New Treatments For Eye Disease

This supplement focuses on recent significant advances in the treatment of patients with eye disease. This series of articles by faculty of the University of Illinois at Chicago cover the use of topical, systemic, and biologic agents for allergies, diabetic retinopathy, macular degeneration, glaucoma, and more.

Highlights:

  • Pharmacotherapy for Ocular Allergy
  • Managing Diabetic Retinopathy and Age-Related Macular Degeneration
  • Treating Inflammatory Eye Disease
  • Pharmacological Approaches to Glaucoma Treatment
  • Refractive Surgery Update
  • Roundtable Discussion: Practical Treatment of Eye Disease

The Demographic Revolution of Healthcare

The proceedings of the 14th Annual Managed Healthcare Symposium provided a riveting series of presentations and panel discussions about the health policy implications of the aging baby boom cohort. Health plan medical and pharmacy directors, decision makers for integrated health systems and pharmacy benefit managers, and other managed care executives in attendance heard thought-provoking presentations about demographic shifts, drug-related morbidity and mortality, forms of health care rationing, and direct-to-consumer pharmaceutical advertising.

Highlights:

  • Demographic Shifts: The Age Wave
  • The Health Care Picture
  • Healthcare’s Uncertain Future
  • Impact of Aging on Payer, Provider, and Patient
  • DTC: A Powerful Tool for Information and Education
  • Special motivational presentations by Jerri Nielsen, MD, and Mitch Albom

Contemporary Issues in Pharmacy Management

The popularity of several new prescription products in has fostered debate on numerous clinical, economic, and health policy issues. At the Managed Care Summit in 2002, health plan medical and pharmacy directors discussed these issues and listened to presentations about the implications of the rise of previously unheralded therapeutic classes.

Highlights:

  • The Shaping of Health Care Policy
  • The Value of Atypical Antipsychotics in the Treatment of Schizophrenia
  • Impact of Proton Pump Inhibitor Utilization Patterns on Gastroesophageal Reflux Disease-Related Costs
  • Management of Chronic Pain: A Clinical Overview

Treating Depression: A Focus on Medication Choices from a Clinical and Managed Care Perspective

What defines effective treatment for patients with depression and what are the cost implications of effective and ineffective treatment? This supplement explores the elements that drive clinical and cost outcomes of antidepressive therapy. The presentations herein, derived from the Economic Working Group Advisory Board, cover such subjects as goals of treatment, what constitutes successful outcomes, the comorbid nature of depression, theoretical foundations of an economic model, and the nuances of accurately measuring which costs really matter.

Highlights:

  • Goals and Challenges of Optimally Treating Depression in a Managed Care Environment
  • Establishing the Real Cost of Depression
  • The Economic Model in Theory
  • The Importance of Adequate Length of Antidepressant Therapy
  • The SSRI Therapeutic Effective Dose Model
  • Roundtable Discussion: Assessing the Utility of and Implementing the SSRI Model Within MCOs

Transforming Dyslipidemia Management

This supplement derives from the 2002 Medical Director Colloquy, a forum for interaction between decision makers in managed care and professionals from academic health centers, quality assurance organizations, and the business world. Lipid management involves numerous critical issues, including efficacy and treatment choices. In addition, successful lipid management brings an economic challenge, because it involves a long-term approach to improving care — with results that may not be immediately apparent. This publication, the first of two based on presentations at the 2002 colloquy, places these issues in perspective for medical and pharmacy directors. Additional presentations and continuing education opportunities are available through "Multidisciplinary Management of Dyslipidemia," the second Managed Care supplement from this meeting.

Highlights:

  • Current Drug Treatments for Lipid Management
  • Promising Therapies for Cholesterol Reduction
  • The Life Science Revolution
  • NCQA's Evolving Clinical Performance Measures
  • Innovation in Disease Management

Multidisciplinary Management of Dyslipidemia

This supplement derives from the 2002 Medical Director Colloquy, a forum for interaction between decision makers in managed care and professionals from academic health centers, quality assurance organizations, and the business world. The second of two publications to address lipid treatment, this supplement provides an important update on managing patients with elevated cholesterol levels by examining advancements in care that minimize risk while maximizing outcomes. The insights provided by Steven E. Nissen, MD, in "Emerging Technologies in Coronary Artery Disease Assessment" is a profound elaboration of the emerging realization that medical science has misunderstood the pathophysiology of coronary artery disease for a half century. Further presentations and continuing education opportunities are available through "Transforming Dyslipidemia Management," the first Managed Care supplement from this meeting.

Highlights:

  • Optimizing Behavior Change and Minimizing Risk
  • Emerging Technologies in Coronary Artery Disease Assessment: Insights Provided by Intravascular Ultrasound
  • Identifying Populations at Risk: Functional Impairment and Emotional Distress
  • Improving Physician Adherence to Cholesterol Management Guidelines
  • Will Health Promotion Save Money for Managed Care Organizations? A Decision Framework

P&T Digest: Glaucoma

Sharad S. Mansukani, MD, Chief Medical Editor

As the American population ages, the prevalence of glaucoma rises, thus consuming greater medical and financial resources. For the first time, MCOs are attempting to understand ophthalmologic diseases, their interest driven by the market appearance of several new pharmaceutical products to treat glaucoma. The efficacy of these products has created demand and, in turn, a need for appropriate criteria for their utilization. This digest of existing literature and best practices gives physicians and pharmacists on pharmacy and therapeutics committees up-to-date information about the most efficacious and cost-effective medical treatments available in a centralized format virtually unavailable elsewhere.

Highlights:

  • Introduction: Glaucoma Arrives on Managed Care’s Doorstep
  • Prevalence, Utilization, and Economic Implications
  • Clinical Guidelines for the Treatment of Glaucoma
  • Glaucoma Medications: A Drug Therapy Review
  • Considerations in the Pharmacoeconomics of Glaucoma
  • Current Formulary Status of Glaucoma Agents
  • Constructing Disease Management Programs for Glaucoma
  • Improving Adherence to Drug Treatment Regimens

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.