By Our Experts

Law enforcement efforts to prosecute pharmaceutical diversion and counterfeiting have begun to emerge as an important deterrent. By enlisting health care providers, the team of law and medical professionals can ensure that the full extent of harms is known to the court, and conviction results in appropriate penalties for this particularly atrocious crime.

Abstract. OBJECTIVES: To describe dual eligibles’ claims before and after Medicare Part D and to evaluate the effect that Medicare Part D has had on the claim percent gross margin (CPGM) earned by Texas community independent pharmacies.

DESIGN: Nonexperimental time series study.

SETTING: Texas, October 2005 through September 2006.

PARTICIPANTS: 313 community independent pharmacies.

INTERVENTION: Review of more than 150,000 Medicaid and 300,000 Medicare Part D claims acquired from a drug claims processor.

MAIN OUTCOME MEASURES: CPGM per prescription claim before and after the implementation of Medicare Part D, controlling for generic/brand drug status.

RESULTS: The mean CPGM for prescriptions dispensed before Part D (Medicaid claims) was 26.7%. The mean CPGM for claims dispensed after Part D (Medicare claims) was 17.0% (using ingredient costs in 2006 dollars) or 20.4% (using ingredient costs adjusted to 2005 dollars), a reduction of 36.3% and 23.6%, respectively. Under both Medicaid and Part D, pharmacies earned higher margins for generic drugs (39.9% and 29.5%, respectively) than for brand-name drugs (8.7% and 8.3%, respectively).

CONCLUSION: These results support community pharmacy assertions of lower reimbursements from Part D payers compared with Medicaid payers. Based on these results, pharmacies can respond to this evolving environment by carefully reviewing their Part D plans’ impact on CPGM and taking available steps to increase the proportion of generic drugs dispensed to Medicare beneficiaries.

Abstract. OBJECTIVE: To evaluate the impact of an extended-release, once-daily morphine sulfate formulation on depressive symptoms and neurocognition in patients with chronic nonmalignant pain.

DESIGN: Prospective, open-label, one-group trial with a pretest-posttest design.

SETTING: Outpatient pain management clinic.

PATIENTS AND INTERVENTION: Chronic nonmalignant pain patients inadequately controlled with short-acting opioid analgesics and eligible for treatment with once-daily morphine sulfate were initiated on a dose at or near the morphine-equivalent dose of the short-acting regimen.

OUTCOMES: The following assessments were made at baseline and 4 weeks after initiating intervention: pain intensity, pain unpleasantness, pain suffering, pain behaviors, Beck Depression Inventory, and cognitive function.

RESULTS: Eighty-four patients provided usable data. Pain intensity, unpleasantness, and suffering scores were significantly reduced at follow-up (P = 0.001). The mean Beck Depression Inventory scores were significantly lower at follow-up (P = 0.001). Significant improvements were seen in scores at follow-up on the three validated neurocognitive tests: the digit span test, the digit symbol substitution test, and the paced auditory serial addition test (P = 0.001).

CONCLUSIONS: Achieving adequate pain control with once-daily morphine was associated with a reduction in pain and improvements in depressive symptoms and cognitive functioning in the short term.

Non-governmental organizations, or NGOs, play a role in engaging the safety of biological medicines. NGOs should reconsider their roles as safety watchdogs in order to promote positive change with respect to biological medicines. Behind the Curve: A Critique of NGO Activity with regards to the Safety Concerns of Biologics