June 2006

Cover Story

When New Drugs Are Costly, How High to Raise Copays?
As some pretty costly, yet very useful, drugs are introduced, will new formulary designs deny access to needy patients?

John Carroll

Retail Medical Clinics Draw Patients & Payers
A growing number of health plans are adding these clinics in retail stores to their networks and are realizing savings

Amanda Brower

Opinions on DM Outcomes Can Be Swayed
An exercise in "point-counterpoint" at a recent disease management meeting showed dramatic swings in views

Prepared by the NMHCC Workgroup on Outcomes Assessment in Disease Management

Hard to Curb Overuse of Drug-Eluting Stents
Health plans find themselves paying for the latest and greatest stent without any control over usage. Even bare-metal stents may be overused.

Tom Pope

Peer-Reviewed

When Overcrowding Paralyzes an Emergency Department
Changing the process and mindset of health care professionals was the key to reducing emergency department overcrowding

Joseph R. Twanmoh, MD, FACEP ; Gail P. Cunningham, MD, FACEP

Editor's Memo

Patients, Payers, and Plans Vexed by Formulary Problems

John Marcille

Legislation & Regulation

Association Health Bill Fails Despite Senators' Support
Patient advocacy groups work overtime to kill legislation that businesses felt would have provided less costly coverage for their employees

John Carroll

Medication Management

Limiting Access to SSRIs Does More Harm Than Good
Despite the higher costs of SSRIs, compared to older antidepressants, limiting members' access can lead to undertreated depression

Martin Sipkoff

Compensation Monitor

Fewer doctors contract with managed care
The Formulary Files

More young adults prescribed ADHD drugs
Employer Update

As Employers Step Back, Individual Plans Step In
Imagine an America where few businesses purchase health care for employees. Should that come about, the individual market will have new products ready.

Lola Butcher

Tomorrow's Medicine

Pompe Disease Therapy Presents Coverage Challenge
Although Myozyme is approved for the infantile form of Pompe disease, it is logical to extend coverage to patients with the late onset form

Thomas Morrow, MD

Managed Care Outlook

All insurers face similar spending growth



News & Commentary

Excessive Use of Screening Tests Costs System Millions Each Year

Headlines On Deadline . . .

Medical Directors Cast Wary Eye On Cost of Biologics

Survey: Workers Not Guided When Choosing Care