PHARMACY

CDC releases new TB treatment protocol

BY Michael Johnsen

ATLANTA — The Centers for Disease Control and Prevention on Thursday released new recommendations to treat latent tuberculosis infection.

The new recommendations, published in CDC’s Morbidity and Mortality Weekly Report, provide guidance on how to administer a new 12-dose regimen for TB preventive therapy that will significantly shorten and simplify the course of treatment from about nine months to 12 weeks. The recommendations are based on the results of three clinical trials, as well as expert opinion.

“This regimen has the potential to be a game-changer in the United States when it comes to fighting TB,” CDC director Thomas Frieden said. “It gives us a new, effective option that will reduce by two-thirds — from nine months to three months — the length of time someone needs to take medicine to prevent latent TB infection from progressing to active TB disease.”

Latent TB infection occurs when a person has TB bacteria but does not have symptoms and cannot transmit the bacteria to others. In the United States, the number of persons with TB disease is at an all-time low (11,182 total cases were reported in 2010); however, approximately 4% of the U.S. population, or 11 million people, are infected with the TB bacterium. TB continues to disproportionately affect people of color and foreign-born persons in this country.

“If we are going to achieve our goal of TB elimination in the United States, we must ensure that those with latent TB infection receive appropriate evaluation and treatment to prevent their infection from progressing to TB disease and possibly spreading to others,” said Kevin Fenton, M.D., director of CDC’s National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention.  “It is critical that we accelerate progress against TB in the United States in order to avoid a resurgence of the disease.”

The new 12-dose regimen adds another effective treatment option to the prevention toolkit for TB, and is not meant to replace other preventative treatment regimens for all patients where the new regimen is not the best option. The regimen includes 12 once-weekly doses of rifapentine and isoniazid. Doses should be taken under the supervision of a health care worker to ensure completion of doses and to allow for monitoring of safety among patients.

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Senate questions what benefit a super-PBM would have for pharmacies, employers

BY Michael Johnsen

WHAT IT MEANS AND WHY IT’S IMPORTANT — The longer this proposed Express Scripts-Medco deal remains under the microscope, the more people don’t seem to like what they see. The general tone at this Senate hearing was against the merger. Many of the senators in attendance were expressing concern that the proposed merger would negatively impact access to pharmacy, which is perhaps the greatest import of the possibility of an Express Scripts-Medco super-PBM. If one of the larger pharmacy chains in the country can’t stomach the proposed reimbursement rates from one-half of that equation, what chance does independent pharmacy have in managing reimbursement rates if Express Scripts and Medco were merged?

(THE NEWS: Express Scripts, Medco grilled by Senate antitrust committee. For the full story, click here.)

Of the concerns raised, senators also questioned how much of the cost savings realized by the combined super-PBM would trickle down to consumers?

"I am particularly concerned that this type of consolidation would leave very few options for large employers who often rely on the big three PBMs to manage and administer their complex benefit plans," noted Sen. Al Franken, D-Minn., in his opening remarks. "This merger will ultimately mean less choice for those companies. That is something we need to be concerned about. … But I am most interested in hearing how Express Scripts can guarantee that those cost savings will be passed down to its customers and won’t just result in higher profits for the company."

There wasn’t a lot of confidence in the room, with the exception of the chief executives of the respective PBMs, that those cost savings would trickle down, necessarily. "We all know that innovation is the fruit of competition and that the more competitors, the more innovation and the better the consumer is served," challenged Sen. Herb Kohl, D-Wis., chairman of the Senate subcommittee. "You seem to be making an argument to the contrary. Have you come up with a new concept for how capitalism works? … Would you suggest that, if you could also take over Caremark and CVS that would be the best thing for everybody? You control the whole market. Would you then innovate in a way that would not be possible otherwise?"

At one point during the hearing, George Paz, Express Scripts CEO, countered that the merged PBM would have to sustain the viability of independent pharmacy and acknowledged how important those smaller chains were to a pharmacy network. "My intention is to work a deal with the independent pharmacist and reimburse them at a higher rate than the [big-box pharmacies]," he said. "Our clients … are going to insist that we have that access to the [independent] pharmacist."

Express Scripts’ clients also may be insisting that the company maintain access with some of those big-box pharmacies as well, namely Walgreens, regarding that national pharmacy chain’s stand-off with Express Scripts over adequate reimbursement rates. Two days following the hearing, Walgreens produced 250,000 signatures from the nation’s military healthcare plan Tricare demanding that Walgreens remain in the Express Scripts network. The pace of petition signatures from Tricare members seeking to retain access to Walgreens and their supporters has reached more than 10,000 per week in recent weeks, the pharmacy operator added.

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Acro hosts Payer/Managed Care Symposium

BY Alaric DeArment

SHARON HILL, Pa. — Attendance at the fifth annual Payer/Managed Care Symposium "far exceeded" that of previous years, the event’s sponsor said.

Acro Pharmaceutical Services said the event, which took place from Nov. 30 to Dec. 1 at the Hyatt at the Bellevue in Philadelphia, attracted more than 130 attendees from specialty drug manufacturers, health plans and other payer organizations representing the majority of patients in the Mid-Atlantic region. The goal of the symposium, Acro said, was to "foster greater insight into the payer perspective on the trends and challenges of managing the specialty pharmacy drug benefit."

"Our efforts over the past years are tangibly translating into significant progress in advancing the cause of specialty pharmacy while bettering the working relationships between payers and the manufacturers of specialty pharmacy medications," Acro president Sajid Syed said. "As part of Lincare Holdings Inc., Acro is now well-positioned to support their mutual needs — not only in the Mid-Atlantic region, but in an increasingly broader service area."


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