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    <recommendedItem id="20090101_19_1834"
                     title="ADA: Wal-Mart, Mail-Order Pharmacies Top Affordable Drug List"
                     score="-0.005"
                     href="http://www.medpagetoday.com/MeetingCoverage/ADA/tb/14611?impressionId=1265810044836"
                     
      NEW ORLEANS, June 9 -- Diabetes patients who shop for the best prices on prescription drugs at mail-order retailers and big-box discounters may save thousands of dollars a year, researchers found.
              &lt;br&gt; 
              &lt;br&gt;In an analysis of pricing data obtained from state attorneys general, Medco by Mail and Wal-Mart were the least expensive, while neighborhood and chain pharmacies generally charged the most, Clifton M. Jackness, M.D., and Ronald Tamler, M.D., Ph.D., both of the Mount Sinai School of Medicine in New York, N.Y., reported.
              &lt;br&gt; 
              &lt;br&gt;&quot;Being an informed consumer is clearly beneficial,&quot; they said here at the American Diabetes Association meeting.
              &lt;br&gt; 
              &lt;br&gt;The total monthly out-of-pocket price for all 10 drugs most commonly prescribed to diabetes patients for any indication ranged from a low of $428.35 with Medco to a high of $641.90 with Rite Aid. 
              &lt;br&gt; 
              &lt;br&gt;The researchers speculated that lower costs may improve adherence, and thus outcomes, since nearly one in five adults with diabetes reports cutting back on their prescriptions because of cost.
              &lt;p&gt; 
              &lt;p&gt;However, there is often a tradeoff for lower prices, commented R. Paul Robertson, M.D., ADA&apos;s president of medicine and science.
              &lt;p&gt; 
              &lt;p&gt;&quot;Pharmacies, especially local ones, offer more than drugs,&quot; he said. &quot;They offer service and the opportunity to talk to a pharmacist.&quot;
              &lt;p&gt; 
              &lt;p&gt;Giving that up in exchange for a lower bill may be worthwhile for some patients who are on a stable regimen and familiar with their medications, whereas for others it might not, Dr. Robertson noted.
              &lt;p&gt; 
              &lt;p&gt;The researchers tabulated the most common prescriptions filled by diabetes patients under age 65 (a population expected to have at least some out-of-pocket cost associated with their medications) from a medical and pharmaceutical claims database compiled by 91 health insurance plans across the U.S.
              &lt;p&gt; 
              &lt;p&gt;After exclusion of nonchronic medications such as antibiotics, the top medications in order of number of prescriptions were: 
              &lt;p&gt; 
              &lt;ul&gt;
                &lt;li&gt;Metformin
                &lt;li&gt;Atorvastatin (Lipitor)
                &lt;li&gt;Lisinopril (Prinivil, Zestril)
                &lt;li&gt;Rosiglitazone (Avandia), excluded from the analysis because of declining use since the time covered by the database
                &lt;li&gt;Furosemide (Lasix, Furocot)
                &lt;li&gt;Pioglitazone (Actos)
                &lt;li&gt;Simvastatin (Zocor)
                &lt;li&gt;Hydrochlorothiazide (Microzide)
                &lt;li&gt;Insulin glargine (Lantus)
                &lt;li&gt;Amlodipine (Norvasc)
                &lt;li&gt;Atenolol (Tenormin)
              &lt;/ul&gt;
              &lt;p&gt; 
              &lt;p&gt;While this list contained several duplicate classes, such as multiple antihypertensives and two statins, Dr. Jackness noted that diabetes patients take an average of 8.9 medications. The typical patient would be on the majority of drugs on the list, he said.
              &lt;p&gt; 
              &lt;p&gt;The cost of a 30-day supply of each -- assuming no prescription drug coverage by public or private insurance -- was determined from the New York and New Jersey State Attorneys General. 
              &lt;p&gt; 
              &lt;p&gt;These offices maintain publicly-accessible Web sites on current prescription drug prices at the pharmacies in their respective states. The researchers confirmed the prices by direct contact with the pharmacies.
              &lt;p&gt; 
              &lt;p&gt;For some drugs, the price differences between pharmacies were dramatic. 
              &lt;p&gt; 
              &lt;p&gt;Consider metformin, the 10th most popular generic drug prescribed overall in 2008, with 40 million prescriptions written, according to &lt;em&gt;Drug Topics&lt;/em&gt; magazine
              &lt;p&gt; 
              &lt;p&gt;Dr. Jackness and colleagues found that metformin sold for $4.00 in the generic drug discount program at Wal-Mart and Target and for $5.00 at Kmart. But the local neighborhood pharmacies averaged $38.95 and pharmacy chain Rite Aid charged $39.99.
              &lt;p&gt; 
              &lt;p&gt;While stores such as Wal-Mart have heavily marketed their low-cost generic programs, they tended to offer more competitive prices for nongeneric drugs as well.
              &lt;p&gt; 
              &lt;p&gt;And, although the superstores and mail-order pharmacies did not consistently offer lower prices for every medication, none of the local chains or independently-owned pharmacies had the lowest price for any drug on the list. 
              &lt;p&gt; 
              &lt;p&gt;When prices for the 10 drugs most commonly prescribed to diabetes patients were added (excluding rosiglitazone), the monthly totals were:
              &lt;p&gt; 
              &lt;ul&gt;
                &lt;li&gt;$428.35 for Medco by Mail (excluding shipping and handling)
                &lt;li&gt;$432.53 for Wal-Mart
                &lt;li&gt;$483.94 for Kmart
                &lt;li&gt;$501.65 for Drugstore.com (excluding shipping and handling)
                &lt;li&gt;$505.95 for Target
                &lt;li&gt;$584.44 for CVS
                &lt;li&gt;$633.11 for Duane Reade
                &lt;li&gt;$638.31 for Walgreen&apos;s
                &lt;li&gt;$639.20 for local pharmacies
                &lt;li&gt;$641.90 for Rite Aid
              &lt;/ul&gt;
              &lt;p&gt; 
              &lt;p&gt;Unfortunately, this kind of price information is not readily available in most other states, commented Patricia Coon, M.D., of the Billings Clinic in Billings, Mont.
              &lt;p&gt; 
              &lt;p&gt;Nevertheless, savvy patients and physicians can find this information locally by doing their homework, Dr. Coon said.
              &lt;p&gt; 
              &lt;p&gt;&quot;They do a lot of shopping from pharmacy to pharmacy to get the lowest price,&quot; said Dr. Coon, who was not involved in the study. &quot;It&apos;s not unusual for patients to be asking to be switched to generics or the generic that&apos;s offered by a Wal-Mart or large brand.&quot;
              &lt;p&gt; 
              &lt;p&gt;Dr. Jackness agreed, noting that even if it&apos;s not posted in a central location, price information is available with a phone call. &quot;People shouldn&apos;t assume a drug is the same price everywhere,&quot; he said.
              &lt;p&gt; 
              &lt;p&gt;In his own New York City practice, Dr. Jackness said he often recommends low-priced local outlets to patients at financial risk. &quot;If we see patients without insurance we tell them to go down to Penn Station and go to Kmart,&quot; he said.
              &lt;p&gt; 
              &lt;p&gt;But realizing the savings from purchasing all medications at a superstore or mail-order company may not be possible for all patients, the researchers noted.
              &lt;p&gt; 
              &lt;p&gt;&quot;The patient must have the physical ability and means of transportation to travel to these stores or order online,&quot; they said.
              &lt;p&gt; 
              &lt;p&gt;They cautioned that the study did not take into consideration insurance coverage, which may limit generalizability.
              &lt;p&gt; 
              &lt;p&gt;But regardless of patients&apos; insurance status, the findings should serve as a wakeup call for physicians to take an active role in ensuring patients are able to obtain their prescribed medications, Drs. Jackness and Tamler concluded.
              &lt;p&gt; 
              &lt;p&gt;If adherence is an issue, physicians should ask patients about the impact of medication costs and suggest cost-lowering strategies, Dr. Robertson agreed.
              &lt;p&gt; 
              &lt;p&gt;&lt;table cellspacing=&quot;0&quot; hspace=&quot;1&quot; style=&quot;border-style:solid; border-width:1px; border-color:#8dabbc; font-family:arial; font-size:12px; background-color:#DBE9F2; padding:5px 5px 5px 5px;&quot;&gt;
&lt;tr&gt;&lt;td&gt;The researchers reported no funding or conflicts of interest.
              &lt;p&gt; 
              &lt;p&gt;Drs. Coon and Robertson reported no conflicts of interest.&lt;/td&gt;&lt;/tr&gt;&lt;/table&gt;
              
    </recommendedItem>
    <recommendedItem id="20100101_19_82"
                     title="Appointment with the Pharmacist May Be Beneficial (CME/CE)"
                     score="-0.005"
                     href="http://www.medpagetoday.com/PublicHealthPolicy/PracticeManagement/tb/17873?impressionId=1265810044836"
                     
      When pharmacists take a more active role in patient care, disease outcomes are improved  --  particularly for diabetes patients, a new study shows.&lt;br&gt;
&lt;br&gt;Diabetics who had an intensive consultation with a pharmacist regarding their medications, as well as subsequent follow-up, saw significant improvements in hemoglobin A1c and fasting plasma glucose, Erin Slazak, PharmD, of the University at Buffalo, and colleagues reported online in the &lt;em&gt;Journal of the American Pharmacists Association&lt;/em&gt;.&lt;br&gt;
&lt;br&gt;The pilot study was small, with only 50 patients, and it lacked a control group, but Slazak said she and colleagues collected the data &quot;because we wanted to show that we were having a positive effect on patient outcomes at the primary care level.&quot;&lt;br&gt;
&lt;br&gt;Adding a pharmacist to a patient&apos;s healthcare management team is not a new idea. Prior studies  --  including the Asheville Project and the Diabetes Ten City Challenge  --  have shown it improves disease outcomes and cost-effectiveness.&lt;p&gt;&lt;/p&gt;
&lt;p&gt;&quot;There is an increasing body of evidence to support that pharmacists provide an effective and unique role in a collaborative disease management model,&quot; said Toni Fera, PharmD, of HealthMapRx and the lead investigator of the Diabetes Ten City Challenge.&lt;/p&gt;
&lt;p&gt;&quot;Medication adherence is critical to the management of chronic diseases, and pharmacists are uniquely trained to help patients understand why they need to take their medications,&quot; Fera said. &quot;And it helps them overcome barriers that prevent patients from taking their medications appropriately.&quot;&lt;/p&gt;
&lt;p&gt;Fera said there&apos;s &quot;growing momentum&quot; to include pharmacists in patient care. Medicare Part D plans, for example, allow pharmacists to provide medication therapy management services, which include a review of medications and proper use.&lt;/p&gt;
&lt;p&gt;Some state-level programs exist, such as the one run by Slazak and colleagues.&lt;/p&gt;
&lt;p&gt;Slazak said patients receive a one-hour consultation in which they bring in all their medication bottles  --  prescription and nonprescription  --  and have a thorough history taken. Pharmacists explain why each medication is relevant to treatment, and discuss necessary diet and lifestyle changes.&lt;/p&gt;
&lt;p&gt;&quot;We make sure the patient leaves with a solid understanding of why they&apos;re taking the medications they&apos;re taking,&quot; Slazak said.&lt;/p&gt;
&lt;p&gt;She and colleagues will then make recommendations to the patient&apos;s physician regarding medications (in New York state, pharmacists don&apos;t have prescribing power, but in some states they can adjust medications as necessary, without consulting the patient&apos;s doctor).&lt;/p&gt;
&lt;p&gt;They&apos;ll also follow up with the patient, either over the phone or in person, on a monthly or weekly basis, depending on the patient.&lt;/p&gt;
&lt;p&gt;In their study, Slazak and colleagues found significant reductions in hemoglobin A1c and fasting plasma glucose after both six months and one year, compared with baseline (A1c -1.1%, &lt;em&gt;P&lt;/em&gt;&amp;lt;0.0001 and fasting plasma glucose -39 mg/dL, &lt;em&gt;P&lt;/em&gt;=0.003; and A1c -1.1%, &lt;em&gt;P&lt;/em&gt;&amp;lt;0.0001 and fasting plasma glucose -35 mg/dL, &lt;em&gt;P&lt;/em&gt;=0.005, respectively).&lt;/p&gt;
&lt;p&gt;There were no significant decreases in other metabolic parameters, including blood pressure and cholesterol.&lt;/p&gt;
&lt;p&gt;&quot;There are a lot of possible reasons for that, mostly because we&apos;re focused on diabetes,&quot; Slazak said. &quot;And our program was fairly new at the time, so we weren&apos;t working as closely with the providers as we are now.&quot;&lt;/p&gt;
&lt;p&gt;She said the relationship between pharmacists and primary care providers is key to this type of collaboration. While physicians may have heeded 50% of pharmacists&apos; recommendations at the beginning of the study, Slazak said, they now heed more than 90%.&lt;/p&gt;
&lt;p&gt;The program also tended to reduce costs. Geometric mean costs tended to decrease versus baseline at six-month (&amp;#8211;$84; &lt;em&gt;P&lt;/em&gt;=0.785) and 12-month (&amp;#8211;$216; &lt;em&gt;P&lt;/em&gt;=0.414) assessments, despite nominal increases in diabetes and total medication costs. None of the changes was statistically significant.&lt;/p&gt;
&lt;p&gt;The researchers have since matched the 50 patients in this study, which was conducted between 2006 and 2007, with 50 controls, for a more complete report, but the data has not yet been published.&lt;/p&gt;
&lt;p&gt;While programs like this one have been appearing around the country, Fera said remaining challenges included determining how to incorporate the pharmacist into the existing healthcare system and how to coordinate care and sharing of information among providers.&lt;/p&gt;
&lt;p&gt;&quot;It really hinges on having the pharmacist prove a cost-benefit ratio to a physician group or third-party payer,&quot; Slazak said.&lt;/p&gt;
&lt;div style=&quot;float:left;border-style:solid;border-width:1px;border-color:#8dabbc;font-family:arial;font-size:12px;background-color:#DBE9F2;padding:5px;&quot;&gt;&lt;p&gt;A co-author reported relationships with Bayer, Cadence, Cubist, Forest, Optimer, Ortho-McNeil, Schering-Plough, and Wyeth.&lt;/p&gt;&lt;/div&gt;&lt;div style=&quot;clear:both;&quot;&gt;&lt;/div&gt;
    </recommendedItem>
    <recommendedItem id="20100101_19_132"
                     title="Economic Burden of Diabetes Tops $200B"
                     score="-0.005"
                     href="http://www.medpagetoday.com/Endocrinology/Diabetes/tb/17950?impressionId=1265810044836"
                     
      &lt;p&gt;Medical costs and reduced work productivity associated with diabetes cost the U.S. $218 billion in 2007, researchers said.&lt;/p&gt;
&lt;p&gt;The annual average cost per patient was $9,975 for diagnosed diabetes and $2,864 for undiagnosed disease, according to Timothy M. Dall of the Lewin Group in Falls Church, Va., and colleagues.&lt;/p&gt;
&lt;p&gt;&quot;The burden of diabetes to society is even higher when one considers intangible costs from reduced quality of life,&quot; the researchers wrote online in &lt;em&gt;Health Affairs&lt;/em&gt;.&lt;/p&gt;
&lt;p&gt;&quot;The sobering statistics presented in this paper underscore the urgency to better understand the cost-mitigation potential of prevention and treatment strategies.&quot;&lt;/p&gt;
&lt;p&gt;Dall and his colleagues, working with funding from Novo Nordisk, developed the estimates from a proprietary economic model based on medical literature, government statistics, and insurance claims data.&lt;/p&gt;
&lt;p&gt;Results from the National Health Interview Survey, corrected with claims data, indicate that about one million Americans had type 1 diabetes and 16.5 million had type 2 diabetes in 2007.&lt;/p&gt;
&lt;p&gt;The economic model indicated that the per-patient economic burden was $14,856 for type 1 diabetes and $9,677 for type 2 disease.&lt;/p&gt;
&lt;p&gt;National Health and Nutrition Examination Survey findings indicate that some 57 million individuals had &quot;prediabetes,&quot; and another 6.3 million Americans had diabetes but have not been formally diagnosed.&lt;/p&gt;
&lt;p&gt;Their average costs were $443 for prediabetes (medical costs only) and $2,864 for undiagnosed diabetes, Dall and colleagues estimated.&lt;/p&gt;
&lt;p&gt;Compared to those with no diagnosis, people with known diabetes accounted for vastly more use of various services, including outpatient care, emergency visits, and hospitalization.&lt;/p&gt;
&lt;p&gt;For example, ambulatory visits for neurological symptoms were nearly eight times as common among among type 1 diabetics as among nondiabetics, and five times as common among those with type 2 diabetes.&lt;/p&gt;
&lt;p&gt;Inpatient days for cardiovascular problems were increased more than six-fold for both types of diabetes, and emergency visits for such problems were about three times as common.&lt;/p&gt;
&lt;p&gt;Undiagnosed diabetes had smaller but still detectable consequences for medical expenses. Compared with people with no history of diabetes, undiagnosed diabetics had 70% more outpatient visits and more than twice as many hospital inpatient days for cardiovascular complaints.&lt;/p&gt;
&lt;p&gt;Overall, the bill for medical services associated with diabetes was $153 billion, according to Dall and colleagues  --  about 7% of the total national healthcare expenditure.&lt;/p&gt;
&lt;p&gt;The researchers put the loss of work productivity at $65 billion, including absenteeism, reduced productivity while at work, disability, and premature death.&lt;/p&gt;
&lt;p&gt;Some of the data underlying the estimate came from National Health Interview Survey data on missed workdays and disability rates, reports in the literature, and CDC estimates of diabetes-related mortality.&lt;/p&gt;
&lt;p&gt;Dall and colleagues noted that patients and their families bear much of the burden in the form of out-of-pocket expenses and reduced earnings  --  not to mention the impaired quality of life and other intangibles.&lt;/p&gt;
&lt;p&gt;But everyone else shares the costs as well, they argued.&lt;/p&gt;
&lt;p&gt;&quot;This diabetes burden represents a hidden &apos;tax&apos; in the form of higher health insurance premiums and reduced disposable income,&quot; Dall and colleagues wrote.&lt;/p&gt;

    </recommendedItem>
    <recommendedItem id="20090101_9_638"
                     title="ACP: Diabetes Initiative Aims to Make Care a Team Event"
                     score="-0.005"
                     href="