Pharmacy & Therapeutics - June 2008 - (Page 367)

Dermatology Trends in Managed Care same time as a separately identifiable office visit, provided that the appropriate separate service modifiers are submitted on the claim. Most dermatologists surveyed considered their carriers’ coverage policies inconsistent, and many reported problems in obtaining fee schedules from health plans. MEETING HIGHLIGHTS: APA continued from page 364 Dermatological Medications on Formularies Table 1 summarizes the tiers occupied by dermatological medications. Some products—usually injectables—appear on Tier 4 of all those MCOs that have four-tiered formularies. In fact, the second edition of The Galderma Report reveals that since the publication of the report’s first edition in 2004, the use of four-tiered formularies by MCOs to manage biologic drug costs has risen by more than 20%. Tier 4 of a formulary is reserved for specialty drugs such as dermatological products, especially biologic agents or injectables such as etanercept (Enbrel, Wyeth/Amgen), infliximab (Remicade, Centocor), and alefacept (Amevive, Astellas) as well as cosmetic products. In general, MCOs have placed dermatological products on Tier 4 because of their high cost, as a way to encourage dermatologists and patients to try other more cost-effective therapies first, and as a way to require patients to invest financially in their treatment. Survey respondents ranked efficacy, then cost, as the most important factors influencing their decision as to whether or not to include a drug on the formulary. To order a copy of The Galderma Report, readers can visit the Web site www.galdermausa.com. I Treatment-related adverse events (63%) and EPS (13%) were similar for both drugs, but clinically significant weight gain (7% or more above baseline weight) occurred more often with olanzapine (30.6%) than with asenapine (16.9%). In the 40week extension study among 218 patients continuing the same dosages, response and remission rates remained similar for both treatments, but they had increased to nearly 100%. Dr. McIntyre stated, “I think it’s axiomatic that the longer an individual remains on therapy, the more the likelihood of response and remission increase.” Weight gain remained higher with olanzapine (55.1%) than with asenapine (36%). The frequency of metabolic syndrome increased in the olanzapine patients (from 20% at baseline to 29.9%) but decreased in the asenapine patients (from 26.4% at baseline to 23.4%). The incidence of EPS increased to 35.4% with asenapine but to a lesser degree with olanzapine, to 18.7%. Virtual Reality Therapy for Post-traumatic Stress Disorder in Iraq War Veterans • Barbara Rothbaum, PhD, Professor of Psychiatry, Emory University School of Medicine, Atlanta, Ga. The combination of virtual reality, psychotherapy, and pharmacotherapy reduced the magnitude of startle (a response to an unexpected stimulus) by a significant 75% in 24 veterans with post-traumatic stress disorder (PTSD). Heightened acoustic startle, a symptom of hyperarousal, is common in these patients. Participants were exposed to virtual reality therapy that was tailored to their own experience. They received D-cycloserine (Seromycin, Lilly) (a broad-spectrum antibiotic that aids in extinguishing fear memories) or alprazolam (Xanax, Pfizer), an antianxiety medication. Ultimately, 150 patients are scheduled to be enrolled in the National Institutes of Mental Health study. The virtual reality sessions consisted of two-minute video clips of scenes depicting the Iraq theater of combat from the viewpoint of a soldier either in a Humvee or on foot patrol. A platform with a “base shaker” (a powerful speaker beneath the patient’s seat) simulated the vibrations of an improvised explosive device. Odors of diesel fuel and burning rubber, sounds of explosions, ricocheting bullets, helicopters, and shouts and cries contributed further to verisimilitude. Dr. Rothbaum explained that these sessions, followed by therapy sessions, are designed to repeat traumatic memories until physical and emotional responses diminish. Acoustic startle was assessed before treatment, immediately after treatment, and at three and six months after treatment. All subjects manifested robust startle responses before treatment. In a preliminary report of results, Dr. Rothbaum said that most subjects were doing well; their PTSD symptoms had fallen into the nonclinical range. Startle magnitude decreased by 75% during the course of treatment and reached a nadir six months after treatment. Similar declines were seen in Clinician-Administered PTSD Scale (CAPS) scores. Although the analysis has not yet compared D-cycloserine and alprazolam effects, Dr. Rothbaum did note that, in her experience, the effectiveness of two virtual reality sessions with D-cycloserine was as great as eight sessions of virtual reality without medication. The planned completion date of the study is late August 2011. I COMING SOON TO P&T EDITORIAL: Myth Busters David B. Nash, MD, MBA DRUG FORECAST: Posaconazole (Noxafil), an Extended-Spectrum Oral Triazole Antifungal Agent Mei Chang, PharmD Candidate, and Larisa Chagan, PharmD, BCPS CONTINUING EDUCATION CREDIT: The Pharmacological Management of Migraine, Part 1: Over view and Abortive Therapy George DeMaagd, PharmD, BCPS Vol. 33 No. 6 • June 2008 • P&T® 367 http://www.galdermausa.com

Table of Contents Feed for the Digital Edition of Pharmacy & Therapeutics - June 2008

Editorial Aliskiren Reduces Plasma Renin Activity Medication Errors Prescription: Washington New Drugs/Drug News/ New Medical Devices Drug Forecast Challenges in Evaluating and Standardizing Medical Devices in Health Care Facilities California e-Pedigree Rules Pose Challenges For Pharmacies Pharmaceutical Approval Update American Psychiatric Association At a Glance: Dermatology Trends in Managed Care

Pharmacy & Therapeutics - June 2008

For optimal viewing of this digital publication, please enable JavaScript and then refresh the page. If you would like to try to load the digital publication without using Flash Player detection, please click here.