- Email: [email protected]
Pharmacists' role in preventing and treating HIV infection
Approval of Generic
ed for approval by the Psychopharmacological Drugs Advisory Committee to treat
obsessive-compulsive disorder.
currently used in any other discipline in higher education, Penna said. The concept involves giving special credentials to pharmacy practitioners who also teach at pharmacy schools and have demonstrated excellence in both areas. The center will not only work to ensure that students receive quality training in pharmaceutical care, Penna said, but will also encourage schools to offer programs for pharmacists who are already in practice.
HMO Enrollment Still Growing
New Center
Expands
Pharmacy Education A new program from the American Association of Colleges of Pharmacy (AACP) will help pharmacists receive the education they need to provide pharmaceutical care. AACP announced the formation of the Center for the Advancement of Pharmaceutical Education in July. Since then, it has been gathering information and forming panels of key thinkers from national pharmacy groups to help plan strategies for meeting the center's goals of: • Identifying the competencies that general pharmacy practitioners need to deliver pharmaceutical care, as well as ways to assess practitioners' skills. • Developing guidelines for Vol. NS33, No. 12
December 1993
innovative and rigorous education in PharmD programs. • Expanding clinical fellowship training programs in pharmacy. • Establishing programs for cultivating "master teachers" who excel in teaching and practice. According to Richard Penna, AACP's associate executive director, the competencies that the center will develop are likely to be used by schools, state pharmacy boards, the National Association of Boards of Pharmacy, and other groups that promote standards of contemporary pharmacy practice and evaluate whether pharmacists are prepared to provide pharmaceutical care. The master teacher concept-an integral part of the plan to enhance pharmaceutical care education-is not
The number of health maintenance organizations (HMOs) is declining, but the number of people who belong to them is increasing, according to a recent report from Marion Merrell Dow. The 1993 Managed Care Digest, HMO Edition, reported that 562 HMO plans were operating in 1992, a 3% drop from 1991. HMO enrollment increased 8.3% from 1991, however, bringing total enrollment to nearly 44 million Americans. The report notes that, for the third year in a row, the growth of hybrid HMOsalso called point-of-service and open-ended HMOswas greater than for traditional HMOs. In hybrid HMOs, patients are allowed to choose any physician or hospital for their medical care, but must pay a greater share of the costs when they
use providers who are not part of the HMO's designated network. Individual members paid 6% more for HMO membership in 1992, bringing the average monthly premium to $128.76. Family rates rose an average of 9%, to $353.57 per month. The report's summary of pharmacy activity notes that HMO expenditures for outpatient drugs remained steady in 1992-an average of $96.41 per memberlargely because of "much tighter controls over costs and utilization." HMOs filled slightly fewer outpatient prescriptions per member in 1992: down to 5.5 from 5.8 in 1991. About 65% of HMOs had drug formularies in 1992, a sharp increase from 39% in 1991. About 40% of all prescriptions were filled with generic products, the same as in 1991 and 1990. The products most commonly excluded from HMO coverage continue to be experimental drugs and cosmetic aids, such as Retin-A. Only about 6% of plans cover them. Other commonly excluded drugs are injectables, anorexiants, smoking cessation aids, fertility drugs, and vitamins. Oral contraceptives were excluded by 22% of HMO plans in 1992. For more information or a copy of the report, contact Marion Merrell Dow Inc., Managed Health Care Markets Dept., 9300 Ward Parkway, Kansas City, MO 64114. (800) 362-7466.
AMERICAN PHARMACY
PHARMACY NEWS
Profits Declining Although the nursing home industry is still thriving, levels of profitability are declining, according to the 1993 edition of the Guide to
the Nursing Home Industry. The report, published by HCIA Inc., a health care information company in Baltimore, and the accounting firm Arthur Andersen & Co., notes that in 1991, for the first time in three years, nursing home expenses increased at a faster rate than revenues. The report attributes the narrower margin between revenues and profits to the growing number of nursing home residents who are Medicaid patients, and state cutbacks in Medicaid payments to nursing homes. In 1991 the median net revenue per patient per day spent in a nursing home increased 4.1%, to $64.06, whereas the median operating expense per patient per
day increased 4.6% to $63.80. According to Darrell Pataska, a partner at Arthur Anderson, nursing homes have been able to remain profitable, despite Medicaid reimbursement levels that are lower than costs, by expanding and differentiating the types of services they offer. "Nursing facilities can charge higher prices for these services and then use the extra revenue to overcome cutbacks in reimbursement from Medicaid," he said. For example, some nursing facilities now have "special care units" for patients with specific disorders, such as Alzheimer'S disease, acquired immunodeficiency syndrome or breathing problems that require the use of ventilators. Some facilities offer infusion services for antibiotic therapy, hydration, pain management, and total parenteral nutrition, the report says.
A growing number of nursing home residents are Medicaid patients, a recent report notes. AMERICAN PHARMACY
Retin-A Repairs Sun-Damaged Researchers at the University of Michigan-Ann Arbor have found further evidence that Retin-A (tretinoin), currently approved in the United States for acne treatment only, can help to repair sundamaged skin. Their fmdings were reported in the New
England Journal of Medicine (1993;329:530-5). The researchers found that formation of collagen I, the predominant fiber that keeps skin elastic, is significantly decreased in slID-damaged human skin. Treatment with tretinoin however, partly reversed that decrease. In comparing samples of sun-damaged forearm skin and protected buttocks skin from 26 subjects, the research team found a 56% reduction in collagen I formation in the sun-damaged skin. The more severe the sun damage, the greater the reduction in collagen I formation, regardless of age. The team then tested the efficacy of 0.1 % strength tretinoin cream in reversing the damage. Daily treatment for 10-12 months in 29 subjects produced an 80% increase in collagen I formation, compared with a 14% decrease with a placebo cream. Although the study's design did not allow a direct correlation between collagen I formation and
tretinoin - induced clinical improvement, the researchers viewed their results as further evidence that the clinical changes seen with the dnlg are more than just cosmetic effects.
New Drugs Emerging for Shingles Researchers are starting to get the results from clinical trials of a handful of antiviral drugs that may tum out to be potent treatments for the disease shingles. Shingles, known medically as herpes zoster, is caused by the reactivation of the chickenpox (varicella zoster) vinlS from its latent state in the nervous system. People at greatest risk for the disease are those with weakened immune systems, including the growing number of people over age 50, and people with acquired immunodeficiency syndrome. Symptoms include chills, fever, rashes, and acute pain. Many cases result in nerve damage and chronic pain, or postherpetic neuralgia. One currently available treatment is capsaicin cream (Zostrix-GenDerm Corp.), which depletes the chemical that transmits pain impulses through the nerves. GenDerm also is working on a more potent cream, which is in clinical studies to be completed in 1995 or 1996. December 1993
Vol. NS33, No. 12
ed for approval by the Psychopharmacological Drugs Advisory Committee to treat
obsessive-compulsive disorder.
currently used in any other discipline in higher education, Penna said. The concept involves giving special credentials to pharmacy practitioners who also teach at pharmacy schools and have demonstrated excellence in both areas. The center will not only work to ensure that students receive quality training in pharmaceutical care, Penna said, but will also encourage schools to offer programs for pharmacists who are already in practice.
HMO Enrollment Still Growing
New Center
Expands
Pharmacy Education A new program from the American Association of Colleges of Pharmacy (AACP) will help pharmacists receive the education they need to provide pharmaceutical care. AACP announced the formation of the Center for the Advancement of Pharmaceutical Education in July. Since then, it has been gathering information and forming panels of key thinkers from national pharmacy groups to help plan strategies for meeting the center's goals of: • Identifying the competencies that general pharmacy practitioners need to deliver pharmaceutical care, as well as ways to assess practitioners' skills. • Developing guidelines for Vol. NS33, No. 12
December 1993
innovative and rigorous education in PharmD programs. • Expanding clinical fellowship training programs in pharmacy. • Establishing programs for cultivating "master teachers" who excel in teaching and practice. According to Richard Penna, AACP's associate executive director, the competencies that the center will develop are likely to be used by schools, state pharmacy boards, the National Association of Boards of Pharmacy, and other groups that promote standards of contemporary pharmacy practice and evaluate whether pharmacists are prepared to provide pharmaceutical care. The master teacher concept-an integral part of the plan to enhance pharmaceutical care education-is not
The number of health maintenance organizations (HMOs) is declining, but the number of people who belong to them is increasing, according to a recent report from Marion Merrell Dow. The 1993 Managed Care Digest, HMO Edition, reported that 562 HMO plans were operating in 1992, a 3% drop from 1991. HMO enrollment increased 8.3% from 1991, however, bringing total enrollment to nearly 44 million Americans. The report notes that, for the third year in a row, the growth of hybrid HMOsalso called point-of-service and open-ended HMOswas greater than for traditional HMOs. In hybrid HMOs, patients are allowed to choose any physician or hospital for their medical care, but must pay a greater share of the costs when they
use providers who are not part of the HMO's designated network. Individual members paid 6% more for HMO membership in 1992, bringing the average monthly premium to $128.76. Family rates rose an average of 9%, to $353.57 per month. The report's summary of pharmacy activity notes that HMO expenditures for outpatient drugs remained steady in 1992-an average of $96.41 per memberlargely because of "much tighter controls over costs and utilization." HMOs filled slightly fewer outpatient prescriptions per member in 1992: down to 5.5 from 5.8 in 1991. About 65% of HMOs had drug formularies in 1992, a sharp increase from 39% in 1991. About 40% of all prescriptions were filled with generic products, the same as in 1991 and 1990. The products most commonly excluded from HMO coverage continue to be experimental drugs and cosmetic aids, such as Retin-A. Only about 6% of plans cover them. Other commonly excluded drugs are injectables, anorexiants, smoking cessation aids, fertility drugs, and vitamins. Oral contraceptives were excluded by 22% of HMO plans in 1992. For more information or a copy of the report, contact Marion Merrell Dow Inc., Managed Health Care Markets Dept., 9300 Ward Parkway, Kansas City, MO 64114. (800) 362-7466.
AMERICAN PHARMACY
PHARMACY NEWS
Profits Declining Although the nursing home industry is still thriving, levels of profitability are declining, according to the 1993 edition of the Guide to
the Nursing Home Industry. The report, published by HCIA Inc., a health care information company in Baltimore, and the accounting firm Arthur Andersen & Co., notes that in 1991, for the first time in three years, nursing home expenses increased at a faster rate than revenues. The report attributes the narrower margin between revenues and profits to the growing number of nursing home residents who are Medicaid patients, and state cutbacks in Medicaid payments to nursing homes. In 1991 the median net revenue per patient per day spent in a nursing home increased 4.1%, to $64.06, whereas the median operating expense per patient per
day increased 4.6% to $63.80. According to Darrell Pataska, a partner at Arthur Anderson, nursing homes have been able to remain profitable, despite Medicaid reimbursement levels that are lower than costs, by expanding and differentiating the types of services they offer. "Nursing facilities can charge higher prices for these services and then use the extra revenue to overcome cutbacks in reimbursement from Medicaid," he said. For example, some nursing facilities now have "special care units" for patients with specific disorders, such as Alzheimer'S disease, acquired immunodeficiency syndrome or breathing problems that require the use of ventilators. Some facilities offer infusion services for antibiotic therapy, hydration, pain management, and total parenteral nutrition, the report says.
A growing number of nursing home residents are Medicaid patients, a recent report notes. AMERICAN PHARMACY
Retin-A Repairs Sun-Damaged Researchers at the University of Michigan-Ann Arbor have found further evidence that Retin-A (tretinoin), currently approved in the United States for acne treatment only, can help to repair sundamaged skin. Their fmdings were reported in the New
England Journal of Medicine (1993;329:530-5). The researchers found that formation of collagen I, the predominant fiber that keeps skin elastic, is significantly decreased in slID-damaged human skin. Treatment with tretinoin however, partly reversed that decrease. In comparing samples of sun-damaged forearm skin and protected buttocks skin from 26 subjects, the research team found a 56% reduction in collagen I formation in the sun-damaged skin. The more severe the sun damage, the greater the reduction in collagen I formation, regardless of age. The team then tested the efficacy of 0.1 % strength tretinoin cream in reversing the damage. Daily treatment for 10-12 months in 29 subjects produced an 80% increase in collagen I formation, compared with a 14% decrease with a placebo cream. Although the study's design did not allow a direct correlation between collagen I formation and
tretinoin - induced clinical improvement, the researchers viewed their results as further evidence that the clinical changes seen with the dnlg are more than just cosmetic effects.
New Drugs Emerging for Shingles Researchers are starting to get the results from clinical trials of a handful of antiviral drugs that may tum out to be potent treatments for the disease shingles. Shingles, known medically as herpes zoster, is caused by the reactivation of the chickenpox (varicella zoster) vinlS from its latent state in the nervous system. People at greatest risk for the disease are those with weakened immune systems, including the growing number of people over age 50, and people with acquired immunodeficiency syndrome. Symptoms include chills, fever, rashes, and acute pain. Many cases result in nerve damage and chronic pain, or postherpetic neuralgia. One currently available treatment is capsaicin cream (Zostrix-GenDerm Corp.), which depletes the chemical that transmits pain impulses through the nerves. GenDerm also is working on a more potent cream, which is in clinical studies to be completed in 1995 or 1996. December 1993
Vol. NS33, No. 12