A look at hospital inpatient formularies and drug use for pneumonia reveals a dramatic shift in therapy over the last five years. This information is based on a panel of representative hospitals reporting their formulary and drug usage data by diagnosis on an ongoing basis to MediMedia USA. This ongoing study (the Hospital Diagnosis and Therapy Audit) monitors all inpatients in the panel hospitals and the drug therapy they received.

Based on an analysis of formulary and drug usage, cephalosporins remain the most widely prescribed therapy for inpatients with pneumonia; however, the introduction of quinolones to hospital formularies has eroded the cephalosporin market share considerably in the past few years. Seventy-six percent of pneumonia patients received some type of cephalosporin in 1998 compared to only 59 percent in 2002. Simultaneously, systemic quinolone therapy rose from 28 percent in 1998 to over 56 percent in 2002. In the quinolone market, Levaquin has remained on top, replacing Cipro, and increasing from 33 percent in 1998 to 61 percent in 2002. These products have made a big impact on hospital formularies, partly because of their dosing schedules. Most cephalosporins, except for Rocephin, need to be administered every eight hours, while the newer quinolones are administered once daily. The slightly higher price of the drugs is offset by the decrease in time spent by the nursing staff.

The Hospital Diagnosis and Therapy Audit reports information quarterly from over a million inpatients, collected from short-term, nonspecialty, nonfederal hospitals. This service is used as an information source for pharmaceutical manufacturers and has been in continuous operation for 14 years.

SOURCE: MEDIMEDIA INFORMATION TECHNOLOGIES

Managed Care’s Top Ten Articles of 2016

There’s a lot more going on in health care than mergers (Aetna-Humana, Anthem-Cigna) creating huge players. Hundreds of insurers operate in 50 different states. Self-insured employers, ACA public exchanges, Medicare Advantage, and Medicaid managed care plans crowd an increasingly complex market.

Major health care players are determined to make health information exchanges (HIEs) work. The push toward value-based payment alone almost guarantees that HIEs will be tweaked, poked, prodded, and overhauled until they deliver on their promise. The goal: straight talk from and among tech systems.

They bring a different mindset. They’re willing to work in teams and focus on the sort of evidence-based medicine that can guide health care’s transformation into a system based on value. One question: How well will this new generation of data-driven MDs deal with patients?

The surge of new MS treatments have been for the relapsing-remitting form of the disease. There’s hope for sufferers of a different form of MS. By homing in on CD20-positive B cells, ocrelizumab is able to knock them out and other aberrant B cells circulating in the bloodstream.

A flood of tests have insurers ramping up prior authorization and utilization review. Information overload is a problem. As doctors struggle to keep up, health plans need to get ahead of the development of the technology in order to successfully manage genetic testing appropriately.

Having the data is one thing. Knowing how to use it is another. Applying its computational power to the data, a company called RowdMap puts providers into high-, medium-, and low-value buckets compared with peers in their markets, using specific benchmarks to show why outliers differ from the norm.
Competition among manufacturers, industry consolidation, and capitalization on me-too drugs are cranking up generic and branded drug prices. This increase has compelled PBMs, health plan sponsors, and retail pharmacies to find novel ways to turn a profit, often at the expense of the consumer.
The development of recombinant DNA and other technologies has added a new dimension to care. These medications have revolutionized the treatment of rheumatoid arthritis and many of the other 80 or so autoimmune diseases. But they can be budget busters and have a tricky side effect profile.

Shelley Slade
Vogel, Slade & Goldstein

Hub programs have emerged as a profitable new line of business in the sales and distribution side of the pharmaceutical industry that has got more than its fair share of wheeling and dealing. But they spell trouble if they spark collusion, threaten patients, or waste federal dollars.

More companies are self-insuring—and it’s not just large employers that are striking out on their own. The percentage of employers who fully self-insure increased by 44% in 1999 to 63% in 2015. Self-insurance may give employers more control over benefit packages, and stop-loss protects them against uncapped liability.