#340b administration

Despite the many concerns posed in the article Novartis, Roche find outcome-based drug pricing an elusive dream, the hopeful manufacturer, Novartis, has struck a deal with the health benefit manager, Cigna (as well as another insurer according to a Jan 27th investor conference). The terms are based on the ultimate success of Entresto, a medication for patients with chronic heart failure, in reducing hospital admissions and includes a rebate that will decrease or increase based on the drugs measured effectiveness.

The combination of the blood thinner warfarin with the sulfonylureas glipizide and glimepiride (used to treat diabetes) lead to a 22% increase in hospitalization due to low blood sugar in nearly 500,000 Medicare patients. While doctors had already suspected a dangerous interaction between the drugs, the study provides the first piece of conclusive evidence. Warfarin increases the impact of the diabetes drugs, resulting in rapidly declining blood sugar. Experts do not suggest that patient medication protocols be changed but, instead, that prescribers and pharmacists work with patients to ensure consistent blood sugar monitoring.

Current strategies around diabetes control place an increased focus on identifying individuals with prediabetes through health risk assessments, physician referrals and educational marketing initiatives.  Efforts are placed on educating these individuals about lifestyle modifications that can slow or stop the progress towards a Type 2 diagnosis. For instance, a newly implemented National Diabetes Prevention Program (National DPP), is being rolled out in six states and creates a year-long intervention plan centered around diet, stress reduction and physical activity.

In the first human application of a gene-editing technique to manipulate immune cells, one-year-old Layla Richards is cancer-free after being diagnosed with leukemia when she was 14-weeks-old.  Despite seven weeks of chemotherapy, a different experimental treatment and a bone marrow transplant, Layla’s leukemia returned.  With no other options, the family initiated the cell therapy – in which “molecular scissors” edit genes to create immune cells programmed to hunt and attack drug resistant leukemia – which had previously only been used in mice.  After months of isolation, Layla is cancer-free.  Doctors caution that any broad implications of the success are limited to this one case, but are hopeful that the treatment will prove viable for general use in the future.

A study of statin use in American seniors revealed that 34% of individuals with no history of heart trouble are receiving the cholesterol lowering drug, compared to 9% in 1999. The importance of the finding lies in the fact that very few studies of the drug’s effectiveness have been conducted on this older population; and questions mount regarding the risk of potentially serious and bothersome side effects in a drug with potentially limited positive health rewards. While experts point to the importance of preventative measures to reduce the serious complications associated with high cholesterol, they note that overprescribing in combination with the already, likely, heavy prescription load of most seniors can present serious problems as well.