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Immunotherapy for Advanced Prostate Cancer: A Novel Treatment Option to Improve Survival
Comparative Effectiveness Research: Paving the Way for Evidence-Based Decision Making
Personalized Medicine: Identifying the Appropriate Patient through Biomarkers in Oncology
Phase 3 Clinical Trials Support STELARA® (ustekinumab) for the Treatment of Moderate to Severe Plaque Psoriasis
Continuing Education Credit
The Impact of Molecular Diagnostics on Treatment Pathways, Outcomes, and Cost
Adjuvant chemotherapy can improve survival in patients with early-stage breast cancer or colorectal cancer who have undergone surgical resection, but the benefit from this treatment is not universal. A distinguished panel of experts addresses the advance in molecular diagnostic testing and its impact on optimal care for cancer patients. David M. Hyams, MD, FACS, presents the epidemiology of breast and colorectal cancers and discusses treatment options and how molecular diagnostics can be used to better manage patients. Cari Bruins, PharmD, focuses on the impact of molecular diagnostics on health outcomes and cost in quality-of-care initiatives. Winston Wong, PharmD, shows the value of incorporating genomic testing into oncology treatment pathways.
This continuing education program is based on an educational symposium held at the Academy of Managed Care Pharmacy 22nd Annual Meeting and Showcase, San Diego, April 6, 2010. The University of Arizona College of Medicine at the Arizona Health Sciences Center designates this educational activity for a maximum of 1.5 AMA PRA Category 1 Credits™. The University of Arizona College of Pharmacy offers 1.5 contact hours. Release date: Oct. 15, 2010 for a period of 2 years.
Regulation of Follow-On Biologics: Ensuring Quality and Patient Safety
An impressive group of experts from the fields of medicine, science, economics, and health policy discuss the quality and safety issues involved in creating a regulatory pathway to bring follow-on biologics, or biosimilars, to market in the United States. Several of the forum speakers participated in a follow-up congressional briefing in November 2009.The discussions provide various perspectives and valuable insights to spur positive action toward assuring that the dual goals of lower costs and patient safety can be met. Speakers include Michael McCaughan, The Pink Sheet; Brian Harvey,MD, PhD, sanofi-aventis; Gundu H.R. Rao, MD, Lillehei Heart Institute; Ann Witt, JD, U. S. Food and Drug Administration; Geno Merli, MD, Thomas Jefferson University Hospital; Judith K. Jones, MD, PhD, Degge Group; Terry Hisey, Deloitte; Laurence Kotlikoff, PhD, Boston University, Randy Vogenberg, RPh, PhD, EPS and Biologic Finance and Access Council.
This supplement is based on a policy forum held at the National Press Club in Washington, D. C., in April 2009, and sponsored by the Jefferson School of Population Health in Philadelphia.
The Ongoing Evolution of Endpoints in Oncology
Albert Tzeel, MD, MHSA, FACPE, Market Medical Officer for Humana Inc’s Great Lakes Region, discusses the importance of understanding surrogate endpoints for managed care decision makers.
Considerations for the Clinical Assessment of the Patient With Plaque Psoriasis
New Approaches to Achieve Best Practices in Treating Myelodysplastic Syndromes
This supplement is based on the Managed Care Clinical Oncology Expert Roundtable held in Dallas on July 31, 2009.
RSV Risk: Understanding RSV-Related Hospitalization of High-Risk Infants
Review of the Clinical Information for SIMPONI™ (golimumab) In Rheumatoid Arthritis
This Clinical Brief reviews the clinical information for SIMPONI™ (golimumab), which was approved by the U.S. Food and Drug Administration on April 24, 2009, for the treatment of adults with moderately to severe active rheumatoid arthritis (RA) in combination with methotrexate (MTX). It is also indicated for treatment of adults with active psoriatic arthritis, alone or in combination with MTX, and adults with active ankylosing spondylitis.
Roy Fleischmann, MD, Clinical Professor of Medicine, University of Texas Southwestern Medical Center, and Co-Medical Director, Metroplex Clinical Research Center, Dallas, discusses this novel agent.
Growth Hormone Treatment: Evidence, Practice, and Emerging Issues
Unmet Needs in the Treatment of Rheumatoid Arthritis
Gonadotrophin Products: Empowering Patients To Choose The Product That Meets Their Needs
Impact of RSV: Implications for Managed Care
Unmet Needs in the Management of Plaque Psoriasis
Opioids in the Workplace
Advances in treatment have helped patients manage chronic pain with pharmaceutical pain relievers, but some drugs — particularly opioids — carry the risk of dependence. Opioid dependence is a medical condition, and it can be treated, but employers may not know about all the treatments that are now available, or that they are covered by most health plans.
Not only are treatments covered by insurance, but the Americans with Disabilities Act and the Drug Addiction Treatment Act, passed by Congress in 2000, encourage employers to support employees with opioid dependency. Qualifying physicians may now treat opioid dependence directly, letting the abuser seek help in the privacy of a physician’s office rather than at a public clinic.
Respiratory Synctial Virus (RSV): Prevention Strategies and the Appropriate Identification of Vulnerable Populations
Respiratory syncytial virus (RSV) infection of the lower respiratory tract is the leading cause of hospitalization of infants younger than 1 year of age in the United States. Up to 126,000 infants are hospitalized each year for bronchiolitis or pneumonia, and close to 20 percent of these are premature infants. RSV hospitalization is costly, amounting to more than $5,000 a day for an infant in need of respiratory assistance. RSV infection is also common among the elderly and immunocompromised individuals, and accounts for about 180,000 hospital admissions each year at a cost exceeding $1 billion. Immunoprophylaxis along with common-sense hygiene measures are key to protecting high-risk populations. This supplement presents up-to-date information on the seasonal variability of RSV, prevention strategies, therapeutic approaches, and managed care considerations to better manage RSV.
This supplement is based on an RSV Expert Panel held in Chicago, Aug. 18, 2008.
Immunization Strategies for Reducing Influenza’s Burden on Public Health
Annual influenza epidemics generate a significant public health burden each year in the United States. Medical and public health professionals, government officials and agencies, and nongovernmental organizations have long called for increasing influenza vaccine usage in the United States and around the world. The reasons for doing so include reducing influenza-associated morbidity and mortality, reducing the economic burden of influenza, and fostering bioterrorism preparedness. Robert B. Belshe, MD, Pedro A. Piedra, MD, Michael A. Kaufman, MD, Allan Kogan, MD, MSS, ABFP, FAAFP, CPE, Alyce Kuhn, RN, RRT, MSHA, and Richard L. Collins, MD, examine the burden of annual influenza epidemics in the United States. Other areas discussed include prevention and management of influenza, access to care, and the idea of universal vaccination.
This supplement is based on an expert panel roundtable discussion held in Dallas on June 30, 2008.
Oral Anticoagulation Patient Self-Testing: Consensus Guidelines For Practical Implementation
Enoxaparin Versus Unfractionated Heparin With Fibrinolysis for ST-elevation Myocardial Infarction
Diagnostics in Oncology: A New Paradigm for Tumor Profiling and Treatment Options
This supplement is based on a satellite symposium held at the Academy of Managed Care Pharmacy 20th Annual Meeting & Showcase in San Francisco on April 17, 2008.
Hematologic Cancer as a Chronic Disease: Shifting the Methodology and Impacting Cancer Care Management
RSV Virology: Understanding RSV Seasonality and the Importance of Local Data
Tumor Necrosis Factor (TNF) Inhibitors
Biologic Therapy Management: The Need For Value-Based Health Benefits Models
Mind Your Body: The Intersection of Physical and Behavioral Health
Based on presentations at the 2007 Medical Director Colloquy held in Las Vegas, December 6-7.
Ulcerative Colitis: The Value of Persistence in Therapy
Postherpetic Neuralgia: A Model for Treating Severe Pain
Postherpetic neuralgia is a disabling condition that impairs quality of life. Varying definitions of PHN have made it difficult to quantify its prevalence or qualify its severity. Clinically, PHN is a consequence of reactivation of the varicella-zoster virus. The result of viral damage to the nervous system, PHN can be severe and intractable to therapy. Targeted analgesia may be useful in reducing the chronic discomfort of PHN caused by central sensitization. Undertreatment of PHN is common and can carry costly implications for third-party payers.
Scientific Understanding of PHN and Its Treatment
Conversations on The Changing Face Of Managed Care: Insights from the 2006-2007 Podcast Series
Based on a series of 10 podcasts conducted in late 2006 and early 2007 by internationally known author, consultant, and futurist Ian Morrison, this publication features interviews with various experts on issues important to the business and bottom line of managed care organizations.
Influenza Vaccination: Trends, Recommendations, and Best Practices
Historically, health care professionals have focused on preventing influenza morbidity and mortality with vaccine, chiefly in the elderly and high-risk populations. Today, the larger public health objective is to prevent epidemics via complementary immunization strategies, which can include herd protection through vaccination of people who spread viruses to those at highest risk of complications and poor outcomes. New immunization strategies include vaccinating healthy children, adults, and health care workers. Efficacy data are presented for of trivalent inactivated influenza vaccine (TIV) and live attenuated influenza vaccine (LAIV), administered by nasal spray.
This supplement is based on the Influenza Vaccine Expert Roundtable, held in Chicago on April 19, 2007. The authors include Robert Belshe, MD, considered a leader in the field of influenza prevention.
Expanding the Boundaries Of Migraine Management: A Focus on Menstrual Migraine
Based on a breakfast symposium at the Academy of Managed Care Pharmacy 2007 Annual meeting, this supplement reviews opportunities to optimize short-term prevention of migraines in patients with specific treatment needs. The authors examine the advances in migraine prophylaxis and the emerging models in preventive treatment.
Clinical Brief: The Unique Burden of Menstrual Migraine
This Brief provides a review of the disability impact of menstrual migraine, with an analysis for managed care decision makers by Maria Lopes, MD, MS.
Consulting on the Patient With Type 2 Diabetes:Matching Medication to Disease Mechanism
This supplement was developed to meet the educational needs of pharmacists who are interested in raising the level of care for their patients with type 2 diabetes.
Managed Care Best Practices in Oncology Management
Cancer, in its various types and presentations, is the number 2 killer in the United States. For managed care companies, access to and availability of cancer care itself and the attendant costs of such care will present an increasingly substantial managed challenge. This publication serves as an important educational tool for managed care professionals, pharmacists, and other health care decision makers so that informed decisions can be made regarding drugs, devices, and procedures utilized when treating patients with cancer.
Based on an expert roundtable discussion conducted in Salt Lake City, Utah, this supplement focuses on collaboration and communication as key principles for ensuring the highest quality of patient care. Case studies that discuss typical patients encountered in the oncology field are also presented.
Innovations in Pain Management: New Therapeutic Options and Tools for Disease Management
Chronic pain is a serious and costly public health issue in the United States and remains largely undertreated. Pain management requires an understanding of how chronic pain manifests and the treatment options that are available to health care practitioners. The standard of care in treating chronic pain includes the judicious use of opioids and necessitates the development of realistic strategies to prevent their misuse. Pharmacists can play an important role in improving patient outcomes by collaborating with prescribers and patients to ensure that pharmacologic treatment is optimized and that patients receive education on the proper use of opioid analgesics.
This supplement is based on a satellite symposium held at the Academy of Managed Care Pharmacy 2006 Education Conference in Chicago. The authors, who are considered leaders in the field of pain management, present thought-provoking articles on the optimal management of patients with chronic pain and the necessity to address this costly and highly prevalent disorder.
Clinical Brief: A Single Tablet to Help Manage Patients With Hypertension and Other Cardiovascular Risk Factors
Clinical Brief: The Etiology of Menstrual Migraine
MOOD – Managing Obstacles to Improved Outcomes in Depression: A Collaborative Approach
Depression is a significant — and inadequately addressed — health problem in the United States. Numerous challenges to adequate diagnosis and treatment of depression have been identified, and some of the barriers are pronounced in certain regions of the United States. Identification of these diverse barriers to optimal treatment provides multiple opportunities to achieve better outcomes. This publication focuses on opportunities for collaboration among primary care physicians, mental health specialists, third-party payers, and patients, to recognize strategies for effective management and treatment of depression.
Based on regional symposia conducted at four locations in the United States, this supplement examines opportunities for, and examples of, collaboration — and presents two case studies in context. The authors also present highlights from the regional symposia with an emphasis on common needs of employers and populations in each area.
Seeing Through Transparency: The Managed Care Evolution
The year 2006 marked the fifth consecutive Medical Director Colloquy. This year’s theme “Seeing Through Transparency: The Managed Care Evolution” probed, challenged, and stimulated rich discussion among participants and faculty about how health plans, employer groups, clinicians, and consumers gather, assess, and use data to evaluate, select, and pay for health care services.
Targeted Therapy for the Treatment of Macular Degeneration
Neovascular age-related macular degeneration (wet AMD) is the leading cause of blindness among older people in the United States. Until mid-2006, treatments for this disease had been known for their ability to reduce the rate of disease progression. Since then, a new therapeutic option that has been shown to maintain visual acuity has been made available. This publication reviews the history of, and recent advances in, the treatment of wet AMD.
Asthma in the Workplace
Because asthma’s effect on the workplace is profound, it is heartening that increasingly, employers are taking necessary steps to address the 20.3 million Americans with the condition. If ever there was a condition that can be effectively managed through employee education and a well designed health benefit, it’s asthma. Pitney Bowes, to take just one example, offered workshops and overhauled its pharmacy program, reducing emergency room visits for asthma attacks by 6 percent and hospital admissions for asthma by 38 percent for its 35,000 employees.
This publication is divided into four parts: The first part describes the effect of untreated asthma on workplace productivity; the second tracks the evolution of therapy and shows how contemporary therapies have been shown to reduce illness and comorbidities; the third is a summary of asthma initiatives by major accrediting bodies (e.g., the National Committee for Quality Assurance); and the last (by no means the least) looks at employer strategies.
Awakening Insomnia Management: A Collaborative Approach to Improved Care
Based on a satellite symposium at SLEEP 2006 — the 20th anniversary meeting of the Associated Professional Sleep Societies, this supplement reviews past and present sleep management practices and identifies and addresses barriers to suitable care. The authors examines the impact of sleep disorders on patients, providers, and employers.
Clinical Brief: Safety of Lipid-Lowering Therapies
This Brief summarizes four studies that examine the safety of HMG-CoA reductase inhibitors (statins). It also includes an analysis for MCOs by Steven R. Peskin, MD, MBA.
Medicare Part D: Transforming Managed Health Care
With up-to-date information about Medicare Part D regulations and enrollment, as well as expert analysis of postimplementation implications for third-party payers, this publication is an important educational tool for managed care professionals. The content of this supplement is based on the MMAction Webcast Series on the Medicare Prescription Drug, Improvement, and Modernization Act of 2003.
The Important Role of Guidelines in the Appropriate Management of Disease States and Their Treatment Options
Based on a symposium at the Academy of Managed Care Pharmacy 18th Annual Meeting and Showcase in April 2006, this supplement examines the purpose of guidelines in managing diseases, with a special emphasis on rheumatoid arthritis. Presenters review new and existing (pre-2005) biologic therapies for RA, describe appropriate uses of the new therapies on the basis of published literature, and identify ways to manage formularies in the absence of guidelines for new RA products.
Clinical Brief: Abatacept for Rheumatoid Arthritis
This Brief summarizes “Abatacept for Rheumatoid Arthritis Refractory to Tumor Necrosis Factor-Alpha Inhibition” (Genovese et al, New Engl J Med 2005), and includes a managed care analysis by Jaan Sidorov, MD.
Depression in the Workplace
Even though depression is common and treatable, it remains a significant problem for employers. This publication outlines and quantifies the effects of untreated depression, outlines the current state of therapy, and describes resources and techniques employers use to help employees with depression.
Hyperphosphatemia is present in patients with end-stage renal disease and is increasingly important as a clinical entity. Several studies have shown that calcium acetate is more cost-effective than sevelamer as a phosphate binder. Calcium acetate can be used effectively with doses of elemental calcium that meet the K/DOQI guidelines.
Advances in Treatment and Management of Early Breast Cancer
Tamoxifen has been the mainstay of adjuvant drug treatment aimed at reducing the risk of recurrence of breast cancer. Yet, in light of new information about the utility of aromatase inhibitors as adjuvant therapy, such as that provided by the Arimidex, Tamoxifen, Alone or in Combination (ATAC) study, oncologists may have more options. Early indications are that, in comparison with tamoxifen, aromatase inhibitors increase disease-free survival for postmenopausal women with hormone receptor-positive early-stage breast cancer.
P&T Digest: Pain Management
Randall P. Brewer, MD, Chief Medical Editor
Chronic pain is a significant public health issue in the United States and an important concern for MCOs. Untreated or undertreated pain can evolve from a symptom to a chronic condition in its own right, one that has serious comorbid, economic, and quality-of-life consequences. As scientific understanding of the mechanisms involved in chronic pain increases, so too does the opportunity to manage affected patients in a cost-effective manner.
This peer-reviewed digest discusses the clinical and economic implications of chronic and acute pain, current guidelines for treatment, therapeutic approaches to care, and patient-management strategies. It also discusses legal and clinical considerations of opioid and nonopioid therapies for adult and geriatric populations. In consolidating the state of the art about this increasingly important subspecialty of medical care, this is a valuable tool for physicians and other clinicians, managed care clinical executives, and P&T committee members.
Pay for Performance: Opportunity and Challenge for Improving Health Care
Pay for performance has emerged as a key issue in health care, generating discussion, anxiety, and a vigorous exchange of ideas. This supplement, derived from the 11th annual Department of Health Policy Summer Seminar at Thomas Jefferson University, features presentations from Andrew Webber, president and CEO of the National Business Coalition on Health, Dennis Scanlon, PhD, associate professor of health policy and administration at Pennsylvania State University, and Margaret Van Amringe, director of the Joint Commission on Accreditation of Healthcare Organizations.
P&T Digest: Asthma
Michael A. Kaliner, MD, Chief Medical Editor
Asthma is one of the most common illnesses in the United States and a major driver of health care utilization costs. It also can be a challenge to manage. Disease severity, as defined by guidelines, does not necessarily correlate with patients’ self-reported symptoms, meaning that vigilance is imperative to reducing poor outcomes.
This peer-reviewed digest of current and evolving guidelines for treatment, existing and emerging therapeutic approaches to treatment of depression, and strategies for managing patients and their conditions, is a valuable tool for physicians and other clinicians, managed care clinical executives, and P&T committee members. Its chapters discuss asthma as a disease syndrome, unmet medical needs, its burdens on society, and what can be done to alleviate those burdens.
How Can Medical Directors Have the Greatest Impact on Quality Improvement?
This supplement derives from the 2005 Medical Director Colloquy, an interactive forum between top medical managers and an expert faculty comprising medical and business professionals. Addressing the general issue of quality improvement, this supplement presents an argument supporting employers’ increased involvement in workplace health-promotion programs, use of quality-of-care indicators, and ways in which information technology can be used to obtain greater value from current U.S. health care expenditures.
The Future of Public Health
Today’s public health system addresses an array of challenges, including chronic diseases, mental health, substance abuse, traumatic injuries, environmental and occupational health, and bioterrorism. This supplement, based on a symposium at the University of the Sciences in Philadelphia, features national experts in public health who contend that increased life expectancy is leading us to a convergence of scientific, demographic, and economic forces that could lead public health to preempt clinical medicine as the primary focus of American health care.
Managed Care Best Practices in the Treatment and Management of Asthma
Asthma is a syndrome, not a single disease, with multiple phenotypes. Much concerning poor outcomes with asthma treatment is related to misdiagnosis or underdiagnosis, inadequate prescribing of preventive therapy, and poor adherence to treatment plans. Recent advances in our understanding of the variable and syndromic nature of the disease have led to the possibility of improved and more individualized care pathways, which will increase the likelihood of successful outcomes for the patient, society, and the health care system. A focus on asthma control, rather than severity, likely will allow for more accurate monitoring of outcomes and improved care delivery.
Mobilizing Efforts in Osteoporosis Management
The number of Americans age 65 and older will more than double by the year 2050. This cohort will include 20 million people 85 and older — potential osteoporosis patients who today are between 25 and 45 years old. Although past their prime bone-building years, they are not yet candidates for bone-density tests or drug therapy. Many should never need these interventions — provided that low-cost preventive strategies are implemented, starting now. Sound health care policy is directed toward ensuring that negative trends are not allowed to continue unchecked. This supplement is intended to achieve that end.
Obstructive Lung Diseases – Asthma and COPD: Managing the Patient and the Costs
Obstructive lung diseases represent a serious financial and resource burden for MCOs. Correctly diagnosing and treating these patients has proven difficult because of limited testing, the potential for presenting with concomitant diseases, and the similarities among diseases. Making an early and accurate differential diagnosis is essential to proper and cost-effective treatment of these patients. This publication reviews current guidelines for treatment, challenges related to proper diagnosis, and benefits of early treatment.
Undertreatment of Depression and Comorbid Anxiety Translates Into Costly Mismanagement of Resources and Poor Patient Outcomes
According to the literature and measured against national standards for quality of care, treatment of depression is substandard. MCOs that frequently adopt step therapy to reduce pharmacy budgets might do well to re-examine those programs in light of the overall medical cost to the system and the quality of care that those patients receive. This publication explores ways in which providers, payers, and employer purchasers can contribute to an overall improvement in quality of care.
Improving Quality by Encouraging Providers To Use Pediatric Combination Vaccines
It is not every day in the health care business where an investment of $1 results in savings of more than $18. There is solid evidence to support widespread pediatric vaccinations, especially combination vaccines, to achieve such cost saving. Goldfarb and colleagues analyze the promotion of pediatric combination vaccines in a managed care setting and make recommendations to improve our current performance.
Considerations in Creating a Medicare Part D Formulary
Access to medications is the key concern of every stakeholder in the Medicare Part D outpatient drug benefit. Beneficiaries want increased access that will reduce out-of-pocket expenses. Prescription drug plans want to control access so as to assure the financial viability of their programs. Medicare Advantage plans want to promote access as a means to reduce hospitalizations and other expenditures. This supplement examines the variables to consider when constructing a Part D formulary.
Managed Care Best Practices in the Treatment and Management of Non-Small Cell Lung Cancer
Lung cancer is the most prevalent form of cancer-related mortality in adults. Because the diagnosis of lung cancer at an advanced stage generally has a poor prognosis, lung cancer must be diagnosed early and treatment options must be expanded. Non-small cell lung cancer (NSCLC) accounts for 80 percent of all cases and has been treated through chemotherapy, radiation therapy, combined chemoradiotherapy, and surgery. Increasingly, combining emerging biologic and experimental therapies with conventional treatments holds the potential for favorable outcomes. This supplement summarizes the growing number of treatment options available.
Managing the Spectrum of Cardiovascular Care
This supplement is the second of two reports that derive from the 2004 Medical Director Colloquy, an interactive forum between top medical managers and an expert faculty comprising medical and business professionals. Decision makers in managed care have a range of concerns relative to cardiovascular disease management, from optimal treatment approaches to cost efficiency and integration of new technologies. This supplement invites readers to benefit from the exchange of ideas that took place at the 2004 Medical Director Colloquy, including an examination of best practices, from theory to implementation.
Exploring the Spectrum of Cardiovascular Care
This supplement is the first of two reports that are based on the 2004 Medical Director Colloquy, an interactive forum between top medical managers and an expert faculty comprising medical and business professionals. Managed care decision makers seek to address the performance gap that exists in translating recent treatment advances in cardiovascular disease to common practice in ambulatory settings. This supplement allows readers to benefit from the exchange of ideas that occurred at the 2004 Medical Director Colloquy, including an overview of unwarranted practice variation, emerging therapies in anticoagulation, and advances in treating systolic heart failure that are aimed at disrupting the neurohormonal cascade.
The Future of Medicaid: What Will Medicaid Look Like in 2010?
Medicaid is the largest, and probably the most complex, health insurance program in the United States. As a federal-state partnership, Medicaid is buffeted by politics at both levels. State budget crises tend to affect it directly, with federal fiscal politics always lurking in the background. What can and should we expect of it? Five experts gathered at the University of the Sciences in Philadelphia in May 2004 to define challenges and craft a consensus on solutions, as summarized in this publication.
Effective Hypertension Management With New Treatment Paradigms
In this context, a distinguished panel convened to discuss the scope of this health care crisis and the steps to to be taken to at long last address it effectively. Their deliberations are contained in this supplement.
Reversing Asthma-Related Morbidity and Mortality Through Patient Persistency
The panelists discussed revising the asthma classification system and initiation of corresponding changes in treatment recommendations. Important studies were examined, highlighting compliance variations relative to pharmacotherapeutic options, the association between treatment and outcomes, the effect of nonreported short-acting beta2 agonist use on asthma classifications and outcomes data, and quality-of-life issues for different initial maintenance therapies. Also, the panel looked at methods of analyzing data on asthma management from individual health plans, outlining how other health plans can apply these insights.
Innovation and Drug Reimportation: Cost, Value, and Tradeoffs – Economic, Legal, and Public Policy Implications
This supplement was generated from a unique forum that focused on the potential impact of pharmaceutical reimportation on medical innovation. The articles within will assist noneconomists in understanding why the pharmaceutical business sector relies more on the integrity of intellectual property and the ability to entice significant investments than do other business sectors.
Discussions on this topic have been heated and are particularly important, as drug costs continue to increase in the United States, and proposed solutions have the potential to be detrimental to the core of the pharmaceutical industry. The costs and benefits of drug reimportation are discussed and analyzed by the country’s top experts in these areas.
P&T Digest: Depression
David V. Sheehan, MD, MBA, Chief Medical Editor
Depression is one of the most common illnesses in the United States and a major driver of health care utilization costs. Failure to diagnose and treat this condition can lead to poor yet avoidable medical and financial outcomes. The primary goals and challenges of treating depression involve accurate diagnosis of this highly comorbid condition and improving patient compliance with therapy.
This peer-reviewed publication is a digest of up-to-date guidelines for treatment, therapeutic approaches to treatment of depression, pharmacoeconomic considerations in treatment, and a discussion of comorbid conditions. It is a valuable tool for primary care physicians, mental health practitioners, pharmacists, and P&T committee members.
The Rationale for Early, Aggressive Treatment of Type 2 Diabetes: The Cost Ramifications of Improved Health Outcomes
This supplement is based on the proceedings of a diverse advisory group, including managed care medical and pharmacy directors, physicians, an employee benefit consultant, and an academician. The initial part of the discussion focuses on current treatment modalities and expected outcomes for type 2 diabetes, with an eye toward designing optimal treatment plans that can prevent disease or mitigate its progression. After the clinical topics, the supplement focuses on issues of disease management and the perspective of the payer.
The Importance of Blood Ketone Testing in Diabetes Management
The relative benefits of blood- and urine-ketone testing for assessing ketosis in diabetes patients are discussed, with a look at why the American Diabetes Association states that blood-ketone monitoring is preferred for diagnosing diabetic ketoacidosis in type 1 diabetes patients. For confirmation of ketosis and ketoacidosis in the home or the decentralized setting, health care professionals and patients with diabetes have had access to urine-ketone dipstick methods for more than 30 years. There are serious limitations to urine-ketone measurements, both in terms of accuracy and predictive value, however. The advent of the specific measurement of the major ketone in blood, beta-hydroxybutyrate, provided a new option.
With annual medical costs to treat patients with DKA in excess of $1 billion, the pharmacoeconomic implications of appropriate management of type 1 diabetes also are a central focus of the discussion.
Reimportation of Pharmaceuticals: Economic and Policy Implications
This supplement explores the reasons for international price differences in drugs and examines the economic and quality ramifications of increased use of reimported pharmaceuticals. In addition, a panel of experts considers the characteristics of pharmaceuticals procured through nontraditional distribution channels. The perspectives of various stakeholder groups are presented. Based on a conference hosted by the University of Michigan Center for Medication Use, Policy, and Economics.
Demonstrating the Value of Pharmaceuticals Across the Healthcare Continuum
At the 16th Annual Managed Healthcare Symposium, some of the most knowledgeable health care experts in the United States were invited to lecture, debate, and explore medical innovation and the role of pharmaceuticals in the delivery of high-quality care. This supplement is derived from those discussions, the topics of which include trends in healthcare consumerism, FDA movements to ensure safety, improvements in disease-state outcomes, increases in quality of life, and the economics associated with these complex subjects.
Diagnosing and Treating Depression in a Managed Care Environment: Concerns, Perceptions, and Misperceptions
Depression remains underdiagnosed, and even when it is diagnosed it is undertreated. Exploratory discussions with providers from managed care environments have yielded several perspectives that might help to explain the well-documented poor performance in the treatment of depression. This supplement, derived from the proceedings of the Economic Working Group's third advisory board, examines perceptions and misperceptions in the managed care marketplace and examines them in light of the published literature.
P&T Digest: Dry Eye Syndrome
John D. Sheppard, MD, Chief Medical Editor
The understanding of keratoconjunctivitis sicca (KCS), also known as Chronic Dry Eye Disease or Dry Eye Syndrome, has changed dramatically in recent years. Until the late 1990s, KCS was thought to have been due to aqueous insufficiency. Today, KCS is understood to be a multifactorial disease that also involves inflammation of the ocular surface and lacrimal gland, neurotrophic deficiency, and meibomian dysfunction. Delay in treatment may cause disease of the ocular surface. The American Academy of Ophthalmology, in November 2003, released guidelines for treatment that recognizes these contributing factors to the epidemiology of KCS and provides evidence-based guidelines for treatment. This collection of review articles places the etiology of KCS, the AAO recommendations, and the most recent advances in treatment in perspective for practitioners, MCOs, and physicians and pharmacists who serve on pharmacy and therapeutic committees.
Is Health Care Prepared For Bioterrorism?
A Discussion Forum About a 21st Century Health Threat
The bioterrorism incidents in the United States in late 2001 were a wake-up call for the health care community. It forced a critical self-evaluation: Are we prepared to deal with similar events in the future? At its 2003 annual Summer Seminar, the Thomas Jefferson University Office of Health Policy and Clinical Outcomes, led by David B. Nash, MD, MBA, assembled a national and regional leadership group to discuss the health care community’s role in a bioterrorism event and its ability to respond effectively. This supplement presents the perspectives of this panel, which identified preparedness gaps, a national research agenda, and the need for better cohesion locally among first responders to a bioterror incident.
Assessing Clinical Outcomes and Cost: Transforming Dyslipidemia Management
This is the second of two reports from the 2003 Medical Director Colloquy, which focused on care and management of patients with dyslipidemia. This supplement includes discussions of new technological tools to optimize care delivery, efficient methods of identifying high-risk patients, and recent advances in the diagnostic arena. It also provides a range of perspectives from an expert faculty on underdiagnosis and undertreatment of dyslipidemia. This meeting yielded novel concepts to balance outcomes and costs of dyslipidemia management.
The Future of Medicare: A Discussion Forum About Medicare Reform and Growth
As the largest single payer for health care, Medicare has strong influence on care delivery and payment. Yet, the program faces critical challenges in such areas as administration, funding, benefit design, and demographics. In a lively discussion forum moderated by Samuel O. Thier, MD, the three previous administrators of the Health Care Financing Administration — Gail R. Wilensky, PhD, Bruce C. Vladeck, PhD, and Nancy-Ann DeParle, JD — offer insights into how Medicare can meet these challenges.
Transforming Dyslipidemia Management: Assessing Clinical Outcomes and Cost
The basis of this supplement is the 2003 Medical Director Colloquy, a forum for interaction between top medical managers and a nationally renowned faculty of medical and business professionals. Decision makers in managed care have a range of critical concerns relative to dyslipidemia treatment efficacy, cost, and options. This supplement allows readers to examine the dynamic issues that influence the balance of outcomes and costs. The important ideas generated at the 2003 Medical Director Colloquy, captured in this supplement, point readers toward innovative approaches to dyslipidemia.
Improving Pain Management In a Managed Care Setting
Persistent nonmalignant pain, which affects 50 million Americans, is a major challenge facing American health care. Chronic pain, a primary reason individuals seek medical care, is a significant driver of direct and indirect costs, exceeding $100 billion annually. This supplement identifies opportunities for managed care medical directors to improve clinical and financial outcomes through pain management and presents an innovative quality-improvement initiative.
P&T Digest: Hypertension
Marvin Moser, MD, Chief Medical Editor
Hypertension, a major driver of health care resource utilization and expenditures, is a serious public health threat — and by extension, a threat to the health of populations for which MCOs bear responsibility. The seventh report of the Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure recognizes several contributing factors to the epidemiology of hypertension and provides evidence-based guidelines for treatment. This collection of review articles by nationally recognized hypertension experts places JNC-7 recommendations in perspective for practitioners, MCOs, and physicians and pharmacists who serve on pharmacy and therapeutic committees.
Implementing a Disease Management Program for Chronic Kidney Disease
In the years ahead, DM programs for chronic kidney disease will improve outcomes and save treatment costs through well-timed and coordinated interventions. This supplement derives from a gathering of health care and business experts who convened to discuss how to improve the care of patients with chronic kidney disease. The panel, moderated by David Nash, MD, MBA, reviewed K/DOQI clinical practice guidelines and approaches to managing chronic kidney disease. The authors also evaluate common barriers to implementation of innovative medical management techniques for CKD and ESRD.
Seeking A Balance: Weighing the Clinical and Economic Factors of Depression and Anxiety Management
This supplement explores the perspectives of health care professionals, insurers, and business leaders on clinical and economic outcomes for patients with depression and anxiety — two common costly chronic problems. The presentations herein discuss how depression and anxiety are treated and managed, how avoidable morbidity and mortality can be reduced, and the inherent conflicts among health plans, employers, practitioners, and quality management.
Managed Care Best Practices In the Treatment and Management of Psoriasis
The emergence of biologic response modifiers for the treatment of plaque psoriasis herals a promising era for a patient population that has long been underserved. Patients and physicians have high expectations now that therapies that are curative, not just palliativem are coming to market. MCOs will take notice, too, as the pharmacotherapeutic focus moves from the older products to the new and costlier biologic therapies. This supplement explores the issues inherent in in this transition.
Managed Care Guidelines for Management of Chronic Kidney Disease
Disease management programs aimed at the ESRD population do not address the substantial costs that these patients generate long before their disease progresses to dialysis or transplantation. Because the average hemodialysis patient incurs annual costs exceeding $70,000, MCOs seek effective ways to improve clinical outcomes and prevent these costs by shifting their focus from ESRD to managing chronic kidney disease. This supplement describes the National Kidney Foundation’s staging system for diagnosing patients with CKD, as well as interventions appropriate to each stage. This system provides a way to slow the development of the disease, reduce morbidity and mortality, and improve patients’ quality of life.
Movements in Healthcare Legislation: An Interactive Town Hall
At the 15th Annual Managed Healthcare Symposium, some of the most knowledgeable health care policy experts in the United States were invited to lecture on and then debate the potential effects of current and emerging legislative and regulatory issues on health care and managed care. The conference keynote featured a lively debate between James Carville and Sean Hannity, two highly provocative political consultants. Presenters discussed the Bush administration’s new and proposed regulations for Medicare reform; the effects of national health care policy at the local and organizational levels; the role that technological innovation can play in reducing costs; and the complexities of consumer-centric health care models.
Effective Asthma Management: Current Guidelines and Treatment Options
The 2002 update of the National Asthma Education and Prevention Program’s Expert Panel Report 2 presented evidence-based recommendations for long-term management of asthma. These recommendations reaffirm the value of low to medium doses of inhaled corticosteroids as the foundation of modern asthma therapy. This supplement presents comparative clinical data demonstrating the value of inhaled corticosteroids, as well as descriptions of two successful asthma management programs in two large MCOs.
Health Care Quality Means Business
This supplement is derived from the Wharton Health Care Management Alumni Association Conference in Philadelphia in October 2002. A distinguished faculty addressed the business case for quality health care. The Institute of Medicine’s reports on medical errors and the urgency of improving the safety of care delivery was the common thread running through many of the presentations herein, which include General Motors’ efforts to reduce waste and inappropriate care, a discussion of the ramifications of the current malpractice insurance crisis, a case study on how technology advances are reducing error rates at a large metropolitan hospital, and more.
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.
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.
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.
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.
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.
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.
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.
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.
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.
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.
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.
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.
The Changing Landscape of Healthcare
Health care was one of the major themes of the 2000 presidential election season. The presentations at the 13th Annual Managed Healthcare Symposium, just prior to the 2000 election, capsulated the political, economic, and social implications of the health care issues that the current administration in Washington now faces and that are still relevant as the 2004 elections approach. These presentations, adapted for this supplement, include discussions of consumer expectations, the uninsured, Medicare reform, employer concerns, and a frank keynote debate between Paul Begala and Robert Novak. The important issues discussed in this supplement will be of interest to health plan medical and pharmacy directors, pharmacists, pharmacy benefit managers, employers, and quality assurance experts.
Using Antiplatelet Agents To Lower Risk of Stroke and MI
Atherosclerosis is a contributing factor to heart attack, stroke, or peripheral arterial disease. These overlapping disease states are linked by common risk factors and a shared pathophysiologic factor, the platelet. Antiplatelet therapy, therefore, may help to reduce the risk of vascular events and thereby lessen the morbidity, mortality, and cost associated with atherosclerosis and its consequences. The material in this publication stems from a panel discussion of experts in neurology, cardiovascular medicine, and vascular medicine, along with representatives of leading MCOs. Their goal was to reach a consensus on use of antiplatelet therapy within a managed care environment. Clinical pathways for therapy related to myocardial infarction, stroke, and peripheral arterial disease were developed by consensus of the panel and are presented herein. Lawrence M. Brass, MD, of Yale University and Randall Zusman, MD, of Harvard University co-chaired the meeting.
Compliance and Persistence With Medication Therapy
Patients' failure to adhere to medication regimens is a major problem. The factors that beget nonadherence are complex and interwoven. Patients' ability to understand their treatment routines or the reasons for them, side effects, financial barriers, simple forgetfulness — or any combination of these and myriad other determinants — can influence adherence to therapy. Removing barriers to adherence ultimately improves the potential for positive clinical and financial outcomes.
Treatment and Management of Type 2 Diabetes
Diabetes affects 16 million Americans at an annual cost of nearly $100 billion. One third of those with diabetes are undiagnosed, while a substantial portion of those with diagnosed disease are undertreated — with staggering clinical and economic implications. This supplement discusses pharmacological options for treatment, the National Committee for Quality Assurance’s role in helping health plans to provide adequate care for its diabetic members, and a case study of a successful diabetes disease management program. The information herein derives from a meeting attended by physicians, pharmacists, health plan medical and pharmacy directors, employers, pharmacy benefit managers, and quality assurance experts.
Implementing the New HEDIS Hypertension Performance Measure
This monograph, written in 2000 by Cary Sennett, MD, PhD, is a description of the National Committee for Quality Assurance's HEDIS hypertension measure, as promulgated that year. The material also includes a discussion of the importance of hypertension control and the need to monitor providers carefully. The implementation of this measure created challenges for health plans, in terms of both performance measurement and performance improvement. The information provided herein is intended to help leaders in managed care plans prepare for those challenges, by providing a greater understanding of the problem of hypertension control, then explaining how measurement can help improvement efforts, what strategies might be helpful, and what implementation might require. The article is drawn from a summit that brought researchers together with health plan medical directors, pharmacy directors, and quality assurance directors to share knowledge and develop recommendations for others.
Payor, Provider, Patient: Healthcare by Consensus
With health care today being a collaborative effort among providers, patients, and payers, the paradigm of care delivery has changed. Providers want autonomy but are increasingly being held to evidence-based and population-based standards. Payers are demanding this accountability, but the managed care backlash has forced them to refrain from micromanaging providers. Many patients, meanwhile, see personalized health care as a right — even as employer cost-sharing tactics bestow patients with a responsibility to exercise cost-conscious decision making. The presentations in this supplement, derived from the 12th Annual Symposium for Managed Care Professionals, explore the issues inherent in this transforming environment.
Outpatient Treatment of Deep Venous Thrombosis In Managed Care
Venous thromboembolism constitutes a clinical spectrum encompassing deep venous thrombosis (DVT) and pulmonary embolism (PE). These are responsible for substantial morbidity and mortality. An exciting advance in this area of medicine involves the outpatient treatment of stable patients with DVT. This therapeutic approach, which has been facilitated by the advent of low-molecular-weight heparin (LMWH) preparations, is the focus of this supplement. The economic impact of DVT outpatient therapy is also addressed.
Reimbursement Considerations In the Treatment of Hypercholesterolemia: Economics and Implications for Medical Groups
The objective of this roundtable discussion is to review the impact of hypercholesterolemia on cardiovascular risk and public health. In addition, participants explore the clinical and pharmacoeconomic profiles of statins and consider their implications for medical group contracts with HMOs. Among the issues discussed: