Cost of skin
drugs rising rapidly, study shows
A new study published by the Journal of the American Medical Association
reveals retail prices of 19 dermatologic drugs have more than quadrupled
between 2009 and 2015. Retail prices of 19 brand-name prescription drugs for
dermatologic conditions ranging from acne to cancer increased fivefold on
average between 2009 and 2015, according to a study that adds new fuel to
the burgeoning debate over the cost of medicines.
In the most dramatic case, a 2-ounce tube of gel called, Targretin marketed
by Valeant Pharmaceuticals International Inc. for a type of skin cancer,
jumped to $30,320 this year from $15,708 last year and $1,687 in 2009, the
report foundâan 18-fold jump in six years. The retail price of another
Valeant skin-cancer drug, Carac cream, also was 18 times higher this year,
at $2,865, than in 2009.
Valeant is already under fire for drug-pricing practices, but the
researchers said their results show big price jumps are a common occurrence
in the industry. Prices for drugs made by companies such as GlaxoSmithKline
PLC and Novartis AG at least doubled or tripled over the same time frame,
far outpacing inflation and growth in healthcare expenditures.
Valeant said it sets prices based on development or drug acquisition costs,
the availability of alternatives including generics and other factors, and
offers patient-assistance programs when possible keep drugs affordable.
Glaxo said it is âcommitted to helping ensure patients can access the
medicines they needâ and to âthoughtfully handle price increases.â Novartis
had no comment.
Drug companies say few patients or insurers pay full retail prices for
prescription medicines and that actual costs are often further reduced with
discount coupons, rebates and other programs. Cheaper generic versions of
the medicines in the study, including four of five Valeant products covered
in the report, were and remain available in many cases.
The researchers said higher list prices at the pharmacy still affect
consumersâ out-of-pocket costs, especially as insurers impose higher
copayments and deductibles in response to increasing costs.
The study found that a 100-gram dispenser of Olux-E foam, which had an
average retail price of $308 in 2009, listed this year for $842, a 174%
increase. A person answering the phone at the drugâs maker, Prestium Pharma,
of Newtown, PA, declined to comment.
The findings come amid growing criticism of industry pricing practices,
sparked by such factors as hepatitis C drugs that hit the market at
$1,000-a-pill; six-figure-a-year cancer treatments with marginal survival
improvements; and companiesâ use of price increases to maintain sales growth
in some products despite flagging demand.
Valeant, a major player in dermatology, has encountered criticism in part
for sharply raising the price of old drugs immediately upon acquiring them
from other companies, despite a limited commitment to investing profits in
research for new drugs. Retail prices of both Targretin and Carac in the
current study rose sharply after Valeant bought or licensed the medicines.
Retail prices for two Glaxo drugs, Altabax for impetigo and Soriatane for
psoriasis, doubled over the six-year period, the study showed.
The antifungal Oxistat cream for jock itch and athleteâs foot, marketed by
Novartis, jumped to $545 this year from $76.50 in 2009, a sevenfold
increase, the report found.
The authors said they didnât set out to expose drug price increases. Their
plan was to establish a database for dermatologists in Florida with price
information on drugs they typically prescribe for patients.
Prices increased relatively modestly between 2009 and 2011. When the 2014
results came in, the price increases were âjust astronomical,â the
Visit the Wall Street Journal for the article.
Roche pulls out
of 'superbug' antibiotic project
Swiss drugmaker Roche Holding has dropped out of a high-profile project to
develop an antibiotic for treating "superbug" infections, the company
Roche had agreed in 2013 to pay privately held partner Polyphor up to 500
million Swiss francs ($485.3 million) for rights to the product, marking a
rare foray by a major pharmaceuticals company into the battle against
superbug infections in hospitals. The deal included milestone payments of up
to 465 million francs.
"Roche has decided to discontinue its involvement in the clinical
development of the investigational antibiotic RG7929/POL7080 for the
treatment of patients with severe Pseudomonas aeruginosa infections and will
return the asset to Polyphor," a company spokesman said by email when asked
about a report to this effect by the NZZ am Sonntag newspaper.
The spokesman cited Roche's assessment that "a streamlined development path
as originally planned is no longer an option for Roche".
Superbug infections, including multi-drug-resistant typhoid, tuberculosis
and gonorrhea, kill hundreds of thousands of people a year and the rise of
antibiotic resistance has been described by the World Health Organization as
"one of the biggest health challenges of the 21st century".
The Roche spokesman said that antimicrobial resistance remained a major
threat to public health and Roche would continues to focus on this unmet
medical need as part of its infectious disease research and development
NZZ said that the experimental product, which is in phase II clinical
trials, will now be developed alone by Polyphor.
Read more at Reuters.
Ebola will always
return unless we develop the tools to end it
On November 7, the World Health Organization declared that Sierra Leone is
officially Ebola-free for the first time in over a year. The biggest lesson
learned with Ebola is that it will return, and we have to be prepared for â
and prevent â the next epidemic.
Since historyâs worst Ebola epidemic began in rural Guinea in December 2013,
it has killed more than 11,300 people worldwide, devastating communities and
families, and leaving behind a generation of Ebola orphans. Health systems
in the affected countries have been severely damaged, resulting in even more
deaths from preventable diseases such as measles and malaria. Ebola has also
set back economies across West Africa, and cost the countries and the world
billions of dollars in humanitarian aid.
And, despite the rapid decline in case numbers in recent months, and the
good news from Sierra Leone, the outbreak isnât over yet â we continue to
see a steady trickle of new cases in Guinea. We have seen the price of
waiting, of losing focus, of downplaying the seriousness of emerging
The Ebola virus has broken out at least 24 times since 1976. Liberia was
declared Ebola-free in March, but then the disease came back. The country
was declared free of the disease again in July. Last week, three new cases
of Ebola were confirmed in Liberia, the countryâs health ministry and the
World Health Organization said.
The reason Ebola keeps returning is that the world doesnât yet have the
tools to stop it. As yet, there is no approved vaccine and more research is
needed to develop a vaccine to protect healthcare workers and populations.
There is no rapid point of care test widely available to diagnose it. There
is no approved drug to cure it.
We are now closer than ever to filling these gaps, because governments,
global health institutions and biomedical researchers have spent the past
year in emergency mode. Pharmaceutical companies, in collaboration with
health authorities, have been running phase I, phase II and phase III
vaccine trials (progressively testing safety) and manufacturing vaccines
simultaneously, instead of treating them as separate steps in a drawn-out
process. They have worked closely with governments in affected countries to
get trials up and running in fewer than six months, a speed that is unheard
The London School of Hygiene & Tropical Medicine is working with partners to
coordinate a number of these studies, including a new trial in Sierra Leone
testing a candidate Ebola vaccine regimen in development at Janssen
Pharmaceutical Companies, part of Johnson & Johnson. This prime-boost
vaccine is designed with the goal of potentially strengthening and
optimizing the duration of immunity â it involves giving two shots, the
first to prime the immune system and the second to boost it. It is just one
of a number of promising vaccine candidates now being investigated in
numerous clinical trials around the world.
Visit the Guardian for the article.
shift from volume to results in American healthcare
Almost a year ago, the Administration announced a vision for the future of
the Medicare program, including clear goals and a timeline for shifting
Medicare payments from volume to value. CMS is continually working to turn
this vision into reality through annual rulemaking and the CMS Innovation
Center, building on bipartisan ideas, initiatives and legislation from both
Congress and the states.
CMS recently published the final 2016 Medicare provider payment rules. Woven
into those very detailed payment rules and regulations are new examples of
the administrationâs commitment to quality, value, and patient-centered
Creating the Home Health Value-Based Purchasing model. This model will link
home health payments to quality performance with the goal of improving
Replacing the Sustainable Growth Rate (SGR) update formula for physician
services with one that supports patient- and family-centered care. CMS is
taking the first steps to implement the Merit-Based Incentive Payment System
(MIPS) and incentives for participation in Alternative Payment Models (APMs).
Paying for advance care planning. A wide range of stakeholders and
bipartisan members of Congress supported our proposal to make separate
payments to doctors and other practitioners who provide elective advance
care planning services to Medicare beneficiaries in a variety of settings.
In addition to the efforts mentioned above, the CMS Innovation Center is
testing a variety of models that build on the Administrationâs measurable
goals and timeline to move the Medicare program, and the healthcare system
at large, toward paying providers based on the quality, rather than the
quantity of care they give patients. The CMS Innovation Center opened its
doors five years ago to test new payment and service delivery models that
either improve quality while keeping costs the same, maintain quality and
lower costs, or â best case scenario â improve quality and lower costs.
CMS says they have seen some positive results from models that the
Innovation Center is testing. Savings in the Pioneer ACO Model were so
significant â and coupled with positive results on improved quality of care
and better patient experience â that the independent CMS Office of the
Actuary certified that expansion of the model as it was tested in the first
two years would reduce net program spending under Medicare.
They have also incorporated elements of the Pioneer ACO Model into the
Medicare Shared Savings Program, which reaches more beneficiaries in more
areas of the country.
One of the most promising trends is the significant improvement in patient
safety and decreased adverse incidents in the hospital setting. Several CMS
programs that are improving patient safety in hospitals, such as the
Partnership for Patients, from 2010 to 2013, there has been 1.3 million
fewer hospital acquired conditions and 50,000 patient deaths avoided,
leading to an estimated $12 billion savings in health care costs. This
translates into a 17 percent reduction in patient harm nationally over the
three-year period. This is a promising start, but we are committed to doing
The recently finalized Comprehensive Care for Joint Replacement model, a
bundled payment model for hip and knee replacements for Medicare
beneficiaries set to begin in April 2016. The modelâs goal is to give
hospitals a financial incentive to work with physicians, home health
agencies, skilled nursing facilities, and other providers to ensure
beneficiaries get the coordinated care they need.
Primary care models, including the Comprehensive Primary Care Initiative and
Independence at Home Demonstration, are demonstrating the ability of
redesigned primary care to improve quality and patient experience while
lowering costs. The Independence at Home demonstration saved over $3,000 per
beneficiary in its first year through coordinated care for beneficiaries
with multiple chronic conditions.
To date, over 4,000 individuals and 610 organizations have committed to
participate in the Learning and Action Network, and 50 partners have set
organization-specific goals to encourage adoption of value based payment.
These efforts have contributed to putting Medicare and Medicaid on stronger
financial footing with improved quality. Per enrollee Medicare spending
growth has been low, averaging 1.3 percent over the last five years.
The Medicare trust fund will remain solvent 13 years longer than the
Medicare Trustees projected in 2009, before the passage of the Affordable
The end of Medicare bonus program will cut pay to primary care doctors and
because of that many primary care practitioners will be a little poorer next
year because of the expiration of a health law program that has been paying
them a 10 percent bonus for caring for Medicare patients. Some say the loss
may trickle down to the patients, who could have a harder time finding a
doctor or have to wait longer for appointments. But others say the program
has had little impact on their practices, if they were aware of it at all.
Medicare generally pays lower fees for primary care visits to evaluate and
coordinate patientsâ care than for procedures that specialists perform. The
difference is reflected in physician salaries. Half of primary care
physicians made less than $241,000 in 2014, while for specialists the
halfway mark was $412,000, according to the Medical Group Management
Associationâs annual provider compensation survey.
The incentive program was an effort to address shortcomings in Medicareâs
system of paying providers mostly a la carte for services, which tends to
undervalue primary care providersâ ongoing role in coordinating patientsâ
care. Earlier this year, Medpac proposed that Congress replace the expiring
primary care incentive program with a per-beneficiary payment to primary
care physicians that would be paid for by reducing payments for non-primary
care services. That proposal hasnât made any headway. Meanwhile, physician
trade groups have lobbied unsuccessfully for an extension of the Medicare
CMS for the article.
Looking for a way
to share your knowledge and expertise with the CS community?
Poster displays at the 2016 IAHCSMM Annual Conference and Expo in San
Antonio, TX are an important educational experience for conference
attendees, providing information and facilitating productive discussions
IAHCSMM invites you to submit a CS-related poster for IAHCSMM's Annual
Conference and Expo, April 24-27, 2016. Now's the time to showcase your
research and learning experiences your company has established. For
examples, review past submissions in our
Deadline: February 8, 2016
Contact Patti Koncur, IAHCSMM Education Specialist, 800.962.8274 ext. 402,
for more information or visit
emerges in China to remind us that antibiotics wonât last forever
According to a study published in Lancet Infectious Diseases, a gene
dubbed MCR-1 is becoming more common in bacteria found in China. MCR-1 gives
bacteria the ability to resist antibiotics called polymyxins. These harsh
antibiotics are considered a last line of defense â a treatment when
bacteria have shown resistance to everything else. But with MCR-1 in tow,
bacteria can thwart our most aggressive drugs. That means they're basically
invincible. And MCR-1 could theoretically end up jumping to all manner of
"Polymyxins were the last class of antibiotics in which resistance was
incapable of spreading from cell to cell," co-author Jian-Hua Liu, a
professor at Southern Agricultural University in Guangzhou, told the AFP.
So much for that.
The researchers tested slaughterhouse pigs and raw meat from markets for the
gene. MCR-1 was found in 20 percent of the sampled pigs and 15 percent of
the meat, and in increasing abundance from year-to-year. The gene was also
found in E. coli K. pneumoniae samples taken from 16 of 1,322
patients at two Chinese hospitals.
Antibiotic resistant bacteria is already implicated in at least 700,000
deaths per year worldwide, and some estimate that the death toll could
skyrocket to 10 million per year by 2050, if trends continue.
Polymyxins are meant to be reserved for dire medical cases â after all,
these drugs are too toxic for a human to want to consume. But in China,
their rare usefulness in humans has led to a secondary use: animal
husbandry. Chinese pigs are some of the biggest consumers of the drug
colistin, a kind of polymyxin, which is used to fatten them up. The
researchers report that this is almost certainly the breeding ground of the
resistance, and that the Ministry of Agriculture has launched an
investigation to assess this.
An estimated 70 percent of the antibiotics important to health are used in
livestock in the United States.
Visit the Washington Post for the story.
Norovirus outbreaks by 91%
Norovirus outbreaks have dropped by 91% at the Queen Alexandra Hospital in
Cosham, Portsmouth, England as shown in a study published in BMJ Quality
& Safety. The hospital implemented a multidimensional quality
improvement initiative based on the use of Bioquellâs hydrogen peroxide
vapor, a superbug-killing automated room disinfection technology, to stop
the spread of one of the most contagious pathogens in existence.
International discussions frequently focus on sharing methods for containing
outbreaks, with this study offering insight on the latest, most effective
techniques and technologies.
Every winter, norovirus outbreaks can create chaos in hospitals as it can
rapidly lead to frequent outbreaks amongst patients, staff sickness, and
general disruption. The CDC reports that there are 19-21 million cases
annually in the United States with a price tag of nearly $2 billion in the
US for treatment and productivity lost. About 63% of norovirus outbreaks
occur in a healthcare facility.
This multidimensional quality improvement initiative led by the use of
Hydrogen Peroxide (HP) Vapor bio-decontamination technology from Bioquell
also includes education, enhanced patient surveillance, early automated
detection and notification of infected patients as well as proactive care
and control measures.
The cleaning robots (Bioquell Q-10 suite) used at the Queen Alexandra
Hospital rely on Hydrogen Peroxide (HP) Vapor to decontaminate rooms. This
technology has been proven to kill 99.9999% of pathogens. A smaller and
faster version (Bioquell BQ-50) of this HP Vapor generator is now available
Visit Bioquell for the study.
Med students call
resident work trials unethical
Two organizations are demanding an investigation into what they say are
unethical clinical trials that have required first-year medical residents
around the country to work up to 28 hours or more at a time.
In letters sent to the Office for Human Research Protections at the
department of Health and Human Services and the Accreditation Council for
Graduate Medical Education (ACGME), the American Medical Students
Association (AMSA) and the watchdog group Public Citizen claim the studies
exposed both the medical trainees and patients to a wide range of risks,
including exposure to blood-borne pathogens.
The letters demand an immediate halt to iCOMPARE, which is an ongoing study,
as well as an investigation of that trial and the FIRST study, which was
completed in June 2015. They also want sanctions implemented against all the
institutions that took part in the trials.
"The 2011 work-hour restrictions were put in place because of clear evidence
of risk to resident physicians," Deborah Hall, MD, a physician and national
president of the medical student association, said in a statement. The
groups cited a 2010 survey of the general public in which 81% said that
patients should be informed if a treating resident was working more than 24
hours and, if so, 80% would want a different doctor.
"Few patients would voluntarily agree to be enrolled in such trials if given
the opportunity to choose," said Michael Carome, MD, director of public
citizen's Health Research Group.
Thomas Nasca, MD, and CEO of the ACGME, said other safeguards have remained
in place for the trials. They include a maximum work week of 80 hours, a
mandatory one day off every seven days, and no more than one night shift
every 3 days. He said institutional review boards at all the participating
hospitals reviewed the trial protocols and determined that patients did not
need to be informed. Nasca noted that since 2003 second and third year
residents have been working up to 28-hour shifts. Prior to that, they worked
shifts of up to 36 hours.
New residency work hours adopted by the ACGME limit shifts to 16 hours, but
critics of those reduced hours said shorter work shifts diluted the training
experience, a hallmark of which was long hours with little sleep and high
demands. They also pointed out that shorter shifts mean more frequent
patient "hand-offs," a known risk to patient safety.
In the letters, AMSA and Public Citizen note that primary goal of the two
trials -- one of which is ongoing -- is to determine whether the rates of
death and serious complications for patients "unwittingly enrolled in the
trials" are higher at hospitals where residents are required to work shifts
for as long as 28 hours than the rates at hospitals that follow the current
16-hour work shift standard.
The University of Wisconsin Hospital and Clinics took part in a limited way
in the FIRST study, which ended in June. In a statement, UW spokesperson
Lisa Brunette, said first-year residents were allow to work up to 18 hours,
not the 28 cited by the organizations. She said evidence about longer work
hours is incomplete and often contradictory.
"Recent studies, including several in Europe, have yielded worrisome trends,
including residents who report feeling less prepared to go into private
practice, who do less follow-up on their patients, and have many more
'hand-offs' or transitions between caregivers â the latter being a known
risk factor for medical error," she said.
Visit Med Page Today for the story.