The Official Medtipster Blog

www.Medtipster.com Source: HealthDay, 9.27/12 – By Steven Reinberg

 The only thing predictable about the flu is its unpredictability, U.S. health officials said Thursday, as they urged virtually all Americans to get vaccinated for the coming season.

Even though last year’s flu season was one of the mildest on record, that’s no sign of what this season will bring. It was only two years ago, officials noted, that the H1N1 pandemic flu swept around the world, sickening millions.

“The last several years have demonstrated that influenza is predictably unpredictable,” Dr. Howard Koh, assistant secretary for health at the U.S. Department of Health and Human Services, said during a morning news conference.

“Even mild seasons can lead to suffering and death,” Koh added. “Sadly, last year there were some 34 influenza-associated pediatric deaths.”

Every year an estimated 5 percent to 20 percent of Americans come down with the flu, leading to 200,000 hospitalizations — including 20,000 children under age 5, Koh said. And over a 30-year span, from 1976 to 2006, estimates of flu-related annual deaths ranged from a low of about 3,000 to a high of about 49,000.

This year’s vaccine contains the same strains as last year’s, plus two new strains — one for a new influenza A virus and another for a new influenza B, Dr. Daniel Jernigan, deputy director of the U.S. Centers for Disease Control and Prevention’s Influenza Division, said at the news conference.

“More than 85 million doses of flu vaccine have already been distributed and more is on the way,” he said, adding that about 170 million doses are expected to be available.

“The best time to get vaccinated is before the flu season gets started,” Jernigan said. “Everyone 6 months and older is encouraged to get vaccinated.”

The typical flu season runs from the fall through early spring.

Koh stressed the vaccine is safe and has only mild side effects. Because the flu is different each year, the vaccine needs to be revised to keep up with the circulating strains.

Despite the low level of flu activity in 2011-2012, about 42 percent of Americans got vaccinated, which is about the same as for the previous flu season, according to CDC records.

Among children, some 52 percent were vaccinated last year, compared with 51 percent the year before, Koh said. Vaccination rates typically drop as children get older, he noted.

For children 6 to 23 months old, almost 75 percent were vaccinated during the 2011-2012 flu season, compared to just 35 percent of teens, Koh said. “We were pleased that, for kids, for the second year in a row there were no racial or ethnic disparities in coverage,” he said.

But when it comes to adults, “there is much room for improvement,” Koh said. “Last year about 39 percent of adults were vaccinated, compared to some 41 percent the year before,” he said.

Vaccination is important for all adults, but particularly for those with conditions such as asthma, diabetes and heart disease, which can leave them susceptible to complications from flu, Koh said. “Coverage among these high-risk adults was only 45 percent last season, compared to 47 percent the season before,” he said.

While there were no racial or ethnic disparities in vaccination rates among children, disparities remained among adults, he said. Whites, American Indians and Alaska Natives had the highest vaccination rates at 42 percent, while Hispanics had the lowest rate at 29 percent, he said.

On the plus side, more pregnant women are getting vaccinated, Koh said, noting that pregnant women are at greater risk of complications from the flu. What’s more, a mother’s immunity can protect her newborn for the six months before the child is old enough to be vaccinated.

Koh also reported that last year 67 percent of health-care personnel were vaccinated, but there were major differences among workers in this group. For example, 87 percent of doctors working in hospitals were vaccinated. But in nursing homes, other than doctors and nurses, the vaccine coverage rate was 50 percent. “This is worrisome because these people care for people at high risk for complications from flu,” he said.

Getting vaccinated is the best protection from the flu, Koh said. Everyone 6 months and older should get a flu shot every year. Last season’s vaccination campaign prevented almost 5 million cases of the flu, 2 million doctor’s visits and 40,000 hospitalizations, according to CDC estimates.

More information

To learn more about the flu, visit the U.S. Centers for Disease Control and Prevention.

SOURCES: Sept. 27, 2012, news conference with Howard K. Koh, M.D., M.P.H., assistant secretary for health, U.S. Department of Health and Human Services; Daniel Jernigan, M.D., M.P.H., deputy director, Influenza Division, U.S. Centers for Disease Control and Prevention

www.Medtipster.com Source: Reuters Health, by Amy Norton – 9.11.2012

When people with chronic health conditions have lower out-of-pocket costs for medications, they are more likely to actually fill their prescriptions, according to a new research review.

The findings, reported in the Annals of Internal Medicine, sound logical. But they lend some hard numbers to the idea that lower drug costs should improve people’s adherence to their medication regimens.

“It was striking to us,” said lead researcher Meera Viswanathan, of RTI International, a Durham, North Carolina-based research institute.

“If you help people with costs, even a little, it seems to improve adherence,” Viswanathan said in an interview.

She and her colleagues reviewed several dozen U.S. studies on various efforts to improve people’s ability to stick with their prescriptions. A few of those studies focused on insurance coverage – either giving people drug coverage or lowering their out-of-pocket costs for prescriptions.

Some looked at what happened after Medicare prescription coverage took effect in 2006; others looked at cutting out-of-pocket payments for people with private insurance.

Overall, better coverage seemed to help. In a study of nearly 6,000 heart attack patients, for example, those given full drug coverage through their insurer got more prescriptions filled over about a year.

Of patients who were on their usual insurance, 36 percent to 49 percent filled their prescriptions, depending on the medication. Those rates were four to six percentage points higher among people with full drug coverage.

Patients with full coverage also suffered a new complication, like a stroke or second heart attack, at a slightly lower rate: 11 percent, versus just under 13 percent.

But while there is some evidence of actual health benefits, not many studies have followed people long-term to see if the better drug adherence translates into a longer or healthier life.

“There were some encouraging findings,” Viswanathan said. But more research is needed to know what the long-term health effects are, she and her colleagues write.

The results do not mean that better drug coverage is the only way to get people to fill their prescriptions, according to Viswanathan.

The studies in the review found some other tactics to work, too. Education plus “behavioral support” was one.

That goes beyond telling patients about their health problem, and why a particular medication is needed, Viswanathan said. “You would also try to get through the barriers that may keep a patient from taking it,” she said.

If a patient was afraid of side effects, for example, a nurse might discuss that with him or her.

Another measure that seemed effective was “case management.” That means the health provider would try to identify patients at high risk of not using their prescriptions, then follow-up with them – with phone calls, for instance.

It’s not clear, Viswanathan said, how programs like that could be “scaled up” to be widely used in everyday practice, and not just clinical trials.

And the specific fixes might differ depending on the health problem. With high blood pressure, a fairly simple move seemed to boost patients’ adherence to their medication: Giving prescriptions in blister packs rather than bottles, so people could more easily keep track of whether they’d taken their daily dose.

With more complex measures, the question of how to work them into the real world remains. “We need to know, what does it take to implement them into clinical practice?” Viswanathan said.

Figuring out how to get people to stick with their medications is considered a key part of improving healthcare. Studies show that 20 percent to 30 percent of prescriptions are never filled, and half of medications people take for chronic ills are not taken correctly.

All of that is thought to contribute to 125,000 deaths a year, and to cost the U.S. healthcare system as much as $289 billion annually.

www.Medtipster.com Source: Drugstore News, 9.4.12 – By Alaric Dearment

In what could symbolize the so-called “patent cliff” that an executive from healthcare market research firm IMS Health spoke of at a recent trade show, a regional mass merchandise chain is taking what used to be the world’s top-selling drug and giving it away for free.

Meijer announced Tuesday that it would offer generic versions of Pfizer’s cholesterol drug Lipitor (atorvastatin calcium) for free at all of its 199 pharmacies, saying it would be the first retailer in the Midwest to offer such a program. The program is the fourth free-drug program offered by the retailer over the last six years.

“We’re pleased to announce that our customers will now be able to fill their generic cholesterol-lowering atorvastatin calcium prescriptions for free in all of our pharmacies,” co-chairman Hank Meijer said. “In keeping with our commitment to provide low-cost solutions for the families we serve, the free cholesterol-lowering medication program is another way to help the customers who rely on our pharmacies.”

Before it lost patent protection, in November 2011, Lipitor had sales exceeding $7 billion per year in the United States. Ranbaxy Labs was the first to launch a generic version when the drug’s patents expired, and Ranbaxy’s own market-exclusivity period expired in May of this year. At the National Association of Chain Drug Stores’ Pharmacy and Technology Conference last month, IMS VP industry relations Doug Long said during a presentation that “We’re in the teeth of the patent cliff,” which refers to a period taking place over the next few years when a wave of expirations of several top-selling drugs’ patents will occur, eventually leaving many therapeutic indications such as cholesterol heavily commoditized and dominated by multiple generics.

“This initiative will have a huge impact because the cost of pharmaceuticals is frequently a barrier to getting appropriate treatment,” West Michigan Heart cardiologist and Spectrum Health Meijer Heart Center Cardiac Catheterization Labs director David Wohns said. “The biggest way to reduce the risk of heart disease comes from treating cholesterol. To have that drug available for free has the ability to impact countless lives.”