BiDil on the block for $24.5M
Man, I knew BiDil wasn't worth much, due to its absurdly high cost relative to its ingredients, but I had no idea that it was worth so little:
Targeted drug maker NitroMed Inc. plans to sell its BiDil drug business to JHP Pharmaceuticals LLC for a possible $26.3 million. New Jersey-based JHP, a privately held specialty pharmaceutical company, will buy the assets related to BiDil for $24.5 million in cash, plus up to an additional $1.8 million for inventory at the closing date.
[...]
NitroMed also reported its financial results for the third quarter which ended Sept. 30. The company's total revenues climbed slightly to $4 million, compared to $3.8 million for the same period in 2007. All of that revenue came from sales of BiDil, officials said. NitroMed's net loss dropped to $400,000 for the quarter, compared to a net loss of $8.4 million last year.
Yeah, sounds like it's time to off-load that to a company that has other winners in its lineup and doesn't need to maintain the marketing and manufacturing overhead required to keep BiDil on the market. Of course, they should have done that in the first place. You can't really build an entire company around an uninteresting drug priced too high to be relevant when its components are already available in generic form for pennies per tablet. It's not a bad drug; it's just too expensive for what it is.
If JHP is smart, they'll cut the price to about a third of its current cost, and let volume take care of the rest. Not that BiDil will ever be a huge winner, but it could certainly be bigger than it currently is if priced and marketed appropriately. Monopoly pricing only works when you have something people want, and are willing to pay for.
I had no idea MS was in the imaging game
News to me. I'm kind of surprised that they don't have smaller products for private practices.
Come join a team of experts to design, build and ship the first version of a product that will change the world of medical imaging! We are a startup group with the goal of bringing cutting edge technology to the market in order to change the way medical image storage, distribution and interpretation happens. Our product will leverage Amalga* platform, creating a system that will enable physicians with completely new access to diagnostic images and other patient information. We have Medical imaging industry experts at the core of our team and are looking for additional expertise.
Job Description
We are looking for an expert software developer to join a team of highly experienced senior software engineers to build a solution that can seamlessly connect imaging systems from multiple departments and provide interactive visualization of up-to multi-GB datasets to physicians whether they are in the hospital or at home. You will work closely with domain experts in DICOM, imaging IT, Volume Rendering, large dataset handling and advanced image processing and you will be a key contributor to guide technology selection and strategy to solve data processing and distribution problems that have yet to be solved. You will work and collaborate with our distributed team across the globe (core team in Redmond, part of the team in D.C., supporting development team in Beijing, China and research team in Cambridge, UK).
The Health Solutions Group is the same group at MS that's responsible for their HealthVault product as well as the Amalga family.
Gardasil: DTC advertising via your college bookstore
Merck is advertising Gardasil directly to college students that utilize Barnes and Noble's bkstore.com. For those unfamiliar, bkstore.com has a plugin structure where students log on to their college's bookstore, choose their class number (e.g. PHRM 328), and their books are loaded up, and you can either pick them up or have them shipped to you. No going to stand in lines or trying to figure out what books you need. One click shopping at it's most convenient.
So these are college bookstores inadvertently advertising prescription drugs to the entire college population. Well, more accurately, to the population that chooses to have their books shipped to their home, anyway. I don't know if the bundles that can be picked up have similar advertising info.
Merck's going about it in a strange way, though. They're sticking the prescribing information into these boxes. No fancy brochures, just the PI packet, which I find rather bizarre.
I can't say it doesn't make sense, or that it's a terrible idea — I think it's better than advertising Ambien on television — but it does make me wonder what's next… Cephalon advertising Provigil to high school and college kids? Med students? Pharmacy students?
(No discounts for having advertising in your box of books, either. 
)
Drug advice from Consumers' Reports
This is going to be quick and dirty because I've got some other things to do, but I've been putting it off far longer than I've meant to. (No time like the present, right?) In the January 2008 issue, CR ran a feature on how people could save money on prescriptions meds. Generally speaking, I am in favor of this kind of thing. I like people to know the alternatives, and how they can save money.
Generally-speaking, it's not a good idea to have word-choice errors in a piece that's supposed to be professional. (See image.) Maybe they should get a medically-trained copy editor and add them to the list of peer-reviewers. Ridiculous.
I've re-created the table they have:
I'll go through it quickly:
Zyrtec is now available OTC, and is comparable to the cost of Claritin. Claritin doesn't work for a goodly number of folks, so Zyrtec is a better option. Zyrtec went OTC the month after this was published — and it wasn't a big secret that it was going to happen.
For ADHD, Strattera is not a popular option. It doesn't work for many people, and ADHD people have a hard time remembering to take their meds consistently, which makes this option less desirable, particularly where it takes a little while for Strattera to begin working. I'm surprised this drug was listed at all, as it's rarely a first-line choice for ADHD spectrum disorders. Even comparing atomoxetine (an NRI) to methylphenidate (a stimulant) is a bit… off, and IMO, does the consumer no favors. Strattera is usually used where someone is at risk for drug abuse or has comorbidities like hypertension or anxiety (iatrogenic or otherwise) and so cannot tolerate stimulants.
Depression… don't have much to say there. Fluoxetine tends to be more stimulating than Lexapro, and there are other subtle differences (half-life, solubility, etc.), but for most people, switching from one to the other is probably not impossible.
As for Diabetes… well. Using a biguanide is usually the first step in treating metabolic syndrome, and then you add other meds on top of that. I'd be skeptical of any doctor who used Actos before using metformin without a given reason. Diabetes treatment tends to go in stepwise fashion like most other chronic illnesses. Removing a TZD from a pre-existing diabetic regimen can be done, but it's not as simple (or desirable) as this little blurb makes it seem. And a TZD isn't normally used as monotherapy. Frankly, I think suggesting Glucotrol rather than metformin would have made more therapeutic sense. And in terms of good use of space, I think think they would have been better going after the ARBs and hypertension in general here.
Heartburn and GERD? Nexium 20mg? Who even uses the 20mg strength Nexium? I see it maybe 3 times a year. They should have done 40mg Nexium and suggested 40mg of Prilosec. (Hilarious sidenote: 40mg Prilosec caps (the one without a generic) cost ~$60 more than 40mg Nexium caps.) Generally, though, this one wasn't too bad.
Insomnia: Eh, probably okay I guess. Insomnia is a poorly-treated condition in this country, and frankly, I'd rather see other methods explored before reaching for the BZRAs at all. But the BZRAs are the easiest, and they keep patients happy. Unfortunately, not enough time is spent diagnosing the underlying causes of insomnia, resulting in a poorly quality of life. There are differences in the polysomnograms of patients on eszopiclone and zolpidem, too, which are not talked about. I'd rather see ramelteon tried before any BZRA, and also see a psychologist about diagnosing an underlying cause for the insomnia in the first place, if a primary care provider cannot take the time (due to financial considerations) to do it themselves. And 5mg of Ambien might help with sleep induction, but the relatively short half-life will do next to nothing for those with sleep maintenance problems.
I'd rather have seen trazodone suggested, since insomnia is usually secondary to some kind of other psychiatric disturbance — a type of uni- or bipolar depression.
Not much to say about arthritis, but I hardly ever see Celebrex used anymore. Now that it stands alone as a COX-2 inhibitor, it's also the most expensive anti-inflammatory in the book and insurers are loathe to use it. I'd rather see diclofenac recommended over ibuprofen, and suggesting that 400mg of ibuprofen daily is anywhere near equivalent to 200mg of celecoxib is laughable.
Schizophrenia. SCHIZO-FREAKIN-PHRENIA? CR is going to tackle SCHIZOPHRENIA in an article about how to save money?!?! I am having difficulty wrapping my brain around that one.
But okay, here goes. Schizophreniform disorders should be managed by a psychiatrist or psychiatric NP, IMNSHO. Diagnosis is tricky, and management is always tricky. All that said… while first generation antipsychotics are often as effective as their second gen counterparts, I am extremely leery of merely saying that Y could be substituted for X. At least CR has the good grace to state "The antipsychotics have major side effects and response to them is highly variable" — AKA "Take our advice with a monster grain of salt." Not the least of the worries are akathisia, tardive dyskinesia, other extrapyramidal symptoms, weight gain, and about a bazillion other possible side effects. My mind is still boggled that they even went there.
Curiously, however, discontinuation rates of perphenazine in schizophrenic patients are lower than with any second gen antipsychotic save olanzapine (Zyprexa) — though people tended to d/c Zyprexa due to its metabolic effects and weight gain, and perphenazine for its extrapyramidal symptoms. Something to consider, I suppose.
–
All things considered, it's nice to see the mainstream media promoting saving money on drugs, but it bugs me that they did it in the way that they did.
Oops
Absolutely perfect timing with Dr Dino's Oops Meter.
Got a phonecall from an FP's office across the street from the pharmacy. Medicaid patient had brought in his Risperdal Consta injection for his bi-weekly shot. The nurse dropped the injection in the office, which broke it, resulting in some non-emergent, but non-trivial lacerations to herself in the process.
Could we get another one? Of course, it's 4pm on a Friday, and MassHealth doesn't do lost/damaged precription overrides — if they did, their budget would probably double (TAP doesn't make this shit up, you know) — but could we pleeeeeeease try. And they would, of course, call MassHealth themselves.
Risperdal Consta is about $650 per dose.
Of course the answer was no, but with both of us on the phone, MassHealth said they could do it tomorrow (that would be today, I guess) as a once-in-a-lifetime early-fill don't-ever-ask-again override.
I'm so glad it worked out, and I feel terrible for this nurse. She's probably wishing she had dropped some cyanocobalamin instead. We'd have just given it to them for nothing had it been something like that.
Based on Dino's examples on the oops meter, I'd give this a solid 8. Right next to breaking wind in front of your boss. On the elevator.
This pharmacist is a model for how other people should win the lottery
Sporting large sunglasses, the winner, a pharmacist, came forward, but she refused to provide her name or where she lived. An occasional player, she bought the winning ticket at a gas station at 851 S. Sutton Rd. in Streamwood.
The first step wasn't to get the money. A family member referred them to Wood Dale attorney Terry Zimmer, who assembled an advisory team, including estate planner Richard Kuenster.
"I told her get an unlisted number A.S.A.P.," Kuenster said.
The team helped the family create the JYS Family Limited Partnership and put together entities to keep the winner's identity from the public, and shield the money from some taxes, creditors and frivolous lawsuits while providing for her, her husband, children and any future grandchildren, Kuenster said.
"We're so proud of them for taking that time," said acting Illinois Lottery Superintendent Jodie Winnett. "What a sharp winner we have in Illinois and we hope that the rest of our community will hear this and that they'll take a deep breath and consider protecting themselves."
I think everyone has thought about what they'd do if they won the lottery. Most of the thought cycles probably spent on how they'd spend the money, rather than on how they'd protect themselves. I've given the collection, protection, and diversification of a large sum of money some thought in the past when Powerball has gotten up into the hundreds of millions. (It's fun to dream isn't it?) The lawyer and financial advisor seemed no-brainers to me, but an estate planner didn't occur to me. Naturally, doing everything in my power to remain anonymous is also right up there, but the third-party organization as a shield was a new one, but a smart one given her profession.
Good on her.
(The press conference is required.)
–
Anecdotally, we have a past lottery winner that comes to our store, and like this pharmacist, she is very discreet, and has managed to not blow all of her winnings in spectacular fashion. Smart people do, in fact, win the lottery sometimes. 
How much does Nexium cost someone on Medicare Part D?
One of my people — we'll call her Jane — takes two drugs. A generic SSRI, and Nexium. While sorting through the options available to her, and running two scenarios, I discovered just how much Nexium costs her per year. More specifically, how much money she will save by switching from 40mg of Nexium to 2×20mg omeprazole capsules.
$594 per year.
I asked Jane if she'd ever taken anything before the Nexium, because it looked to me like she started it in early 2006, and she told me that she hadn't. The doctor had given her samples, and then a prescription, and she'd been taking it ever since.
Here's the thing: Nexium isn't better than Prilosec. Yes, we all know it's the isolated, active enantiomer of omeprazole, and its time to acid drop is a bit better, and "studies" (paid for by AstraZeneca) have shown that Nexium beats Prilosec in squashing acid production.
Except that it doesn't, because if you look at the fine print, you'll see that those glossy, purty brochures that the big-titted drug reps bring you compare 40mg Nexium to 20mg Prilosec. In fact, when AZ did studies comparing 40mg to 40mg, they discovered that the difference was inconsequential, so they didn't include those results in their marketing materials. (My source for this is a former sales manager for AZ who used to have Nexium as a drug, and then went on to be a regional drug rep manager. He's with Forest now.)
Pretty slick. And underhanded.
Oh, and time to acid drop isn't a particularly important metric, by the way, because PPIs are maintenance meds, not Tums. And Nexium was only something like 2% better than Prilosec for the 8% of the study participants that even showed a difference. Whoopty-do. Clinically significant? Not especially.
Back to saving money. By changing from Nexium to Prilosec, Jane is able to pick a different Part D plan that has a lower premium, not to mention that when she comes to the pharmacy, her copayment will be lower, too. So Jane will be switching. And she could probably eke out a few more dollars in savings if she tried just 20mg omeprazole daily, but I thought I'd be generous by allowing for a non-standard dose in my calculations so her doctor would feel better about switching.
There is a tiny, tiny percentage of people — less than 1 in 100 — that do not respond to omeprazole that do respond to esomeprazole. No one knows why this is, and simply changing from one to the other results in marked improvement. That is no excuse for reaching right for the Nexium over the omeprazole, because sometimes the reverse is true: omeprazole works when esomeprazole does not. Sometimes neither of them work and you need to pick a different drug altogether. This phenomenon is true across all drug classes, and is another reason that having an inflexible, national formulary is a BAD idea.
[tags]healthcare, inefficiency[/tags]