The written record on medicinal marijuana stretches back over 2,000 years, yet after hundreds of studies, experiments, and reports, there is still no consensus about its effects. Other than opiate narcotics, it is hard to think of another medicinal plant that has generated so much controversy.

Back in 1985, the FDA approved dronabinol (trade name Marinol) as a treatment for the nausea and vomiting associated with cancer chemotherapy in patients who failed to respond adequately to conventional treatments. In 1992, the FDA approved another indication — this time as a treatment for appetite loss in people with acquired immunodeficiency syndrome.

The active ingredient in dronabinol is synthetic delta-9-tetrahydrocannabinol (delta-9-THC) and therein lies the controversy.

"Marinol is not marijuana. Marinol's active ingredient is synthesized delta-9-THC, a single compound. The marijuana plant growing in the wild has hundreds of compounds," says Donald Abrams, MD, a professor of medicine at the University of California San Francisco and a highly regarded Stanford-educated AIDS expert. All of those compounds contribute to the plant's effect when smoked.

"The pharmacokinetics of the drug are such that it can take up to two-and-a-half hours for it to work," says Abrams. "Compare this to the smoked plant, which reaches a peak plasma concentration in two-and-a-half minutes."

"If a patient is taking Marinol he needs to take it two-and-a-half hours before it's needed. It does not exhibit the best onset of action." Adding fuel to the controversy is the price: "Marinol is also very expensive," says Abrams.

So maybe Marinol, in its present dosage form, isn't going to quell the controversy. But manufacturers are investigating other delivery methods.

Dronabinol coverage increases slowly Formularies that were surveyed are in conventional HMOs (including Medicaid and Medicare), POS plans, PPOs, PBMs, and Medicaid plans. Data presented for 2000 and 2005 only.

Source: MediMedia's Formulary Compass, MediMedia Information Services
MediMedia's Formulary Compass is a constantly updated compilation of formulary information containing product position for over 3,000 separate drug benefit designs for HMOs, PPOs, PBMs, POS plans, Medicaid, employer groups, and private insurers.

Managed Care’s Top Ten Articles of 2016

There’s a lot more going on in health care than mergers (Aetna-Humana, Anthem-Cigna) creating huge players. Hundreds of insurers operate in 50 different states. Self-insured employers, ACA public exchanges, Medicare Advantage, and Medicaid managed care plans crowd an increasingly complex market.

Major health care players are determined to make health information exchanges (HIEs) work. The push toward value-based payment alone almost guarantees that HIEs will be tweaked, poked, prodded, and overhauled until they deliver on their promise. The goal: straight talk from and among tech systems.

They bring a different mindset. They’re willing to work in teams and focus on the sort of evidence-based medicine that can guide health care’s transformation into a system based on value. One question: How well will this new generation of data-driven MDs deal with patients?

The surge of new MS treatments have been for the relapsing-remitting form of the disease. There’s hope for sufferers of a different form of MS. By homing in on CD20-positive B cells, ocrelizumab is able to knock them out and other aberrant B cells circulating in the bloodstream.

A flood of tests have insurers ramping up prior authorization and utilization review. Information overload is a problem. As doctors struggle to keep up, health plans need to get ahead of the development of the technology in order to successfully manage genetic testing appropriately.

Having the data is one thing. Knowing how to use it is another. Applying its computational power to the data, a company called RowdMap puts providers into high-, medium-, and low-value buckets compared with peers in their markets, using specific benchmarks to show why outliers differ from the norm.
Competition among manufacturers, industry consolidation, and capitalization on me-too drugs are cranking up generic and branded drug prices. This increase has compelled PBMs, health plan sponsors, and retail pharmacies to find novel ways to turn a profit, often at the expense of the consumer.
The development of recombinant DNA and other technologies has added a new dimension to care. These medications have revolutionized the treatment of rheumatoid arthritis and many of the other 80 or so autoimmune diseases. But they can be budget busters and have a tricky side effect profile.

Shelley Slade
Vogel, Slade & Goldstein

Hub programs have emerged as a profitable new line of business in the sales and distribution side of the pharmaceutical industry that has got more than its fair share of wheeling and dealing. But they spell trouble if they spark collusion, threaten patients, or waste federal dollars.

More companies are self-insuring—and it’s not just large employers that are striking out on their own. The percentage of employers who fully self-insure increased by 44% in 1999 to 63% in 2015. Self-insurance may give employers more control over benefit packages, and stop-loss protects them against uncapped liability.