With the emergence of biologic therapies to treat chronic diseases, new models of health insurance and health care financing are needed. Personalized medicine adds yet another dimension of complexity to the challenges that managed care decision makers face. For patients, biologics offer improved quality of life and life-saving options. The higher cost of biologics presents affordability issues that employers must address if they are to continue to offer health benefits to their workers and their dependents. This special supplement presents a peer-reviewed white paper by The Biologic Finance and Access Council that forms the framework for BFAC’s fully integrated approach to resolving difficult health care financing and benefit design issues. BFAC comprises thought leaders from large employers, national and regional health plans, and pharmacy benefit managers, as well as nationally known health economists, actuaries, consultants, clinicians, patient advocates, and academicians.
Major depressive disorder (MDD) is a common chronic condition in the United States with a prevalence rate that extends to the typical U. S. workforce. Of every 100 employees, 6 will have MDD, and, between absenteeism and presenteeism, each of these workers will lose 27 workdays per year. Managed care decision makers face numerous challenges in managing populations with chronic depression or other behavioral health conditions and associated comorbidities. Effective treatment begins in primary care — the setting in which most patients with depression are seen. This publication provides insight into the inextricable link of mind and body and provides information that can help elevate the standard of care for patients with depression.
Based on presentations at the 2007 Medical Director Colloquy held in Las Vegas, December 6-7.
This Brief reviews the structure, function, and mechanisms of action found among the tumor necrosis factor (TNF) inhibitors. Given the significant difference among these agents, therapeutic interchange may be inappropriate. TNF inhibitors represent distinct biologic entities that perform diverse functional activities.
Respiratory syncytial virus (RSV) bronchiolitis is a common and easily transmitted disease that affects infants, particularly premature infants, and young children, and is the leading cause of hospitalization among infants <1 year of age in the United States. RSV immunoprophylaxis tailored to local conditions can help ensure infant protection and avoid hospitalization. This Clinical Brief discusses the substantial variations in RSV seasonality throughout the country and the importance of using local RSV data to guide immunoprophylaxis management programs. A commentary is provided by Barry S. Lachman, MD, MPH, Medical Director, Parkland Community Health Plan, Dallas, Texas.
In 2007, the American Cancer Society estimated that approximately 178,460 new cases of breast cancer would be diagnosed and 40,460 women would die from the disease. Nearly half of the new cases were expected to be categorized as node-negative, estrogen-receptor (ER)-positive. Although the benefit of ER blockade in combination with chemotherapy has been demonstrated in women with node-negative, ER-positive tumors, low distant recurrence rates with ER blocker monotherapy suggest that chemotherapy may provide minimal benefit in most cases. Molecular diagnostics represent a paradigm shift in breast cancer management, allowing treatment decisions to be based on the genetic profile, or signature, of an individual tumor. Alan H. Heaton, PharmD, RPh; David Hyams, MD; Jill M. Kolesar, PharmD, BCPS, FCCP; and Winston Wong, PharmD discuss the innovative gene expression profiling tools that can help to determine the aggressiveness and prognosis of the cancer, and to predict the likely benefit from a specific treatment.
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.
This supplement was developed to focus on the practical issues and challenges in the management of hematologic malignancies, including multiple myeloma and myelodysplastic syndromes. It will also provide Centers for Medicare & Medicaid Services guidance with respect to clinical management of cancer patients and Medicare reimbursement policies in the arena of hematologic malignancies.
This Brief summarizes “Enoxaparin Versus Unfractionated Heparin With Fibrinolysis for ST-elevation Myocardial Infarction” (Antman et al, New Engl J Med 2006), and includes a managed care analysis of the article by Steven R. Peskin, MD, MBA.
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.
Warfarin’s narrow therapeutic range, variable biological effects, and potential for food and drug interactions present challenges in managing oral anticoagulation therapy with warfarin. Patient self-testing has been shown to result in significant benefits for patients and their families, health care practitioners, and health care systems.
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.
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.
This Brief reviews a potential treatment option for patients with ulcerative colitis. This chronic inflammatory disease may significantly affect a person’s health and quality of life. A once-daily oral medication, MMX mesalamine, may be beneficial to these patients by limiting pill burden and potentially increasingly the likelihood of medication compliance.