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Group develops guidelines for CPOE standards

The Institute for Safe Medication Practices has developed a set of guidelines aimed at helping providers create drug-prescribing standards for their computerized physician order entry systems.


March 14, 2010 Posted by | drugs, healthcare, Safety | , , , | Leave a comment

Is the ‘Cost is a Barrier’ a Busted Myth?

Maybe so, maybe not.

ANN ARBOR, Mich.—Only 68 percent of corporate executives took their cholesterol lowering medication as prescribed by a doctor, a new study shows.

Overall, the executives who took their medication even sporadically were twice as likely to meet their cholesterol goals. The study finding also questions the prevailing wisdom that income is a primary factor in medication adherence.


Researchers in this study did not look at reasons why the executives did or didn’t follow their doctor’s orders, but past research on the topic suggests cost is a factor. However, this study population was predominately white male and more highly educated and compensated than more than the average person.

“Many people think cost is the main reason for medication non-adherence but this doesn’t appear true since these people have relatively high salaries,” said Schultz.

Using statins could actually save money. Previous research on the effectiveness of statin use in a population at high risk for cardiovascular disease found that a health plan with 210,000 covered lives and 9,336 at-risk employees could yield a $1,735 reduction in costs per treated patient.

So what can employers do? Make sure statins are a covered benefit, said Schultz. Do screening to identify at-risk employees. Partner with health care and pharmacy providers to address reasons for poor medication adherence.

March 2, 2010 Posted by | Chronic conditions, drugs, healthcare | , , , | Leave a comment

Comments on the President’s Health Care Proposal

The President’s proposal would change the Senate-passed bill by:

  • Modifying the Employer Free Rider Assessment (Partial Mandate): Would charge employers with more than 50 employees who do not offer coverage comprehensive enough to meet governmental standards for each full-time employee qualifying for federal tax credits for exchange coverage $3,000 instead of $750 and $2,000 per full-time employee for employers who do not offer coverage—the first 30 workers would be exempt from the calculation. LIKELY IMPACT WILL BE A FINANCIAL CALCULATION BY EMPLOYERS ON WHETHER TO OFFER COVERAGE OR OPT OUT. AT RISK: THOSE CURRENTLY OFFERING COVERAGE AND PAYING MORE THAN THE THRESHOLD.
  • Increasing the “Cadillac” Tax Thresholds: Would include the union modifications to raise the thresholds for the 40% excise tax on the aggregate value of employer-sponsored health coverage, beginning in 2018, from $8,500 to $10,200 for individuals and from $23,000 to $27,500 for family coverage, indexed annually to general inflation, not medical inflation, plus 1%. The proposal would still adjust the thresholds higher if insurance costs grow faster than expected, for certain high-risk occupations, firms whose health costs are higher due to the age and gender of their employees, and would not count dental and vision benefits as taxable. LIKELY IMPACT WOULD BE FOR EMPLOYERS TO CONTINUALLY REDUCE THE BENEFITS PACKAGE TO STAY BELOW THE TAX THRESHOLD. AT RISK: EMPLOYERS WILL REDUCE THE COVERGE AND THEREBY SHIFT THE COST OF HEALTH CARE TO PLAN PARTICIPANTS.
  • Delaying Taxing Employers’ Retiree Drug Subsidy (RDS): Would delay prohibiting employers with retiree prescription drug plans from excluding the Medicare Retiree Drug Subsidy (RDS) from gross incomes for corporate income tax purposes until 2012. LIKELY IMPACT WILL BE ONE MORE YEAR OF EMPLOYER SPONSORSHIP OF THESE PLANS FOR THEIR RETIREES. AT RISK: WITHOUT THE SUBSIDY EMPLOYERS WILL END THEIR SPONSORSHIP OF RETIREE DRUG PLANS AND PERHAPS RETIREE MEDICAL ALTOGETHER.
  • Applying Insurance Reforms to Employer-Sponsored Plans: Would require employer-sponsored plans to cover dependents up to age 26 on their parents’ plans LIKELY IMPACT IS THAT IT WILL MAKE PLANS MORE EXPENSIVE. EMPLOYERS WILL SHIFT MORE COST TO EMPLOYEES; prohibit dropping coverage and require all plans to implement internal appeals processes for coverage determinations and claims—self-insured plans would have to use an external review process established or approved by the HHS Secretary. LIKELY IMPACT IS THAT IT INCREASES THE COST OF PLANS. PLANS THAT CURRENTLY SHIFT CLAIMS FIDUCIARY LIABILITY TO THEIR ASO CARRIER PAY APPROXIMATLEY 1% INCREMENTAL ASO FEES. After state-based exchanges start in 2014, it would prohibit annual and lifetime limits, ban pre-existing condition exclusions (medical history, genetic information or evidence of domestic violence) and prohibit setting different premiums based on gender, salary or age. LIKELY IMPACT IS THAT WITHOUT AN INDIVIDUAL MANDATE COST WILL SPIRAL. ALSO DISALLOWING PREMIUM DIFFERENTIALS MEANS THAT INDIVIDUALS WILL NOT BE RESPONSIBLE FOR THEIR OWN LIFESTYLE CHOICES. IT ELIMINATES MONETARY INCENTIVES TO MAKE THE RIGHT DIET, EXERCISE AND BEHAVIOR CHOICES. In 2018, it would require all plans to cover proven preventive services with no cost sharing. LIKELY IMPACT IS THAT THIS INCREASES COSTS SIGNIFICANTLY FOR ALL PLAN SPONSORS. IT WILL CAUSE MORE COST TO BE PASSED ON TO PLAN PARTICIPANTS.
  • Delaying Insurers’ Fees: Would delay implementation of a $67 billion assessment on health insurers over 10 years until 2014. The fee would begin at $2 billion annually in 2014, increase to $4 billion in 2015, $7 billion in 2016, $9 billion for years 2017 through 2018 and $10 billion for years after 2018. WITHOUT REAL INCENTIVES TO KEEP COSTS DOWN, THESE ARE TAXES THAT GET PASSED TO PURCHASERS.
  • Increasing Pharmaceutical Companies’ Fees: Would increase the total amount collected from an annual fee on pharmaceutical manufacturing based on market share, beginning in 2011, from $23 billion to $33 billion over 10 years. WITHOUT REAL INCENTIVES TO KEEP COSTS DOWN, THESE ARE TAXES THAT GET PASSED TO PURCHASERS.
  • Creating a New Federal Board to Evaluate Individual Market Premium Increases:  Would establish a new seven-member federal Health Insurance Rate Authority to help States determine if a rate increase is unreasonable and unjustified and could require health insurers to lower premiums, provide rebates, or take other actions to make premiums affordable. IF THIS IS MANAGED AS PHYSICIAN REIMBURSEMENTS, IT WILL BECOME POLITICAL AND THE WILL TO KEEP THESE UNDER CONTROL WILL BE MISSING. IF NEEDED INCREASES ARE NOT ALLOWED IT IS LIKELY THAT INSURERS WILL DISAPPEAR FROM THE MARKET OR FIND THEMSELVES WITHOUT NECESSARY RESERVES. AT SOME POINT PERHAPS REQUIRING A GOVERNMENT BAILOUT.
  • Changing Requirements for Medicare Advantage Cuts: Would replace the proposals establishing competitive bidding and lowering payments to local fee-for-service rates with a set of benchmark payments for quality and enrollee satisfaction set at different percentages of the current average fee-for-service costs in an area. It would also revise and implement risk-adjustment for payment purposes. IT IS ALL IN THE DETAILS…ANY CHANGES TO MEDICARE ADVANTAGE, IT IS LIKELY THAT SENIORS WILL BE MADE EXTREMELY UNCOMFORABLE AND FEAR THE WORST.
  • Modifying a New Voluntary Retirement Program: While the plan offers no specifics, it would make a series of changes to improve the financial stability of a new national voluntary disability benefit program that employers would automatically enroll employees in (employees could opt-out) and the federal government would deduct premiums ($65 per month, possibly more, or as little as $5 for low-incomes) from employees’ paychecks that would pay $50 per day after year 5 to purchase nonmedical services and support independence at home or in community residential settings. $50/DAY, REALLY? HAVE YOU SEEN THE COST OF IN HOME HELP WHEN SOMEONE IS DISABLED?
  • Lowering the Individual Coverage Mandate Penalty:  Would decrease the penalty for not acquiring coverage from $495 to $325 in 2015 and from $750 to $695 in 2016, or up to 2.5% of income. THIS LINKS TO NOT ALLOWING FOR RATING BASED ON AGE, SEX, CONDITIONS AND SO FORTH. IT MAKES IT EVEN MORE LIKELY THE HEALTHY WILL OPT OUT CAUSING COSTS TO SPIRAL HIGHER.
  • Closing the “Doughnut” Hole in Medicare Part D Coverage:  Would offer a $250 rebate to Medicare beneficiaries who hit the doughnut hole in 2010 and completely phase it out by 2020 so that coinsurance is the standard 25% throughout the coverage gap. THE MONEY HAS TO COME FROM SOMEWHERE. THIS WILL JUST CAUSE COSTS TO BE SHIFTED TO A DIFFERENT SET OF CONSUMERS.
  • Ending Pay-to-Delay Generic Drug Agreements: Would allow the Federal Trade Commission (FTC) to prohibit settlement agreements in which brand-name drug companies pay generic competitors to stay out of the market. HERE IS ONE WE SHOULD ALL AGREE TO.

March 1, 2010 Posted by | drugs, Federal Government, healthcare, insurance | , , , , | Leave a comment

Overuse and Misuse

More PCT testing could reduce unnecessary antibiotic use
If physicians commonly tested patients for procalcitonin, or PCT, it would help them identify those whose respiratory tract infections respond to antibiotics and help prevent prescribing unnecessary drugs, researchers said. The study estimated antibiotic prescriptions for respiratory tract infections could drop by more than 40% if the simple test was used routinely. MSNBC/Reuters (2/25)

February 26, 2010 Posted by | drugs, healthcare, Overuse, quality | , , , , | Leave a comment

Leads and Clues to the Ever Increasing Cost of Health Care

State of the Union’s Health Report released

The use of medical technology in the United States increased dramatically between 1996 and 2006, according to “Health, United States, 2009,” the federal government’s 33rd annual report to the President and Congress on the health of all Americans.

The report was prepared by the Centers for Disease Control and Prevention’s National Center for Health Statistics from data gathered by state and federal health agencies and through ongoing national surveys.

This year’s edition features a special section on medical technology, and finds that the rate of magnetic resonance imaging, known as MRI, and computed and positron emission tomography or CT/PET scans, ordered or provided, tripled between 1996 and 2007.

Highlights of the special section include:

* The rate of adults aged 45 and over discharged from the hospital after receiving at least one knee replacement procedure increased 70 percent from 1996 to 2006 (26.5 per 10,000 population in 1996 to 45.2 per 10,000 in 2006).

* From 1988-1994 to 2003-2006, use of antidiabetic drugs among adults aged 45 years and over increased about 50 percent, and the use of statin drugs to lower cholesterol among this age group increased almost tenfold.

* The number of new organ transplantations per 1 million people increased 31 percent for kidney transplants (43.7 per 1 million in 1997 vs. 57.2 in 2006) and 42 percent for liver transplants between 1997 and 2006 (15.6 per 1 million in 1997 vs. 22.2 in 2006).

The full report contains 150 data tables in addition to the special feature on medical technology. The tables cover the spectrum of health topics, serving as a comprehensive snapshot of the nation’s health.

* Life expectancy at birth increased more for the black than for the white population between 1990 and 2007, thereby narrowing the gap in life expectancy between these two racial groups. Overall U.S. life expectancy in 2007 was 77.9 years.

* In 2007, 20 percent of U.S. adults were current cigarette smokers, a slight decrease from 21 percent in the previous three years. Men were more likely to be current cigarette smokers than women (22 percent vs. 17 percent).

* In 2005-2006, 30 percent of adults often or almost always had trouble sleeping in the past month.

* In 2007, 20 percent of adults 18 years and over had at least one emergency department visit in the past year, and 7 percent had two or more visits.

* The percentage of the population taking at least one prescription drug during the previous month increased from 38 percent in 1988-1994 to 47 percent in 2003-2006, and the percentage taking three or more prescription drugs increased from 11 percent to 21 percent.


February 22, 2010 Posted by | Cost, diabetes, drugs, healthcare, Overuse | , , , , , , | Leave a comment

Senate report links diabetes drug Avandia to heart attacks

(CNN) — The diabetes drug Avandia is linked with tens of thousands of heart attacks, and drugmaker GlaxoSmithKline knew of the risks for years but worked to keep them from the public, according to a Senate committee report released Saturday.

February 20, 2010 Posted by | diabetes, drugs, healthcare, quality, Safety | , , , , , | Leave a comment

Filling Your Prescription

NEW YORK (Reuters Health) – Many people whose doctors start them on medications for conditions like diabetes and high blood pressure may never fill those prescriptions, a new study suggests.


Researchers found that among more than 75,000 Massachusetts patients given drug prescriptions over one year, 22 percent of the prescriptions were never filled. The rate was even higher — 28 percent — when the researchers looked only at first-time prescriptions.

Such “non-adherence,” the study found, was common even among patients prescribed drugs for chronic conditions that can have serious health consequences.

February 18, 2010 Posted by | Chronic conditions, Cost, diabetes, healthcare, High Blood Pressure, insurance | , , , , , | Leave a comment

Your Health: Pharmacists Adjust to Changing Roles

USA Today
Kim Painter

January 25, 2010

More than 20% of prescription drug sales were fulfilled through mail order in 2008 leaving some to wonder what the future holds for pharmacists.

While some studies and pilot programs show that pharmacists can be successful as medication coaches for some patients, other studies show that patients using mail order run out of their prescriptions less often.

For complete story, click here.

January 25, 2010 Posted by | drugs, healthcare, innovation | , , , | Leave a comment

Mail Order vs Retail Medication Compliance

In a recent study, 84.7% of people who mail-ordered their medications for diabetes, high blood pressure or cholesterol, took them as prescribed by their doctors, versus 76.9% of people who bought their medications at local pharmacies.

Source: “Mail-Order Pharmacy Use and Adherence to Diabetes-Related Medications,” The American Journal of Managed Care, January 14, 2010, abstract only, 

January 25, 2010 Posted by | diabetes, drugs, healthcare, High Blood Pressure | , , , , , | Leave a comment

Drug Utilization Increases Among Those Covered by Medicare Part D

Part D Payer Shares of Prescriptions Dispensed Rise for Eight Major Drug Classes

The shares of all prescriptions dispensed covered by Medicare Part D rose by at least three percentage points, between midyear 2007 and midyear 2009, in each of eight major drug classes profiled. The largest percentage increases over this period were in the osteoporosis (to 26.9% in 2009 from 20.5% in 2007) and antiplatelet (to 28.4% from 22.5%) markets.

  2007 2008 2009
Antiplatelets 22.5% 23.9% 28.4%
Asthma 9.8% 10.7% 13.2%
Cholesterol 15.3% 16.3% 19.6%
Diabetes 16.1% 17.4% 20.1%
Hypertension 17.5% 19.2% 22.3%
Oncology 15.4% 17.2% 19.6%
Osteoporosis 20.5% 21.7% 26.9%
Sleep Disorder 9.1% 10.8% 12.5%
Data Source: SDI 2009.
Publication: Managed Care Digest Series.

January 19, 2010 Posted by | drugs, healthcare, insurance, Medicare | , , , , | Leave a comment