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Here is practical background on the new drug benefit, for persons on Medicare or eligible for it--including details on who can qualify for the major low-income help in paying the fees.
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Explore the source record for details and available documents.
Explore the source record for details and available documents.
Explore the source record for details and available documents.
BACKGROUND: Provincial governments are responsible for administering publicly-funded anti-cancer drug benefit programs in Canada. This study examines inter-provincial variations in not only the content of such programs, but also the policies/processes used when considering a new drug for coverage. METHODS: Pharmaceutical manufacturers and provincial/regional cancer boards were surveyed to identify the drugs covered by public drug benefit plans. Kappa coefficients were calculated to determine inter-provincial coverage variations. The comprehensiveness of availability of anti-cancer drugs across the country was also assessed. A semi-structured survey of all 10 provincial/regional cancer board pharmacy and therapeutics (P&T) committees was employed to examine decision-making policies/procedures. It included questions on committee composition and processes and on factors influencing decisions regarding the introduction of new drugs. Completed surveys were analyzed using qualitative and quantitative techniques. RESULTS: All cancer boards and 75% of manufacturers contacted provided information on drugs covered in each province. Where lists were obtained from both sources, there was full agreement on content. Kappa values calculated ranged from -0.403 to 0.594, indicating poor to moderate agreement on anti-cancer drug coverage between provinces. Only 7 of the 115 drugs were available in all 10 provinces. Regarding decision-making processes, while ratings for both the relative importance and use of factors involved in decision-making (clinical effectiveness, patient preference, etc.) were similar across provinces, those for the relative importance and use of different information types (clinical trials, expert opinion, etc.) varied. CONCLUSION: Access to anti-cancer drugs clearly varies across the country. In part, this may be due to differences in the views of P&T committees on the usefulness of information they use in their deliberations.
In today's complex medical world, physicians often face difficult decisions about whom they serve first--patients, corporations, insurance companies, the government, etc.
OBJECTIVE: To investigate the extent to which preferred drug lists and tiered formularies reflect evidence of value, as measured in published cost-utility analyses (CUAs). METHODS: Using 1998-2001 data from a large registry of cost-effectiveness analyses, we examined the 2004 Florida Medicaid preferred drug list and the 2004 Harvard Pilgrim Pharmacy Program 3-tier formulary, and compared cost-utility ratios (standardized to 2002 US dollars) of drugs with preferred and nonpreferred status. RESULTS: Few drugs on the formularies had any cost-utility data available. Of those that did, median cost-utility ratios were somewhat higher (less favorable) for Florida's preferred drugs compared with the nonpreferred drugs (25,465 dollars vs 13,085 dollars; P = .09). Ratios did not differ for drugs on tiers 1 and 2 of the Harvard Pilgrim formulary, although they were higher for tier 3 and for excluded drugs (18,309 dollars, 18,846 dollars, 52,119 dollars, and 22,580 dollars, respectively; P = .01). Among therapies reported to be cost-saving or to have cost-utility ratios below 50,000 dollars, 77% had favored status in Florida Medicaid and 73% in Harvard Pilgrim. Among dominated drug interventions (reported to be more costly and less effective than alternatives), 95% had favored status in Florida Medicaid and 56% in Harvard Pilgrim. CONCLUSIONS: This study underscores the paucity of published cost-utility data available to formulary committees. Some discrepancies prevail between the value of drugs, as reflected in published cost-utility ratios, and the formulary placement policies of 2 large health plans.
Despite limited evidence to support their use, hospice and palliative care programs commonly employ protocols and/or algorithms for symptom management. The use of these tools may assist in the standardization of care and help manage pharmacotherapy-related costs. The process used by one national palliative care pharmacy company to create palliative care guidelines and algorithms is described along with some of the challenges in validating such tools.
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Beginning January 1, 2006, Medicare beneficiaries will have the option of enrolling in a new Medicare program covering prescription drugs. This article summarizes the new benefit, suggests the factors beneficiaries and their physicians might consider when selecting a prescription drug plan, and outlines practice implications for physician offices.
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Explore the source record for details and available documents.
Recent legislative changes have enabled nurse supplementary prescribers to prescribe controlled drugs. This article explores the scope of supplementary prescribing for substance misuse clients within a primary care setting and shares practical experiences of incorporating this new development into clinical practice.
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Greater understanding of disease pathology at the molecular and cellular level has enhanced the roles of various proteins in disease pathogenesis. Because so many diseases have common physiologic pathways, many biologic therapies have been found to work in multiple therapeutic areas, particularly cancer, inflammation, infections, and metabolic and blood disorders. Thus, the search for agents to inhibit or block these critical therapeutic agents has been accelerated. This supplement reviews the factors contributing to the enormous growth of biotechnology drugs--both those currently marketed and those in late-stage development--from a clinical and managed care perspective. Specifically, the growth of expanded indications for drugs approved by the US Food and Drug Administration (FDA) will be examined, along with the challenges of managing biotechnology therapies being used beyond their original indications. A review of currently marketed biologics under investigation for new indications will be presented, along with a discussion of the implications of expanding indications and the resultant impact on managed care organizations in terms of cost, benefit design, access management strategy, safety and efficacy, and other pertinent issues. Managed care executives will face the challenge of making critical formulary decisions within the context of ever-increasing biologic options, including greater utilization of biotechnology drugs, more biologics for common conditions, and expanded indications for FDA-approved drugs.