Off we go…
I'm sitting in the airport in Charlotte, North Carolina, and I've just finished registering for Harvard's 8-week accelerated Organic Chemistry I and II (and labs). Ironically it's less expensive than doing the same thing at UMass, and will be over much quicker.
Gotta love free Wi-Fi. 
I'm debating re-taking Biology I and II as well. Man, I really messed up as an undergrad…
[tags]Medicine, med school[/tags]
Peace
I'm on vacation at the moment, and I can't stop thinking about med school. It's pretty bad, actually. We all go out to do whatever, and my thoughts are a million miles away dwelling on something else.
Wishing I was somewhere else.
I've stopped mentally searching for a plan. This hasn't happened to me since the first time I went to pharmacy school. I actually feel like I have a plan, now, and I can't wait to get started. There's this odd sort of peace. Finally.
[tags]Medicine, med school[/tags]
Med school
It seems a good time to revisit the subject of what I'm doing with myself in the hopes that some of my regulars will share their thoughts with me.
(If you don't care to read about my life, stop reading now.)
How Sepracor could make a buttload of money
In 2008, CFC inhalers are going away, a topic I've covered extensively here and here. That leaves Sepracor in a position to make themselves quite a lot of money if they're willing to do one thing out of the ordinary: price the Xopenex HFA MDI at or below the same price as the other HFA albuterol products. This would set up the PBMs to be receptive to making the product a Tier 2 copay, like most of the racemic albuterol HFA formulations.*
Then send out the drug reps.
In theory, levalbuterol almost sells itself. At least they won't have to resort to underhanded marketing tactics quite as much.
Will they do it? I don't know. Probably not. That would require doing things differently — like lowering the price right off the bat — and I think we all know how much Big Pharma likes to do things Their Way. Risk is, well, risky.
If I were captain of the ship, though, I'd roll the dice. The inhaler market is huge — and only going to get more lucrative once CFCs disappear — and right now, Sepracor is not positioned to be anything more than a niche player when they could easily have most of the pie.
* Cursory research indicates that some PBMs have the Xopenex HFA MDI at Tier 2 already, but most seem to require a Prior Authorization.
[tags]Medicine, pharmacy, Asthma, Sepracor, albuterol, Xopenex[/tags]
"What states don't have residency requirements for welfare?"
Today's Ziggy:
Massachusetts, for one. If you're an illegal alien, you get covered automatically. If you're a citizen of the US, you need to prove your identity, and that you live in Massachusetts.
Brilliant!
"What's this made out of? Gold?"
How many times have you heard this phrase?
No, my fabulous pharmacy friends, these items are often considerably MORE expensive than gold… we're talking Americium expensive.
For comparison, the price of Ridaura — a gold salt in capsule form — is $295.79 for 60 caps.*
In no particular order:
- Zyvox (linezolid): $1,546.78 for 20 tablets.
- Cocaine HCl 135mg: $1,144.80 for 100 tablets
- 1L of normal saline: $100**
- Casodex (bicalutamide): $519.76 for 30 tablets.
- Enbrel (etanercept): $7,500/ounce.
- Lamisil (terbinafine): $435.84 for 30 tablets.
- OxyContin 80mg: $662.31 for 90 tablets. (Street value is approximately $7,200 for these same 90 tabs).
- Aldara (imiquimod) cream: $268.38 for 12×1 gram packets.
- Vancocin: $651.85 for 20 pulvules
- Iressa (gefitinib): $2,127.35 for 30 tablets
- Gleevec (imatinib): $3,563.26 for 30 tablets.
Got anything to add?
* All prices are AWP.
** Except this one. 
Do we need Tekturna (aliskiren)?
Thursday saw the delivery of a new Novartis drug: Tekturna (aliskiren). None of us had any idea what it was for, so we looked it up on Facts and Comparisons, and there was next to no information whatsoever, except that it is a "direct renin inhibitor" — whatever that meant.
Now that I'm home on a non-firewalled Internet connection, I can actually get real drug information. (How sad is it that I can't do this at the pharmacy?) Aliskiren:
Aliskiren is a direct renin inhibitor, decreasing plasma renin activity (PRA) and inhibiting the conversion of angiotensinogen to Ang I. Whether aliskiren affects other RAAS components, e.g., ACE or non-ACE pathways, is not known
I'm sure you could play games targeting specific points and pathways in the renin-angiotensin-aldosterone system until the cows come home, but how many of them will be meaningful? Medscape has an article comparing, contrasting, and using Diovan and Tekturna in parallel:
Do we need Tekturna? Would not an ARB plus a diuretic do a better job? There are benefits to combining an ACEi with an ARB, that are fairly well understood. Is Tekturna going to create some sort of super trifecta?
I'm thinking not. Combining an ACEi with an ARB does a couple of things. First off, ACE inhibitors only stop the conversion of angiotensin I to angiotensin II. Blocking the pathway there does nothing to stop any non-specific binding to the angiotensin II receptor sites. ARBs block much of this non-specific binding because the receptor sites themselves are blocked. However ACEis also block the breakdown of bradkinin (which is broken down by ACE) which leads to greater vasodilation, which is why ACEis and ARBs are usually similar is study results. Bradykinins, of course, are a double-edged sword: they may contribute to vasodilation, but they are also responsible for the dry cough and angioedema associated with ACEis.
I don't see how aliskiren is going to add to this. Is there component to the RAAS that I'm not thinking of? Is it not better to attack a problem from many different angles instead of hitting the same pathway three different ways?
[tags]Medicine, pharmacy, hypertension, cardiology, physiology[/tags]