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Are PBMs making unfair profits on generics?
To some, examining how pharmacy benefit management companies function is like watching sausage being made. No matter how tasty the product, it's not a pretty sight. "It is difficult for anyone to completely understand how these companies work," said Robert Garis, Ph.D., an assistant professor in the pharmacy school at Creighton University, Omaha, who has studied PBM profit margins. "Few people have the expertise to see what the true costs are for a drug benefit, including the employers who hire these companies."
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Authorized generics continue to cause controversy
The squall over authorized generics continues to swell. Congressmen are squabbling, the Federal Trade Commission is investigating, Congress has legislated, and the Supreme Court may yet get the last word. "The issue has proponents on both sides," said Edward Thwaite of E.W. Thwaite Associates, a generic industry consulting firm in Totowa, N.J. "There are strong feelings everywhere."
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Surgery when INR=2.8
An ambulatory 70-year-old man, F.H., has been admitted to your hospital with a hip fracture that will require surgery. Although F.H. has a history of atrial fibrillation (AF) episodes and transient ischemic attacks (TIA), his heart is currently in normal sinus rhythm. Medications on admission included verapamil 120 mg and warfarin 5 mg daily; fracture pain is being treated with morphine intramuscular (IM) injections at present. F.H.'s INR (International Normalized Ratio) on admission is 2.8; blood pressure is 135/75; lab tests were within normal limits. F.H.'s physician requests an anticoagulation consult to aid him in determining the timing of surgery and venothromboembolism (VTE) prophylaxis. What do you suggest?
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Resolving HF 'revolving door'
A 68-year-old man is hospitalized with shortness of breath, fatigue, and 2+ edema—his third hospitalization in 12 months. He has heart failure (HF) (currently New York Heart Association class IV, ejection fraction 20%), LVH, and MI history. Heart rhythm is normal; lungs clear; lab tests within normal limits except hemoglobin=10.5 gm/dl, SrCr=2.3 mg/dl; BP=160/90, pulse 85, respiratory rate=22.
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