Will the newer oral MS agents be welcomed by managed care organizations?

Of the new generation of multiple sclerosis (MS) drugs, 4 oral agents--dalfampridine, laquinimod, cladribine, and fingolimod--could produce significant changes in the treatment landscape for MS. Current first-line treatments, which are administered via injection, are associated with poor treatment adherence, often due to lack of efficacy (perceived and real), adverse drug reactions, cost, and injection anxiety. Although concerns about safety and cost remain, preliminary results indicate that these oral agents are as effective as, or even more effective than, current injectable treatments.

Current and future directions in MS management: key considerations for managed care pharmacists.

Background: The management paradigm for multiple sclerosis (MS) continues to evolve and is shifting toward earlier diagnosis, differentiation of patients with varying clinical prognoses, and earlier initiation of treatment in selected individuals. Based on surveys conducted at the 2008 annual conference of the Academy of Managed Care Pharmacy (AMCP) and at regional meetings held in 2009, several topics were identified for which pharmacists indicated a need for new and updated information.

Objective: To review (a) recent insights into the pathophysiology underlying MS, (b) the improvements in identification of patients with a clinically isolated syndrome (CIS) who will progress to clinically definite MS (CDMS), (c) the current role of magnetic resonance imaging (MRI) and other technologies in the diagnosis and ongoing management of MS, (d) the optimal time to initiate treatment in patients with CIS or MS, and (e) the potential utility of new and emerging therapies in MS management.

Assessing the short-term and long-term burden of illness in cervical cancer.

Human papillomavirus (HPV) infection is associated with significant clinical, social, and financial burdens. Infection is often asymptomatic, which increases the risk of unwitting transmission. Up to 29 million American women between the ages of 14 and 59 years are currently infected, and 80% of women will contract the infection by 50 years of age.

Injectable biologic case studies.

Objective: To identify strategies used by a commercial managed care organization (MCO) to affect appropriate cost-effective use and prioritize payment for biologic agents.

Summary: With the rapid increase in the number of biologic agents and the lack of head-to-head comparative trials, determining clinical superiority of one agent may be challenging. Four case studies are presented that highlight strategies used by a commercial MCO to manage the costs and utilization of these agents and identify a preferred biologic therapy to recommend for its internally developed prior-authorization (PA) criteria for rheumatoid arthritis, asthma, psoriasis, and multiple sclerosis.

Anticipating the future: how the emergence of innovative biologic agents impacts benefit design, utilization, and provider relations.

Objective: To review the impact of biologic therapies on commercial and government payers.

Summary: Biologic agents, a mainstay in the treatment of cancer and immunopathologic conditions, are being used for an expanding number of indications, and new agents are being developed for use in many other diseases. These biologic agents have the potential to improve patient quality of life and the overall quality of care with minimal risk of adverse events.

Advances in migraine management: implications for managed care organizations.

Migraine headache is a disabling disease that poses a significant societal burden. Stratified care and early intervention are current strategies for migraine management. It has been shown that early treatment with triptans in select patients can improve treatment outcomes.

Overview of pharmacologic therapy for the treatment of dyslipidemia.

Although the National Cholesterol Education Program Adult Treatment Panel III (ATP III) guidelines stress the importance of nonpharmacologic lipid modification interventions such as diet and exercise, the guidelines also recognize that many patients will require drug therapy to achieve low-density lipoprotein cholesterol (LDL-C) target goals. Currently available lipid-modifying drugs include bile acid sequestrants (or resins), fibrates, nicotinic acid, and statins, with each class exerting different effects on the lipid profile. In addition, nonprescription agents such as plant stanols and sterols have been shown to be effective in modifying plasma lipids.

The National Cholesterol Education Program Adult Treatment Panel III guidelines.

Coronary heart disease (CHD) persists as a major cause of morbidity and mortality in the United States, with more than 40% of all deaths each year directly attributed to the disease. Dyslipidemia is recognized as a major risk factor for the development and progression of CHD, with clinical trials clearly demonstrating the public health and economic benefits of favorable cholesterol modification. As a result of this evidence, the National Cholesterol Education Program (NCEP) has developed guidelines for the detection, evaluation, and treatment of high blood cholesterol in adults.

Effective management of patients with dyslipidemia.

Coronary heart disease (CHD) is the leading cause of morbidity and mortality in the United States. A direct relationship has been demonstrated between dyslipidemia and the risk for developing CHD. Improving lipid status has been clearly demonstrated to reduce the morbidity and mortality associated with lipid disorders.

Etanercept and its implications for managed care.

Etanercept, a new drug for psoriatic arthritis (PsA), offers a safe and effective, but somewhat costly treatment for a condition for which therapeutic options have been scarce. Its debut poses a challenge to managed care organizations in terms of its potentially adverse impact on the pharmacy budget. Managed care organizations must take the initiative in developing appropriate criteria for authorizing the use of etanercept and in overseeing the management and reimbursement of various treatments for PsA.