Diabetes Intervention: Achieving Tight Glycemic Control Through Combination Therapy

The alarmingly rapid increase in prevalence of type 2 diabetes has profound implications for morbidity, mortality, and economic outcomes. Health plans that adopt aggressive approaches to treatment will reap substantial clinical and financial benefits. The articles in this supplement, which derive from the proceedings of the National Association of Managed Care Physicians Diabetes Advisory Board in November 2000, address issues relevant to these concepts.


  • NCQA/HEDIS 2000 Guidelines for Diabetes
  • A Retrospective Study of Persistence With Single-Pill Combination Therapy vs. Concurrent Two-Pill Therapy in Patients With Hypertension
  • Glyburide/Metformin HCl Clinical Overview
  • Blueprint for Conversion of Patients on Metformin and Sulfonylurea to Glucovance

New Options in the Treatment of Rheumatoid Arthritis

This supplement is based on a meeting of leading experts in rheumatology to discuss treatment options for rheumatoid arthritis. The goal of this meeting was to create a step-care algorithm for treatment. The presentations herein address advances in combination therapy that have resulted in a significant reduction in disease-related disability, measurable improvement in quality of life, and a substantial decrease in economic losses.


  • Pharmaceutical Agents for the Treatment of Rheumatoid Arthritis
  • Combination DMARD Therapy for Rheumatoid Arthritis
  • Economic and Quality-of-Life Impact of Rheumatoid Arthritis
  • Discussion/Development of RA Treatment Algorithm

New Evidence-Based Treatments for Depression

When depression is unrecognized and untreated, it can have negative consequences on medical resource utilization. Even when depression is treated, appropriate selection of pharmacologic therapy can make a difference in outcomes. This supplement, based on Magellan Behavioral Health’s 2001 Clinical Medical Retreat, addresses concepts in treatment and management of depression, including a discussion of drug-product selection based on differential efficacy and compelling considerations about antidepressant medication interactions.


  • Depression’s Ripple Effect on Health Status and Costs
  • Overview of Antidepressant Therapy
  • Antidepressant Drug Interaction Considerations
  • Using Pharmacoeconomic Data To Compare Antidepressant Therapies
  • The Texas Medication Algorithm Project for Major Depression
  • Cost-Effective Therapy: Translating Evidence Into Practice

Recent Advances in Care: Treatment of Acid-Related Disorders

The prevalence of acid-related disorders, which include duodenal ulcer disease, gastric ulcer disease, Zollinger-Ellison syndrome, and gastroesophageal reflux disease, is relatively high in the United States. This has a significant impact on quality of life and health care resource utilization. The articles in this supplement explore therapeutic approaches and best practices related to acid-related disorders.


  • Health Care in the United States: Current and Future Challenges
  • Impact of Acid-Related Disorders in the United States
  • Comparative Pharmacology of Proton Pump Inhibitors
  • Optimizing Acid-Suppression Therapy
  • Evidence-Based Health Care: Making Health Policy and Management Decisions

Current Practice Trends and Treatment Guidelines for Reducing Hypercholesterolemia Risk

Considering the National Cholesterol Education Program’s guidelines for treating patients with hypercholesterolemia, managed care’s greatest challenge is the underdiagnosis and undertreatment of this condition. This supplement derives from a meeting of medical and legal experts who convened to discuss these and other issues faced by those who manage and treat patients with hypercholesterolemia. These concerns are discussed from the perspectives of practitioners, health plans, employers, and health economists.


  • NCEP Guidelines for Treatment of Hypercholesterolemia
  • Clinical and Economic Benefits of a Cardiovascular Risk-Reduction Program
  • Employer Objectives Behind Value-Based Purchasing for Pharmacy Benefits
  • A Pharmacoeconomic Approach to Managing Lipids
  • Roundtable Discussion: Meeting the Challenges of Treating and Managing Hypercholesterolemia

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.