Archive for the Medication Category

Big Brother says, “Take your medicine.”

Posted in Health Care Policy, Medication with tags , on April 12, 2009 by drbobbs


Did I remember to take my Victory lisinopril?

Did I remember to take my Victory lisinopril?

The Daily Mail out of Britain, the most suveilled Western nation on Earth, has a story about a plan to monitor patient drug compliance:

Microchips in pills could soon allow doctors to find out whether a patient has taken their medication.

The digestible sensors, just 1mm wide, would mean GPs and surgeons could monitor patients outside the hospital or surgery.

Developers say the technology could be particularly useful for psychiatric or elderly patients who rely on a complicated regime of drugs – and are at risk if they miss a dose or take it at the wrong time.

It could also be used for the chronically ill, such as people with heart disease, to establish whether costly drugs are working or whether they are causing potentially dangerous side effects.

The sensors could even remind women to take the Pill if they forget.

The ‘intelligent’ medicine works by activating a harmless electric charge when drugs are digested by the stomach.

This charge is picked up by a sensing patch on the patients’ stomach or back, which records the time and date that the pill is digested. It also measures heart rate, motion and breathing patterns.

The information is transmitted to a patient’s mobile phone and then to the internet using wireless technology, to give a complete picture of their health and the impact of their drugs.

Doctors and carers can view this information on secure web pages or have the information sent to their mobile phones.


PBM tries to get doctors to write more expensive drug

Posted in Economics of Health Care, Medication, Medicolegal with tags , , , , on November 17, 2008 by drbobbs

Any primary care doc can attest that the pharmacy benefit manager (PBM) companies try to get doctors to write cheap generic drugs in place of expensive branded medications, regardless of whether that is in the patient’s best interest.  Dr. Doug at the Placebo Journal Blog reports that Caremark is doing the opposite:

Caremark has been sending letters to doctors prodding them to add Januvia to specific patients’ treatments. How is that for patient privacy? The letter tells the physician how CVS went through a thorough review process to identify which patients would benefit from the switch. It also states at the bottom that Merck, which happens to make Januvia, paid for the whole thing.

Whatever the merits of Januvia  — Full disclosure: Drug reps from Merck have paid for my lunch on numerous occasions —  the point here is that PBMs often wield considerably more practical influence on what drugs patients get than do the usual suspects: so-called “Big PhRMA”.  Usually they use the “sentinel effect” of trying to deter physicians from writing expensive (but sometimes necessary) prescription drugs by refusing to pay for them unless physicians or office staff fill out prior authorization forms or spend time on the phone with a prior auth drone that could be spent taking care of patients.

When the PBMs and the pharmaceutical industry start working together to try to influence physicians to write more expensive drugs, it demonstrates the problem with having third parties interfere in the physician-patient relationship.

Starting in 2009, new PhRMA guidelines will restrict drug reps from “influencing” doctors with such trivial marketing items as pens or mugs with the names of their drugs on them.  If that is considered undue influence, then what will be the fallout of Caremark-Merck-Januvia incident?

Much less than should be, I suspect.

Getting Medicare patients a better deal on their medications

Posted in Economics of Health Care, Medication with tags , on November 5, 2008 by drbobbs

J.C., M.D. at Citizen Economist writes about an online service that allows Medicare patients to manage their prescription drugs:

This is a company that essentially allows the patient to create an account and manage their prescriptions drugs. It is a free site that provides online shopping comparison for prescription drugs. If you are not yet enrolled in Medicare Part D their site allows you to do so. If you already take medication you can find out if there are lower cost drugs such as generic brands as well as mail-order and retail pharmacy prices. They have created what they call a “Medicine Cabinet” to allow you to manage your prescriptions. You can even look up medical conditions and find out what treatments are available so you can initiate a discussion with your physician about treatments.

I try to help my patients get their meds as cheaply as possible by calling around to different pharmacies to check prices and often sending patients to different drug stores for this or that prescription to minimize the expense.  Sometimes the price differences are shocking.  For example, one pharmacy about half a mile from my office has generic fluticasone nasal spray for $70.  Another pharmacy two miles up the road has the same prescription for about $17.  However, the pharmacy that has the much pricier fluticasone spray also offers about half a dozen generic antibiotics for free.  I think it’s important for health care providers to know the lay of the land in their local area regarding prescription drug costs so they can direct their patients where the cost is lowest.

I like the idea of an online service that allows patients to comparison shop for medicine.  For such a large and important industry, I’m often surprised by how little true competition exists in health care.  Competition tends to drive quality up and prices down.  Health care could use more of it.

ADA, EASD advice against using Avandia

Posted in Medication with tags on October 31, 2008 by drbobbs

The American Diabetes Association and the European Association for the Study of Diabetes have released a consensus statement advising against the use of rosiglitazone (Avandia).  In fairness, the consensus statement acknowledges that the recommendation is based on meta-analysis data that is less than conclusive.  Still, this is another major hit against GlaxoSmithKline’s TZD drug.