Current issues in pharmaceutical reimbursement.

Purpose: Six issues in pharmaceutical reimbursement arising from recent or proposed changes in Medicare rules or rates or the health care environment are described, along with possible strategies for addressing these issues.

Summary: Recent reductions in Medicare pharmaceutical reimbursement rates, increases in use of specialty pharmacies, proposed changes in rules for erythropoiesis-stimulating agent (ESA) reimbursement, increases in need for patient assistance programs, proposed changes in the clinical trial policy, and possible reductions in reimbursement for cases involving medication errors or other negative events as part of pay-for-performance initiatives are cause for concern. A multidisciplinary team approach to improving reimbursement can reduce institutional financial losses and increase options for Medicare beneficiaries.

Partial reversal of heparin anticoagulation by intravenous protamine in abciximab-treated patients undergoing percutaneous intervention.

Serious hemorrhage and vascular complications after abciximab therapy are associated with elevated activated clotting time values. Our preliminary experience suggests that low-dose intravenous protamine administration is both safe and effective in reducing elevated in-laboratory activated clotting time values and the potential for serious hemorrhage in abciximab-treated patients.

Rifampicin-induced renal failure.

Renal failure is a rare complication associated with the use of rifampicin for the treatment of tuberculosis, usually occurring well into the course of therapy. The following is a report of 2 cases of rifampicin-induced renal insufficiency. In the first case oligo-anuric renal failure occurred on the thirteenth day of treatment, after the patient had taken only 9 doses of medication.

Current issues in the management of hypertension.

Major trials evaluating antihypertensive therapy are reviewed, and the current issues surrounding the choice of therapy in mild and isolated systolic hypertension are discussed. Several major trials have shown that patients with mild hypertension benefit from therapy. These results have prompted widespread use of antihypertensive agents; however, there are still no clear guidelines on when drug therapy should be initiated.

Psychotic-like reaction to procaine penicillin G.

A patient developed a psychotic-like reaction immediately after receiving an intramuscular injection of procaine penicillin G. The patient complained of a metallic taste, dizziness, ringing of the ears, and the fear of imminent death. No cardiovascular or pulmonary disturbances were noted.