Biologics---Selected Articles

What pay for performance means for musculoskeletal medicine

Pay for performance (P4P) is causing physicians to examine how they provide care individually and collectively within local health systems. It is the most recent attempt by Medicare and commercial payers to reduce the cost and improve the outcomes of health care. Understanding P4P and deciding how to manage the multiple programs being implemented by payers will challenge physicians' ethics and practice resources. Improving health care for musculoskeletal diseases will require cooperation among the specialties that share responsibility for this care and improved methods for coordinating and documenting it.

Antidepressants: Brand Name or Generic?

For many antidepressants, the issue of brand-name versus generic has no practical significance. Elavil was first marketed almost a half century ago, and its patent has long expired. It lives on, however, but as generic amitriptyline. Today, only a few antidepressants are still fully protected by patents, namely, Cymbalta (2010), Lexapro (2012), and Pristiq (2022) for major depressive disorder (MDD); and Seroquel (2011) and Symbyax (2017) for bipolar depression. The issue of brand-name versus generic, however, is far more complex than merely listing patent expiration dates. Patents can be extended, challenged, and infringed on; financial considerations are enormous; and patient care issues are often of central importance. To place antidepressants in proper perspective, it is first necessary to provide some general background about patents and drug regulation.

RA therapies in 2009: The latest on drug effectiveness

Clinical study findings of recent years support the notion that patients with rheumatoid arthritis (RA) should be treated earlier and more aggressively. Monotherapy with disease-modifying antirheumatic drugs (DMARDs) is effective in some cases, but triple DMARD therapy is superior to double therapy or monotherapy in early or late RA. Leflunomide is at least as effective as methotrexate (MTX) and sulfasalazine and more effective than placebo. Tumor necrosis factor α antagonists are effective in patients with early or late RA, especially in combination with MTX. Anakinra is more effective than placebo as monotherapy or when combined with MTX. Rituximab and abatacept are useful as monotherapy but are more effective when used in combination with other DMARDs.

Payer’s budget to get right targeted drug to right patient

When laboratory tests are inaccurate or misinterpreted, patients may receive costly targeted drugs that provide no benefit. If the medical community doesn’t resolve the problem, payers will take action on their own.