dependence and withdrawal reactions upon discontinuation, they are neither recommended or FDA-approved for chronic use. The novel cyclopyrrolone eszopiclone (es zoe pik? lone) (Estorra, Sepracor) is a stereoselective isomer of the agent zopiclone, which has been available in Europe for more than a decade. Clinical trials in patients with chronic insomnia suggest the medication may help manage both transient and chronic insomnia with minimal side effects. The most commonly reported side effect with the agent is a bitter taste. The apparent efficacy and favorable side effect profile together with its potential for obtaining the first indication for the management of chronic insomnia in the United States make eszopiclone an attractive therapeutic option. If the drug is approved by FDA, a key issue for formulary decision-makers will be whether to make it openly available or through prior authorization for specific clinical situations. Eszopiclone?s pricing may ultimately determine its use by clinical psychiatrists and reimbursement by insurers.

One of the primary goals in today?s medical environment is to find treatments that provide positive clinical outcomes but also satisfy pressures on healthcare professionals and hospitals to deliver care as cost effectively as possible. To attain this goal, a hospital must have a pharmacy and therapeutics committee that is both scientifically and economically sound. Based on the experience of over 25 years each of the former chairman of the pharmacy and therapeutics committee (R. Quintiliani) and the director of Drug Information Services (R. Quercia) at Hartford Hospital, a large tertiary hospital in Connecticut, this article addresses ways to accomplish this goal, with particular attention given to anti-infective agents.

No matter what happens outside the industry, we provide a vital service that will endure whatever else society must contend with. In this respect at least, some might argue that healthcare is recession-proof.

The following is the second in a two-part series designed to help executives determine their leadership style.

Expert analysis of the October DTR chart information

Compiled from company proxy statements by Managed Care Week, Atlantic Information Services and wwwAISHealth.com.

Policies governing controversial or experimental modalities need to be in tune with best practices

Premiums climb almost 14% prompting hefty deductibles, tiered drug plans

Every state will be forced to implement Medicaid cost-containment strategies in 2004.

The competition in healthcare has never been fiercer than it is today. Even in the best of economies (which the current one certainly isn't, even though Wall Street seems to be gaining steam), health plans usually operate on a profit margin of 2% or less.

Users of statins were 20% less likely to have cancer (adjusted odds ratio, 0.80; 95% CI, 0.66­0.96) in a case-control study from the Academic Medical Centre, University of Amsterdam, Netherlands, that was presented at the 39th Annual Meeting of the American Society of Clinical Oncology

Finasteride (Propecia, Merck), an inhibitor of 5a-reductase, prevents or delays the appearance of prostate cancer by 24.8% (P<.001), according to researchers from the University of Texas Health Science Center, San Antonio, Texas.

Three different drugs at half the standard dose are estimated to reduce the risk of stroke by 63% and ischemic heart disease (IHD) events by 46% for those aged 60 to 69 years, according to a study in BMJ. Another study published in the same issue recommends that those with known occlusive vascular disease and everyone aged 55 years or older take a "polypill," including the combination of blood pressure-lowering drugs, a statin, folic acid, and aspirin.

5-HT3 receptor antagonist indicated to prevent delayed CINV

First combination therapy for treating hepatitis C in children

Approved as monotherapy for pediatric epilepsy

FDA actions

FDA pipeline

New statin approved for the treatmentof various lipid disorders

In these tight economic times, hospitals and managed care organizations are looking to eliminate unnecessary costs.

Asthma is a chronic inflammatory disease of the airways affecting 5%–7% of the US and European populations. It accounts for nearly 400,000 hospitalizations and 5,000 deaths per year. Acute asthma comprises those asthmatics with severe symptoms, despite attempts at appropriate control. Typically these patients will present to a local emergency department for evaluation and treatment. This review examines the pharmaceutical treatment options made available to these patients in emergency settings, including their risks, benefits, side effects and overall effectiveness. (Formulary 2003;38:537–543.)

Lumiracoxib (Prexige, Novartis) appears to be the next COX-2 specific inhibitor that will be marketed in the United States. Currently, lumiracoxib is being studied for the treatment of osteoarthritis, rheumatoid arthritis, and acute pain. Lumiracoxib has been shown in vitro to be more selective for the COX-2 isoenzyme compared to rofecoxib and celecoxib, but clinical head-to-head studies between these agents are lacking. Small controlled trials, presented in abstract form, have shown lumiracoxib to have comparable efficacy to diclofenac and celecoxib in osteoarthritis. It has an adverse effect profile similar to other COX-2 inhibitors and superior to traditional NSAIDs concerning gastrointestinal safety, but cardiovascular and renal safety data are still not available. While existing clinical data on lumiracoxib are minimal and only published in abstract form, research is ongoing, including comparing lumiracoxib to ibuprofen and naproxen in the largest arthritis trial undertaken to date. When the results of this study are published, lumiracoxib?s efficacy and safety profile will be better understood. (Formulary 2003;38:528?536.)

Coleman-Stephens v. Commissioner of Internal Revenue tax court okays depression exemption; insurance scams; 2003 Hay Benefits Report tracking the health care cost shift

As prescription drug spending grows, employers ? who pay a large part of the bill ? want to know if they are getting their money's worth. A critical review of scientific literature on some common diseases provides the answer.