Managed Care - April 2008 - (Page 58) TOMORROW’S MEDICINE Atlanta, GA Managed Care Opportunities At DeKalb Medical, Atlanta, GA, we push beyond ordinary healthcare, into a realm of the extraordinary. Become a member of our first-rate team as: Director of Contracting and Process Improvement The Director will be responsible for the design and implementation of the overall managed care strategy for DeKalb Medical – providing managed care and workers’ compensation expertise, monitoring contract performance and collecting underpayments. Bachelor’s degree with health management or financial emphasis and/or health services with a Master’s degree preferred, and at least 10 years of progressive healthcare management experience. OR has been developed and been approved by the FDA. But there is more. . . . There is another interleukin-1 pathway blocker available in the United States, anakinra, sold under the brand name Kineret. Anakinra works by binding to the interleukin-1 receptor at the cellular level. Although this is a slightly different approach (remember that rilonacept binds the messenger IL-1 ), anakinra has also been used experimentally in patients with CAPS. Anakinra is not approved for CAPS, but its cost is only about $14,000 per year! Managed care issues Given that managed care is constantly promoting an evidence-based approach, will managed care organizations pay for the only drug with an FDAapproved indication for this rare, disabling disease even though a nonapproved drug that has a mechanism of action that suggests efficacy is available for one-twentieth the cost? Will these organizations wait for proof of efficacy for anakinra? Will they force a trial of a nonapproved drug? Will they require prior authorization for the diagnosis of this disease before starting therapy? What about patients who appear to have the disease but whose tests are not confirmatory? What about that small but tragic population, those with NOMID, where rilonacept was not tested? Finally, other IL-1 mediated diseases are also known to exist. What will managed care decision-makers do when physicians request payment for rilonacept for other disorders mediated by IL-1? The questions are numerous. Although the discovery of the cause of the CAPS disorders raises many questions, one thing is without question: Through his dedication, Hal Hoffman has given the medical community and patients with CAPS a significant advancement and has earned a place in the Tomorrow’s Medicine Hall of Fame! The author is a director in the value-based health department at Genentech Inc. During the last three years, before taking the Genentech position, he received honoraria or other financial benefits from: Amgen, Amylin Pharmaceuticals, AstraZeneca, Biogen Idec, Centocor, Galderma, GlaxoSmithKline, Johnson & Johnson, Merck, Novartis, Novo Nordisk, Pfizer, Procter & Gamble, Q-Med, Sanofi-Aventis, Teva Pharmaceuticals Industries, UCB, and Wyeth. The views expressed in Tomorrow’s Medicine are the author’s alone. Managed Care Contract Analyst Responsible for researching, analyzing and trending Managed Care Contract modeling, ongoing performance and other special projects as assigned. Bachelor’s degree in Business/Finance, Master’s preferred. At least two years of related experience on the REVENUE side of acute healthcare is preferred. Excellent benefits package and relocation assistance. 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