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Study: Diabetes drugs may be associated with increased bladder cancer risk

BY Allison Cerra

NEW YORK — A drug commonly used to treat diabetes may be associated with an increased risk of bladder cancer, according to a new study published in the Canadian Medical Association Journal.

The researchers — who noted that Type 2 diabetics are at an increased risk of developing cancers, including a 40% increased risk of bladder cancer — conducted a systematic review and meta-analysis to evaluate the risk of bladder cancer among adults with Type 2 diabetes taking thiazolidinediones. The systematic review and meta-analysis of randomized controlled trials and observational studies involved more than 2.6 million patients. Among them, 3,643 had newly diagnosed bladder cancer.

"We observed an increased risk of bladder cancer associated with the use of thiazolidinediones," said Jeffrey Johnson of the School of Public Health at the University of Alberta. "In particular, use of pioglitazone was associated with an increased risk of bladder cancer based on a pooled estimate from three cohort studies involving more than 1.7 million individuals."

The researchers also looked at a possible association with rosiglitazone (another type of thiazolidinedione) but did not see an effect.

"Although the absolute risk of bladder cancer associated with pioglitazone was small, other evidence-based treatments for Type 2 diabetes may be equally effective and do not carry a risk of cancer," conclude the authors. "This study quantifies the association between pioglitazone use and bladder cancer and may help inform decisions around safer use of pioglitazone in individuals with Type 2 diabetes."


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WSJ report: Interest in narrower pharmacy networks on the rise

BY Antoinette Alexander

NEW YORK — The trend toward “narrow” pharmacy networks is expected to continue, according to a Wall Street Journal report.

Walgreens’ split from PBM giant Express Scripts — many of whose millions of plan members now are getting their prescriptions filled elsewhere after the two companies failed to come to terms over reimbursement rates — has opened the door for interest in networks that limit the number of drug stores available to pharmacy-benefit customers, the WSJ reported.

The WSJ said that shifts to such networks won’t necessarily happen overnight but there’s no doubt that narrow networks are getting a lot more attention today compared with prior years.

"It’s more of a discussion point than it’s been in the past," David Dross, who leads the managed-pharmacy practice at consulting firm Mercer LLC, was quoted as telling the WSJ.

Tony Perkins, senior director of investor relations at PBM SXC Health Solutions, cited a "huge spike" in requests to explore narrow networks, driven by the need to create comparisons with Express Scripts offerings, but a smaller increase so far actually using such plans, the article stated.

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White House to meet with retail leaders on Affordable Care Act implementation issues

BY Marianne Wilson

NEW YORK — White House officials have agreed to meet with members of the retail industry to discuss issues associated with implementation of the health-reform law, responding to the industry’s July 2 letter urging the administration to immediately release "long overdue" regulations that would allow employers to move forward on the law’s requirements.

The most important policy issue for retailers is clarification of how the administration intends to define a "full-time employee," said officials with the Retail Industry Leaders Association. Employers also have pressed for a transition phase during which employers who offer coverage in good faith would be exempt from penalties.

The July 2 letter aimed to send a message that these regulations are past due, and RILA is pleased that top White House advisers took notice, said RILA VP government relations Christine Pollack. With less than a year and a half before the statute goes into effect, employers need regulations — not bulletins or guidance — in order to move ahead, according to Pollack.

A key issue, Pollack explained is how the administration intends to define a "full-time employee." The administration currently is proposing that a full-time employee should work an average 30 hours per week, and would allow employers a three-month "look back" period when determining hours. The administration had originally suggested allowing employers a 3- to 12-month lookback, which RILA said it would prefer.

Many employers also seek a more flexible approach for determining FTE status in order to prevent possible churn between employer coverage and exchange coverage for certain employees, which is another key concern amongst retail and other employers that have varying work hours, Pollack said.

RILA and other employer groups, including members of the Employers for Flexibility in Health Care Coalition, also are urging the administration to create a transition period until 2016 during which time employers working in good faith to comply with regulations would not be penalized.

"RILA is gravely concerned that overly burdensome, inflexible regulations will cause millions of Americans to churn in and out of the employer-sponsored system," the letter says. "Employers of variable workforces face unique challenges. RILA strongly urges that regulations recognize these unique challenges by including flexible approaches that can avoid the revolving door, or churn, effect of employees bouncing between employer-sponsored plans, Exchange coverage, or federal health programs."

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