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pharmacy challengesHigh drug prices will continue to be the biggest pharmacy challenge for payers in 2017, sparked by the entry of many new specialty drugs on the market for some common chronic diseases— such as diabetes, heart disease, Alzheimer’s, and rheumatoid arthritis—and rare diseases, such as lupus and NASH (nonalcoholic Steatohepatitis, more commonly known as fatty liver disease).

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oncologyOncology therapeutic and supportive care agents in the development pipeline promise to be more effective, more therapeutically targeted, more personalized—and far more costly, according to industry experts.

“At the same time, more effective management of cancer care is increasingly facilitated by increasing penetration of electronic health records [EHRs], EHR-embedded clinical pathways, increasing share of patients treated in integrated delivery systems and larger oncology practices, transition from fee-for-service payment to risk-share payment, and the use of 'big data' to discover how resources can be optimally applied,” says Elan Rubinstein, PharmD, MPH, principal of EB Rubinstein Associates, a pharmaceutical management consulting firm. “Understanding the many changes under way in the healthcare marketplace, including oncology drugs in the pipeline, healthcare executives can coordinate the reaction of their organization to those market changes and thereby maximize value for money related to the care of cancer patients.” 

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Health system pharmacists are keeping a close eye on prescription drug prices as they plan ahead to 2017.

remedioA recent report projects an 11% to 13% increase in total drug expenditures in hospitals and health systems in 2016—which includes a 15% to 17% rise in clinic spending and a 10% to 12% growth in hospital spending.

Data from the report published in the July issue of the American Journal of Health-System Pharmacy (AJHP) extracted information from the IMS Health National Sales Perspective (NSP) database to examine trends in drug expenditures and expected changes in the drug marketplace that may influence drug costs, including anticipated new drug approvals and patent expirations, to make their predictions.

Report author, Glen Schumock, Pharm.D. said it’s important that health system pharmacists keep track of rising drug expenditures.“Drugs are the largest expenditure category in a hospital pharmacy budget. If one is to provide appropriate financial management in a hospital pharmacy, then understanding trends, factors that influence expenditures, and ways to control drug costs is vital,” said Schumock.

Schumock, professor in the Department of Pharmacy Systems, Outcomes and Policy, at the University of Illinois at Chicago, noted that controlling drug spending takes a coordinated effort that involves not just managers but also staff pharmacists. 

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Depression is one of the most common mental disorders in the United States, affecting approximately 6.7% of adults each year, according to the Anxiety and Depression Association of America.

sept 03Depression also takes a heavy economic toll. In 2010, the estimated economic burden of depression, including workplace costs, direct costs, and suicide-related costs was $210.5 billion, according to a report published by the Journal of Clinical Psychiatry. Of that $210.5 billion, only 38% of the total costs were due to major depressive disorder (MDD) itself as opposed to comorbid conditions.

“Depression is often a comorbidity with other chronic illnesses, such as heart conditions or cancer, and often is an impediment to managing other chronic illnesses,” says Cynthia Ambres, MD, a partner at KPMG Strategy and a member of the firm’s Global Healthcare Center of Excellence.

Current treatments

Antidepressants are a popular treatment choice. Although they may not cure depression, antidepressants can reduce symptoms, such as low mood, anxiety, and decreased energy.

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oct 03Completion of Phase I of ASHP’s Standardize 4 Safety initiative is fast approaching.

Branded as the first national effort to standardize medication concentrations with the goal of reducing medication errors, Phase I includes standardization of > 50kg continuous infusions and compounded liquid concentrations. Completion is set for year’s end.

Phase II, < 50kg continuous infusions and standard doses of oral liquids, is scheduled for sometime in 2017. Phases III and IV—intermittent medications, Patient Controlled Analgesia, epidurals, and standard doses of oral chemo agents—are scheduled for 2018.

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Lack of awareness results in delayed diagnosis

Dermatologists are vital in the care of patients who develop  drug reactions with eosinophilia and systemic symptoms (DRESS), Stevens-Johnson syndrome (SJS, L51.1), toxic epidermal necrolysis (TEN, L51.2), and acute generalized exanthematous pustulosis (AGEP) and need to familiarize themselves with these conditions to avoid delays in diagnosis.

READ: Keys to managing adverse drug reactions

"Unfortunately, a delay in diagnosis of DRESS, AGEP, and TEN is common," says Roni P. Dodiuk-Gad, M.D., dermatologist and stand-in department chair, dermatology department, Ha'emek Medical Center, Afula Israel and research fellow, Division of  Dermatology, Department of Medicine, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, Canada. "The delay is caused mostly due to the lack of awareness among physicians about these rare and life-threatening cutaneous adverse drug reactions."

august 04There is no international consensus on the treatment of these severe diseases, Dr. Dodiuk-Gad says. Recently, she published data suggesting knowledge gathered about how to treat TEN has largely not been incorporated in clinical practice.1

Treatment protocol

Dr. Dodiuk-Gad and colleagues designed an assessment and treatment protocol for patients with SJS/TEN. Symptoms usually present within four days to a month after initiation of a drug therapy. Investigators note that SJS/TEN consists of "flu-like" symptoms in initial phases and progresses to cutaneous and mucous membranes with other systemic involvement. The culprit drug is withdrawn and patients are transferred to a specialist unit.2