#scriptcare

Article Summary: There are currently three approved biosimilars meant to treat rheumatoid arthritis and, while its commonly accepted that biosimilars will be an important piece in helping to control the cost of specialty drugs, the actual impact these drugs will have remains unclear. Acceptance will be highly dependent on the FDA classifying the drugs as “interchangeable.” Further, actual cost impacts will likely not be realized immediately upon release, as most prescribers are unlikely to change therapy for a patient if it has already proven successful. Lastly, it is still unknown to what extent insurers will cover drugs coming from an unproven distribution chain.

Continued criticism around drug company pricing policies has extended to the insulin market, with a 197% price increase from 2002–2013, despite only minor modifications/improvements to the drug class. Oral diabetes medications, however, did not experience this drastic price hike – with the cost of some drugs actually decreasing. The exception to the insulin price hikes is Lantus (by Sanofi) a well-established, long-acting form of insulin. After major pushback from PBMs, Sanofi decreased the cost of the drug by 14% in 2015. Drug cost predictions are also hampered by the anticipated release of a biosimilar version of Lantus – although generic competition typically drives down drug costs by 80%+, actual price impacts of biosimilars on the US market remain unknown. Drug manufacturers continue to defend drug costs, stating that the list price is very rarely the cost paid by insurers or patients.

Stanley Riddell of the Fred Hutchinson Cancer Research Center announced at a conference in February that his team had discovered a way to program patients’ immune systems to recognize and fight cancer cells. The treatment lead to complete remission in 24 of 26 late stage cancer patients and, by targeting only cancer cells, the unpleasant side effects associated with chemotherapy are avoided. While the patients tested all had various types of blood system cancer, researchers are hopeful that the therapy will have similar effects on localized tumors, as well.

Links to the podcast from The Naked Scientists:

http://www.thenakedscientists.com/HTML/specials/show/20160224/

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.

Both Hillary Rodham Clinton and Bernie Sanders have gone on record to voice their disapproval of the recent price hikes in prescription costs. Sanders history includes a 2014 investigation into the soaring costs of generics, an inquiry letter to Turing Pharmaceutical about the Daraprim price increase and, most recently, the introduction of legislature that would allow the Department of Health and Human Services to negotiate drug prices, impose stiffer penalties for fraud, ban ‘pay-for-delay’ practices and ease access of lower-cost Canadian medications. Clinton’s approach is similar to Sanders’, banning ‘pay-for-delay,’ allowing Medicare to negotiate costs and imposing a $250 monthly cap on out-of-pocket specialty drug costs. Experts, however, site that legislation should promote market competition to systematically reduce drug costs instead imposing regulations that could hamper future innovation.

Permethrin, the most commonly used OTC treatment for head lice (as well as bedbugs, mosquitoes and other insects) is losing its effectiveness as the targeted critters develop genetic mutations due to continued exposure to the drug. A study of 109 lice populations found 100% resistance in 104 of the populations. Tested states include Arizona, California, North and South Carolina, Connecticut, Florida, Georgia, Illinois, Maine, Massachusetts, New Jersey, New Mexico, New York, Oregon, Texas, and Virginia; only Michigan had lice populations with no resistance. Prescription medications without permethrin are available and remain effective against lice.