Better Outcomes With Combo Therapy in Early RA from MedPage Today

By Nancy Walsh, Staff Writer, MedPage Today

Patients with rheumatoid arthritis who received initial combination therapy with adalimumab (Humira) plus methotrexate for two years had better long-term disease control than those who started on monotherapy, an open-label study showed.

At five years, 35% of patients whose initial treatment included both drugs met the stringent criteria of clinical remission, normal function, and no radiographic progression, compared with 13% of those who received only adalimumab and 14% of those taking methotrexate alone, according to Désirée van der Heijde, MD, PhD, of Leiden University in the Netherlands, and colleagues.

These findings "indicate a window of opportunity to influence the disease course with early, aggressive treatment and suggest that there are consequences associated with delay of combination treatment in patients whose disease activity warrants such therapy," the investigators wrote in a paper published online by the Journal of Rheumatology.

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Walgreens: no new Medicaid patients as of April 16 | Seattle Times Newspaper

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By Janet I. Tu - Seattle Times staff reporter

Effective April 16, Walgreens drugstores across the state won't take any new Medicaid patients, saying that filling their prescriptions is a money-losing proposition — the latest development in an ongoing dispute over Medicaid reimbursement.

The company, which operates 121 stores in the state, will continue filling Medicaid prescriptions for current patients.

In a news release, Walgreens said its decision to not take new Medicaid patients stemmed from a "continued reduction in reimbursement" under the state's Medicaid program, which reimburses it at less than the break-even point for 95 percent of brand-name medications dispensed to Medicaid patents.

Walgreens follows Bartell Drugs, which stopped taking new Medicaid patients last month at all 57 of its stores in Washington, though it still fills Medicaid prescriptions for existing customers at all but 15 of those stores.
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In Sour Economy, Some Scale Back on Medications

By STEPHANIE SAUL Published: October 22, 2008, New York Times As people respond to hard times by juggling the cost of necessities, drugs sometimes have to wait. The trend, if it continues, could have potentially profound implications. If enough people try to save money by forgoing drugs, controllable conditions could escalate into major medical problems. That could eventually raise the nation’s total health care bill and lower the nation’s standard of living. Martin Schwarzenberger, a 56-year-old accounting manager for the Boys and Girls Clubs of Greater Kansas City, is stretching out his prescriptions. Mr. Schwarzenberger, who has Type 1 diabetes, is not cutting his insulin, but has started scrimping on a variety of other medications he takes, including Lipitor. “Don’t tell my wife, but if I have 30 days’ worth of pills, I’ll usually stretch those out to 35 or 40 days,” he said. “You’re trying to keep a house over your head and use your money to pay all your bills.” Although the overall decline in prescriptions in the IMS Health data was less than 1 percent, it was the first downturn after more than a decade of steady increases in prescriptions, as new drugs came on the market and the population aged.

Astronomical Increases For 2009 Medicare Part D

Posted by Ronni Bennett in the Time Goes By blog - Although enrollment does not begin until 15 November, the Medicare website has just published the Prescription Drug Plans (Part D) available for 2009, and in my case, it is a shocker. The monthly premium for my current coverage plan increases (are you ready?) by 221.4 percent. No, that is not a typo. And, according to the calculations on the Medicare site, the co-pay for my single prescription drug at the pharmacy will increase by 160 percent, averaging out to an increase (assuming no additional drugs during 2009) of 186.6 percent. The least expensive plan available to me for 2009, including both monthly premium and pharmacy co-pay, costs 75 percent more than my current plan – a helluva lot cheaper than 186.6 percent, but still off the charts in terms of what the insurance and pharmaceutical companies are raking in. In Maine, while there is one such plan for 2009 (premium less than $20/month), the high co-pay for the drug I take and a high deductible, make it much more expensive annually than a couple of other plans with higher premiums. So when you review your coverage for next year, don’t rely only on the monthly premium - it is important to also compare co-pays and deductibles to keep your increase as low as possible. Fortunately, the Medicare Part D website makes comparison relatively easy. Be sure, on page 2, to scroll down to the area on the bottom left of the screen where you can click on “View your current plan.” This will show you the premium and other costs for 2009, and allow you to plug in the drugs you use. You can then compare your current plan to other plans in your state which can vary even from county to county. There are an enormous number of Part D plans in each state – 46 in Maine – but by using the version that allows you to include your drugs in the search, you can reduce the number to plans pertinent to your circumstance. It is outrageous that premiums can be allowed increase more than 200 percent in a year. With only one drug, my cost is not a lot in dollars, but that huge percentage can make a difference, to people who use several and/or more expensive drugs, between affording drugs and not . Enrollment for a new Part D plan begins on 15 October and continues until the end of the year. You can save yourself a rush during holiday season by starting now. I’ve tentatively chosen my new carrier - which will increase my costs over this year by "only" 34 percent - although I’m waiting until Medicare posts consumer ratings, which hasn’t been done yet, to confirm the change for myself. If you choose to keep your current Part D plan, you need to do nothing. The problem of unconscionable price increases (not to mention the hassle of researching and changing carriers each year) is due to unregulated, for-profit insurers and that, unlike Medicaid and the Veterans Administration, by law, Medicare is not allowed to negotiate prices with the pharmaceutical companies. Thank the Republican Congress for that, and for the doughnut hole too.

Drug Coverage Options for Poor Medicare Recipients Dwindle

Posted by Vanessa Fuhrmans in the Wall Street Journal Health Blog Low-income Medicare beneficiaries are starting to look a lot like the girl no one wants to take for a spin on the dance floor. In a growing number of states, many will have fewer drug plans to choose from next year. Only 308 Medicare drug plans have qualified to serve low-income beneficiaries in 2009, almost 200 fewer than this year. That means about 1.3 million people will have to be reassigned to another plan, up from the 1.2 million that Medicare shifted to new plans in 2008 and just 250,000 in 2007. In six states — Arizona, Florida, Hawaii, Maine, Nevada and New Hampshire–low-income seniors will have five or fewer drug plans to choose from, according to an analysis by Avalere Health, a Washington-based research and consulting firm. In Nevada, low-income beneficiaries will have only one stand-alone drug plan available; in Arizona, two. The government automatically assigns a chunk of these 6 million people, who are eligible for both Medicaid and Medicare, to the Medicare drug plans of companies whose premiums are lower than the average. Then the government subsidizes the costs of the plan. That combination encouraged plan providers like Humana and others to compete hard with low prices and give poor Medicare members an array of plan choices. But for many companies, making money on these folks has proved harder than originally thought, despite the subsidies. The result, Avalere says, is that many previously low bidders are now among the highest, and that’s going to lead to a major upheaval next year. Avalere points out that could leave some of those enrollees, many who are among the sickest Medicare members, in a plan with a drug formulary that doesn’t cover all of their health care issues.

MEDICARE HOSTS NATIONAL CONFERENCE TO PROMOTE ELECTRONIC PRESCRIBING

WIDESPREAD USE OF E-PRESCRIBING WOULD ELIMINATE THOUSANDS OF ANNUAL MEDICATION ERRORS Boston , MA – October 7, 2008 – More than 1,400 health care professionals and industry leaders convened in Boston today at the National E‑prescribing Conference hosted by the Centers for Medicare & Medicaid Services (CMS) and 34 co-sponsoring organizations. Featuring U.S. Department of Health and Human Services Secretary (HHS) Mike Leavitt, CMS Acting Administrator Kerry Weems, Senator John Kerry (D-MA), Former House Speaker Newt Gingrich, Massachusetts Governor Deval Patrick, Rhode Island Governor Donald Carcieri, and Health Evolution Partners Chairman David Brailer, M.D., Ph.D., the conference addressed the potential of electronic prescribing (e-prescribing) to improve health care in the United States. Topics of discussion included a newly enacted federal e-prescribing incentive payment program; strategies and tools for integrating e-prescribing with current health care delivery practices; and privacy, security, and risk management implications. “Our Nation’s health care system is undergoing a major transformation thanks to health information technology advancements like e-prescribing,” said HHS Secretary Leavitt. “From the smallest rural communities to the largest metropolitan areas, e-prescribing is streamlining the prescription process for patients, providers, health plans, and pharmacies. Today’s National E‑prescribing Conference is a vital step in overcoming e-prescribing barriers and sharing both best practices and insights to accelerate adoption.” Prescribing electronically gives physicians secure electronic access to each patient’s prescription history, helping to avoid prescriptions that may result in drug interactions. E-prescribing also: Eliminates the possibility of medication errors caused by illegible handwriting; Improves quality and efficiency by actively promoting appropriate prescribing patterns; Furnishes information to providers and dispensers about formulary-based drug coverage; Speeds up prescription renewals; and Facilitates communication between physicians’ offices and pharmacies. The Institute of Medicine reported in 1996 that more than 1.5 million Americans, including an estimated 530,000 Medicare beneficiaries, are injured each year by drug errors. Medicare is advancing e-prescribing by bringing together members of the health care community at the National E‑prescribing Conference. Under provisions in the Medicare Improvements for Patients and Providers Act of 2008 (MIPPA), physicians and other eligible professionals who meet federal requirements as a successful electronic subscriber between 2009 and 2013 will receive incentive payments from Medicare. Under MIPPA, the Secretary of HHS is authorized to identify successful electronic prescribers for a reporting period using one of two possible standards: one based on the reporting of electronic prescribing measures established under Physician Quality Reporting Initiative and one based on the electronic submission of prescriptions under Medicare Part D. Incentive payments, which are available from 2009 through 2013, will be set at 2 percent for 2009 and 2010; 1 percent for 2011 and 2012; and 0.5 percent for 2013. Beginning in 2012, eligible professionals who are not successful electronic prescribers will be subject to a penalty in the form of a percentage reduction in their Medicare physician fee schedule payment. “Medicare is leading the way in implementing innovative technology solutions to deliver optimal health services for beneficiaries,” said CMS Acting Administrator Weems. “Widespread adoption of e-prescribing will mean a significant reduction in annual medication errors, improved efficiency and convenience, and will garner financial savings for both physicians and consumers.” Co-sponsoring organizations of the National E-prescribing Conference were the following: AARP; America ’s Health Insurance Plans; American Academy of Family Physicians; American College of Physicians; American Medical Association; American Medical Group Association; American Optometric Association; American Osteopathic Association; American Osteopathic Association of Medical Informatics; American Pharmacists Association ; American Society of Consultant Pharmacists; Arizona Health-e Connection; Blue Cross Blue Shield Association; Blue Cross Blue Shield of Massachusetts ; California HealthCare Foundation; eHealth Initiative; ePrescribe America ; Florida Agency for Health Care Administration; Health IT Now Coalition; Healthcare Information and Management Sys­tems Society (HIMSS); Lahey Clinic; Massachusetts College of Pharmacy & Health Sciences; Massachusetts Health Data Consortium Inc.; Massachusetts Medical Society; Medical Group Management Association; National Alliance of State Pharmacy Associations; National Association of Chain Drug Stores; National Association of Community Health Centers; National Community Pharmacists Association; National Council for Prescription Drug Programs; New England Healthcare Institute and Massachusetts Technology Collaborative; Pharmaceutical Care Management Association; State of Tennessee ; and SureScripts-RxHub. HIMSS independently sponsored an E-prescribing Solutions Showcase exhibition during the conference. The HIMSS exhibition featured e-prescribing innovations by Allscripts, EHS, Greenway, NextGen, RxNT, Sage Software, and Zix. This e-prescribing initiative is part of HHS’ bold vision for health care reform built on the four cornerstones of value-driven health care. These include: adopting interoperable health information technology; measuring and publishing quality information to enable consumers to make better decisions about their providers and treatment options; measuring and publishing price information to give consumers information they need to make decisions on purchasing health care; and promoting incentives for high-quality, efficient delivery of care. For more information, visit www.hhs.gov/valuedriven or www.cms.hhs.gov/pqri. National E-prescribing Conference presentations can be downloaded at www.e-prescribeconference.com.

Medicare and Generic Prescription Drugs

A report released by Medco Health Solutions, a pharmacy benefits manager, showed that when prescription drugs are covered by insurance, two-thirds of prescriptions initially filled by people with Medicare are for brand-name drugs, but when people fall into the coverage gap they switch to generics. During the coverage gap, people with Medicare must pay the full cost of the drug. When people with Medicare enter catastrophic coverage they tend to switch back to brand-name drugs, with 59 percent of drugs filled during catastrophic coverage being brand-name. (“Seniors Not Quite Embracing Generic Drugs”, Medco Health Solutions, September 2008).

Patients Cut Back on Prescriptions, Doctor Visits Amid Tough Times

Posted by Sarah Rubenstein in the Wall Street Journal Health Blog The health sector tends to be pretty resilient during economic downturns, because even in tight times, people generally make medical care a priority. But this year things aren’t quite hewing to past form. A number of indicators show that patients, pressed by a combination of economic woes and shrinking health benefits, have been cutting back on care.

Privacy Advocates Sound Alarm About Electronic Prescribing

Sarah Rubinstein in Health Blog

Where there’s a push to make medical records electronic, there’s a worried patient-privacy advocate.

In an interview with USA Today, Tim Sparapani, senior legislative counsel for the American Civil Liberties Union, raised a red flag about electronic prescribing: “Any time you put something in a digital format and standardize it, it becomes much more profitable and easy to move those records.”

FDA Requires Conventional and Atypical Antipsychotics to Warn of Increased Death Risk in Elderly Dementia

The US Food and Drug Administration (FDA) announced that manufacturers of conventional antipsychotics are now required to add warnings to labels and prescribing information to indicate that these drugs are linked with an increased risk for death in elderly patients with dementia-related behavioral problems.

Clinical Outcomes of a Home-Based Medication Reconciliation Program After Discharge from a Skilled Nursing Facility

From Pharmacotherapy The transfer of patients from one health care setting to another can be associated with poor postdischarge outcomes. Recent evaluations suggest that approximately 20% of patients discharged to home from a hospital will experience an adverse event (i.e., an injury caused by medical management) during this transition and that 66-72% of these events are drug related. Assuming a frail patient population with multiple comorbidities, one might argue that patients discharged from a skilled nursing facility (SNF) are at greater risk of experiencing an adverse event. With appropriate transitional care, however, such poor outcomes may be prevented and/or mitigated. An important component of transitional care is the review and reconciliation of drug orders between two transition points. The term medication reconciliation refers to the process of comparing the drugs that the patient, client, or resident has been taking before the time of admission or entry to a new setting with the drugs that the organization is about to provide. A "new setting" could include an SNF, hospital, or ambulatory care and other settings. An analysis of changes in drug therapy for primary care patients discharged from an acute care facility revealed a 50% turnover in drugs used between the primary care practice and acute care facility. For example, antihypertensive drugs were discontinued whereas antiulcer agents were begun widely in acute care facilities, resulting in confusion among discharged patients as to which drugs they should be continuing after discharge. Medication reconciliation, thus, is a critical component of a patient's transition between levels of care. Accrediting organizations, such as the Joint Commission, have included medication reconciliation as part of their goals to help promote patient safety.