Pharmacy Partnership

Sometimes generic medication isn't always a bargain.  This leads to non-compliant patients, who cut pills, do not fill prescriptions, or order their medication from Canada. Walgreen's may have the answer. Walgreens, the nation's largest pharmacy chain will now be able to use the size and scale of AmerisourceBergen and Alliance Boots to buy generic drugs at cheaper prices.  This will help the chain to "outmuscle" domestic competitors, Like CVS Caremark, and power into new markets. 

Walgreen's is confident that they will be able to lower prices through agreements with generic manufacturers on a global scale, helping them expand into Europe.  In addition to Europe, Walgreen has their eye on Asia and Africa's pharmacy market, for there is a lot of growth potential. Although a risky and aggressive move, since other companies have not partnered up to this extent before, they will have a leg-up while shifting the pharmacy/wholesaler generic pricing landscape.  
AmerisourceBergan will become the second largest distributor behind McKesson in the United States this year, as they are replacing Cardinal Health's contract with Walgreen that expires this August. I think the deal will absolutely put pressure on other companies to join forces, whether at the retail level or further down the supply chain.

This is an interesting new concept that I think is on the rise, since generics will play a very large role in the impending healthcare changes.  I think we will still have to wait to see how much actual savings are realized. Generic manufacturers can't afford to cut too many corners, since they still need to profit while continuing to create medication in line with FDA regulation. 

The real test: If Walgreen can compete with WalMart in the generic pricing arena.




Check out article at WSJ.com

The Brightside for Biotech

 If you have ever seen Monty Python, or tuned into Philly's classic rock radio station 102.9 MGK at precisely 9am, then you've heard  Eric Idle's song, "Always look on the Bright Side." It's a chipper tune, and I must admit as an avid 102.9 MGK morning listener, it definitely helps kick off my work day. Well it looks like Biotech has been singing a similar song as well, to the tune of $516 million!

It was announced today by Third Rock Ventures that $516 million has been raised to create about 15 new biotechnology companies over the next few years.  Due to economic downturn the past several years, funding had been put on pause, stifling research and development, especially for start-ups. 

Third Rock Venture's goal is to grow budding healthcare companies, advance product launches, and bring innovative life changing products to market.  This could not come at a better time, for pipelines in big pharma and biotech have run dry and everyone is after the next big thing in and willing to pay the price.


 Check out rest of article at WSJ.com:
Biotech has a rare, $516 Million Moment....

Dollars for Docs

 It's common knowledge that pharmaceutical companies pay large amounts to physicians whom participate and are trained to lecture on their specific products in a non-biased format.  All this information is available to public now via the Sunshine Act.   It was just released through journalism group ProPublica, that 22 physicians have received over $500,000 since 2009 based on speaking and consulting feeds.  This is an annual report by ProPublica called "Dollars for Docs"  which has revealed one major trend: Psychiatrists were most commonly listed, with the top 5 all working in psychiatry. The top paid doctor is Jon Draud, MD, who is a medical director at of a psychiatric and addiction medicine program in Tennessee.  According to the article, Dr. Draud has received a total of $1,009,213 from AstraZeneca, Cephalon, Lilly, Forest, Merck, Novartis, and Pfizer- all the major players in CNS.

This is an issue that you either side with or are against; typically, if you are an academic you disagree.  It's perfectly legal for physicians to consult or speak for pharmaceutical companies.  I think the hope is that their is honest communication and clear, set guidleines, so there is no confusion in what each parties intent is for the agreement.  Pharmaceutical companies utilize thought leaders, because they are typically innovative in their medical approach and not afraid to try new products, if the data and mechanism of action warrants it, of course!  But of course there is that underlying question whether they are only using the product (or as much of the product) because they are being paid.

To read more, check out this article on medscape.
Dollars for Docs

Curbing Health Tests

Amid a growing effort to curb unnecessary health care, a consortium of medical groups is issuing a sweeping set of recommendations to limit commonly overused tests and treatments.  Working in a patient focused setting, I see these tests occur daily... but I also over hear how overused or unnecessary certain tests are according to some healthcare professionals.

The article discusses a list compiled of 90 recommendations designed reduce costs and protect patients from potential harm.  These overused tests range anywhere from electrocardiograms to mammograms. They suggest against doing routine imaging for lower-back pain within the first six weeks unless certain warning signs are present, and don't order annual electrocardiograms, or EKGs, for low-risk patients without symptoms.

The recommendations, spearheaded by the nonprofit ABIM Foundation, part of the American Board of Internal Medicine, were based on the individual medical groups' assessment of existing scientific evidence, according to the foundation. "Our goal is really to get the scientific information out there, the same information in front of the doctor and the patient, so they can have that conversation, particularly so the patient can realize that more is not better," said Christine Cassel, an internist and chief executive of the ABIM Foundation.

The full set of recommendations can be viewed here

This is a great example of more not always being better.  Just because it is offered, it doesn't mean patients always need it, or need it as consistently. I think that as we see the healthcare platform continue to change, less will be offered on a  reoccuring basis in an effort to cut costs.  And that is the argument to this list of recommendations... Is it really about the patients safety, or more so about the cost reductions in an ever changing environment. From a patient persective, I think it would nice to always have the option for the specific test.

Read full article here

Good Stress?

It turns out stress isn't always a bad thing, it's more about how one reacts and views the nature of stress.  This article discusses research regarding stress and the changes in body chemistry and behaviour when coping with stressful situations.  The study is expected to be published in March via the Journal of Personality and Social Psychology. 

Stress is usually portrayed as having negative health consequences, but it also can aid in boosting the immune system and in the speed of brain processing or even improving memory.  "You could have tons of stress, but it's the mindset about stress that matters," said Alia Crum, a post-doctoral researcher at Columbia and an author of the study. When people see stress as debilitating, the body does not react as well as when one views it as having positive side effects, so it really depends on a persons attitude.

I found this interesting, because I stress-out easily and often, sometimes for good and othertimes for bad.  Now knowing this information, at least stress is healthy and could potentially have positive health benefits if I keep an open mind set and work through the stress?

Check out article at WSJ.com

AA: Antidepressants and Arrythmias

It has been found in studies recently that high doses of certain antidepressants may leave patients at risk of developing prolongation of the QT interval, which is a marker for possible ventricular arrythmia. Investigators looked at over 38,000 electronic medical records and found a "slight but significant" association between QT prolongation and prescriptions of citalopram or escitalopram to name a few.  Others were associated with shortening the QT interval, which has been seen before in research.  The full list of medications is included in the article, so check it out.

I just found this interesting, because now certain medications both prolong and shorten, leaving a little inconsistency, and making the physician's job much more difficult.  The higher the dose, as with any drug, the side effect profile typically goes up. The antidepressant market is very different than other areas or disease states I have dealt with in the past. It is not cut and dry, there is a lot more to it and i understand that once patients find something that work for them, it's best to stick to it, but most data shows that over 40% of patients have side effects on therapy and 50% do not even respond to initial therapy.  Now arrythmias is another thing to consider and I am sure updates to the prescribing information will be occurring as more concrete evidence is found. 




Some Antidepressants cause Arrythmias

painKILLER.

This article discusses the over abuse of the painkiller hydrocodone.  The FDA is recommending this widely used drug be rescheduled.  It is currently Schedule III and under consideration for a move to schedule II.  Schedule II means it has greater potential for abuse and dependence than Schedule III. The fact is that the death rate from overdoses involving hydrocodone have tripled in the last 12 decades.  Because it is easier to get, people have found a way to abuse it.  Because it is schedule III, there is a widespread mis-perception by physicians that it safer and less dangerous, when it comes to long term abuse, which just isn't true.  There are people who do use and need samples for the appropriate reasons, especially those in rural settings.  If it is controlled, samples will no longer be available, and cost disadvantages could arise as coverage would change.

This becomes an ethical dilemma of sorts.  Can the public be trusted?  I know many companies, Shire for example, which makes ADHD medicine has incorporated time- released technology into its medications, so it cannot be abused.  I think this is the future for abused medicine, like hydrocodone. The dilemma that arises with this is that it's branded and there is probably something similar that is generic, but will not have that time released technology until it's patent expires in 16 years. The need for affordable medicine and care is at an all-time high, but what about patient safety?  I could rant about this, but my opinion is biased for several reasons, so instead I'll just let you think it over...

Check out article on Medscape