By: Tracy Siler, Senior Rx Coordinator at BioPlus Specialty Pharmacy

Now is the perfect time to think about the immune system: not only is April National Primary Immunodeficiency Awareness Month but this week (April 22-29) is also World PI Week, both of which have the goal of earlier diagnoses and optimal treatment for these immune conditions.

Primary immunodeficiency disorders (PIDD) affect as many as 250,000 people in the United States, while thousands more go undiagnosed (but suffering nonetheless) with this uncommon genetic condition. With PIDD, part of the body’s immune system doesn’t function properly or is missing altogether. This results in severe, persistent, unusual, or recurrent infections. Severe combined immunodeficiency (SCID) and ataxia-telangectasia both fall under the umbrella of PIDD.

Diagnosis of PIDD includes a thorough patient history, as well as a physical exam and blood and immunoglobulin level tests. PIDD should be suspected in a patient who experiences two or more of the following:

By: Dr. Stephen Vogt 

Chemotherapy, while necessary for the treatment of many types of cancer, is known to increase the later risk of acute myeloid leukemia (AML), a rare but often fatal cancer. A new study from researchers at the National Cancer Institute clarifies this risk of AML, in terms of different patient populations.

Over the past three decades, a steady rise in AML has been noted in adult patients treated with chemotherapy for non-Hodgkin’s lymphoma. Longer post-treatment survival for patients may account for some of this rising risk for AML. When an individual patient is considered, chemotherapy remains an effective treatment choice and the chance of developing leukemia in that particular patient is low. However, aggregate data in larger numbers does show a pattern of elevated risk for treatment-related AML.

The National Cancer Institute researchers gathered data for this study from the Surveillance Epidemiology and End Results (SEER) cancer registries, which included approximately 426,000 adults diagnosed with cancer between 1975 and 2008. All of these patients were treated with chemotherapy. Of this group, 801 patients were later diagnosed with AML. This incidence of AML is 4.7 times higher than would be expected in the general population.

By: Dr. Stephen Vogt

Hepatitis C medications – while being the best game in town for treating this life-threatening disease – admittedly come with a significant burden in side effects for most patients. Medication combinations that can shorten treatment time and cure more cases of acute hepatitis C infections are welcome news to both patients and physicians. Dr. Daniel Fierer, from Mount Sinai Hospital in New York City, presented data about a quicker, better cure for hepatitis C at this year’s Conference on Retroviruses and Opportunistic Infections in Atlanta.

Hepatitis C infections are considered “acute” in the first six months after the initial infection. Acute hepatitis C is a short-term illness that causes jaundice, fatigue, and nausea in some people, while others have no symptoms at all. An estimated 15-25 percent of people will clear the virus on their own without any treatment, but most people (that is, 75-85 percent) go on to develop chronic hepatitis C infection.

Chronic hepatitis C can cause several long-term health problems, including cirrhosis, liver cancer, and liver failure. Chronic hepatitis C infection is the most common reason necessitating liver transplantation.

By: Sharon O. Ferrer, Director of Pharmaceutical Contracting at BioPlus Specialty Pharmacy

The pharmaceutical industry’s hard work is paying off with a number of new drugs poised for approval by the U.S. Food and Drug Administration (FDA). The FDA approved 39 new pharmaceuticals last year, making 2012 the most prolific year for new drug approvals since 2004, when 36 new medications were given the green light.

This year may be yet another record-breaking year with the work of pharmaceutical companies coming to fruition with targeted approaches to drug development. This comes at a good time for many pharma companies whose bottom lines have been affected by patent expirations.

The FDA approves medications in three classes: existing medications to be used in new ways, generic versions of medications that have lost patent protection, and new pharmaceuticals (which are novel compounds that treat diseases in a new pathway than any existing medications).

Like ripples in a pond, every single hepatitis C-infected injection drug user is likely to infect an additional 20 people with this disease. Time is of the essence in stopping this disease spread, since about half of these transmissions happen in the first two years after the drug user’s initial infection. Not surprisingly, these drug users at the center of an uptick in infection cases are called “super-spreaders.” Diagnosing and treating a super-spreader can make a huge impact on the health of a community overall.

Tracking the transmission of a relatively slow-spreading disease – which hepatitis C is, compared to, say, influenza – has rarely been attempted before. A new tracking technique was developed in a joint effort led by Gkikas Magiokinis, M.D. and fellow researchers from Oxford University, University of Athens, and Imperial College. This new tracking method combines epidemiological surveillance and molecular data to reveal, in detail, the transmission of the hepatitis C virus through a population.

Blood transfusions used to be the key way that hepatitis C infected new people; but that was virtually solved in 1992 when routine screening for the hepatitis C virus was introduced. Today, intravenous drug use (due to the sharing of syringes) claims the top spot as the main transmission route for hepatitis C infection.

By: Dr. Stephen Vogt

Who doesn’t want to keep health care costs down? It’s not just prudent, but increasingly a necessity in these tight economic times. And when there’s a way to lower costs without a big initial investment, all the better. That’s exactly what University of Oregon researchers say they have found with the idea of “patient activation.”

Patient activation is all about giving patients the skills and confidence to be actively engaged in their own health care, explains Judith Hibbard, Dr.P.H. at University of Oregon’s Department of Planning, Public Policy & Management in this month’s issue of Health Affairs. Dr. Hibbard and her colleagues took a look at 33,000 patients, paying particular attention to health care costs and “patient activation,” a metric measured by levels of motivation, knowledge, skills, and confidence.

This study measured patient activation with a questionnaire of beliefs, knowledge, and confidence related to the management of health tasks. Scores on this questionnaire predicted health care costs, even when differences in age, gender, income, and the severity of a patient’s disease were taken into account.

By: Dr. Stephen Vogt

The hepatitis C virus affects 4 million people in the United States and research about this dangerous, liver-damaging virus carries on in earnest in laboratories around the world. New discoveries are continually being made about the hepatitis C virus to refine the effectiveness of current treatments and even explain why some people don’t respond as well to treatment as others.

For example, just this year National Institute of Health scientists uncovered a gene that keeps the body from clearing the hepatitis C virus. This means, for unlucky individuals who inherit this gene, they may not respond as well to hepatitis C treatment.

This gene variation, called IFNL4 (short for Interferon Lambda 4), appears more often in people of African descent. This discovery could account for why African-Americans treated for hepatitis C infection have a lower cure rate than patients of European or Asian descent. Now that this is known, I hope that future research will find more effective treatments for people with this gene.

Navigating through cancer treatment tends to go better for patients when healthcare professionals offer adherence-promoting tools and proactively manage side effects, concludes a study this month in the journal Cancer Nursing by Sandra Spoelstra, Ph.D. and fellow researchers from Michigan State University.

Not long ago, chemotherapy for cancer treatment meant intravenous administration at a healthcare facility. Today, a wide variety of oral chemotherapy medications are available to be taken at home by patients. Not surprisingly, most patients with cancer prefer oral medications to intravenous ones; however, medication compliance can be an issue with this route of administration.

At first glance, cancer treatment in pill form sounds like it would be easier for patients, and in some ways it is, but any oncology therapy is inherently complex and presents challenges due to multiple medications, dosing schedules, and side effects. Non-adherence to treatment can stem from not understanding complex instructions or in response to mounting side effects. In any case, missing doses can lower treatment effectiveness.

By: Dr Stephen Vogt, PharmD

As it is right now, health care costs account for a shocking 17.6 percent of the United States’ GDP (gross domestic product), according to data from the Organization for Economic Co-operation and Development (OECD). The health care system is not just a money pit, but a time sink as well, with doctors spending three-quarters of an hour every day dealing with payers, formularies, and getting prior authorizations in order. As Dr. Cutler points out, “The amount of time and money spent on administrative tasks is one of the most frustrating aspects of modern medicine.”

Since administrative costs represent a large area of health care spending, Dr. Cutler and his colleagues suggest that this is an appropriate area to target for savings. They recommend that standardization is a key way to garner rapid and large savings. The Health Insurance Portability and Accountability Act (HIPPA) created electronic processing standards that started us off on the right foot and the Affordable Care Act (ACA) made a bit more progress.

By: Elvin Montanez, Pharm.D., Senior Vice President at BioPlus Specialty Pharmacy

The U.S. Food and Drug Administration (FDA) recently added a boxed warning to some of the newer treatments for hepatitis C, warning patients to stop treatment if a systemic or progressive rash develops. Some media outlets treated this information as if it were completely new; however, this rare but real risk of a life-threatening systemic reaction has been known since the publication of the trials that led to the approval of this treatment several years ago.

The new boxed warning addition to the label is helpful because it gives patients a better understanding that a specific medication must be discontinued if a progressive rash develops. This warning will also raise public awareness overall and bring attention to this potential life-threatening event.

By: Dr. Stephen Vogt

As Hurricane Sandy made landfall, many hospitals throughout the region faced the difficult decision of whether to care in place for their patients after their generators failed or evacuate patients to other locations. Likewise, some individual households with chronically ill family members faced the same dilemma. The successful evacuation of the 700 patients from Bellevue Hospital (and similar evacuations from an additional two large hospitals) to other facilities serves as a story of disaster response success.

One of the vital public health concerns during a disaster is to restore essential supply chains. “The most obvious and critical concern is ensuring that patients receiving life-critical medications or supplies have uninterrupted access,” say researchers from Columbia University in a recent article in the New England Journal of Medicine.

by Dr. Stephen Vogt

IgG therapy treats a wide variety of health conditions, including “Bubble Boy disease.” Bubble Boy disease refers to severe combined immune deficiency syndrome; the alliterative name was coined by the media after a boy who had lived in a plastic isolation ward in the 1970s. At the time, there were no treatments available, but today IgG therapy successfully treats this condition by replacing immune compounds that the patients’ bodies are missing.As many as 250,000 people have severe combined immune deficiency syndrome or another related primary immunodeficiency, while thousands more go undiagnosed. People with a primary immunodeficiency are more susceptible to infections and illness.

Immune-related health problems are not the only reason for using IgG therapy. Fully 75 percent of its current use relates to one of a variety of inflammatory and autoimmune diseases, including everything from neurologic disease, transplant rejection, skin diseases, and other inflammation or autoimmune-related conditions.

By: Dr. Stephen Vogt

A faster, easier, and more complete flow of information between health insurers and healthcare providers will result in more effective therapeutic outcomes for patients – and a better bottom line, notes the recent study “Advancing Healthcare Informatics: The Power of Partnerships” which was developed by the consulting company PricewaterhouseCoopers.

Here at BioPlus we agree completely with the value of integrating informatics to help achieve the goals of an outcomes-based healthcare style. Informatics – which is the intersection where information science meets healthcare – leverages data to improve health outcomes for patients. This is the goal of our latest technology tool: Therapy Access Portal (TAP App).

By: Laurry Hinds, R.N., Regional Director for Business Development at BioPlus Specialty Pharmacy

It was a cold day back in January of 2008 as I made my way to an appointment with my high-risk obstetrician for a scheduled Caesarian section. The gender of my baby would be a surprise I’d find out shortly, but what I did know was that, with me as rH negative, this child would have complications related to elevated bilirubin levels and anemia after birth.

It wasn’t long until I met my son that day, but the joy of that moment was soon replaced with concern as my son’s journey began – or should I say the fight of his life. It was a challenging two weeks at the hospital as he and I relied on the expertise of the physicians and nurses caring for him to get him through this rough time. After several conversations and interactions with various nurses and physicians specializing in everything from Neonatology to Hematology and Oncology, he was discharged home two weeks after he was born.

By: Dr. Stephen Vogt

The patient holds the center piece of the health care puzzle – which is a big change from a few decades ago, when the system and doctors held all the cards. Today, patients have a bigger role in the decision-making process and also a bigger responsibility for the choices they make: from prevention through diagnosis and recovery.

The U.S. Congress – in a move proving how serious it is about patient-centered outcomes – authorized funding for research in the Patient Protection and Affordable Care Act (ACA). The ACA will fund more than $3 billion in research between now and 2019. To be in the running for this funding, research will need to be relevant to patients, their caregivers, and clinicians. In short, says the Patient-Centered Outcomes Research Institute (the group implementing the ACA), this act “aspires to transform applied medical research by more fully integrating the persons who will use the research into the research process.”

By: Nick Maroulis, Pharm.D., Director of Pharmacy at BioPlus Specialty Pharmacy

The fallout from Alzheimer’s disease doesn’t stop at the destruction of the patient’s mind, but spills over to everyone who loves that person. I’ve seen this heartache with my friend Linda’s family. Her mother, Fidelina, was diagnosed with Alzheimer’s disease 10 years ago at the age of 69.

The then-latest arsenal of medications stalled Fidelina’s disease progress for only a year. Since then, Fidelina’s ongoing decline has left this previously vibrant woman unable to even recognize her daughter. “Alzheimer’s disease has been a thief in my mom’s life, robbing her of dignity as well as her precious mind and spirit,” Linda shared with me.

Until recently, a diagnosis of Alzheimer’s disease equaled a death sentence. In laboratories and universities around the world, however, scientists are working to turn this disease into something treatable or, better yet, even preventable.

By: Dr. Stephen Vogt

Over the past few years, the number of prescribers using electronic health record (EHR) systems has doubled (from 17 to 34 percent). This is just the beginning, with the 2009 federal Health Information Technology for Economic and Clinical Health (HITECH) Act providing incentives for the adoption of EHR systems.

A natural off-shoot of an EHR system is the development of patient portals. Currently, at BioPlus Specialty Pharmacy, our Therapy Access Portal (TAP) application shares pharmacy notes with prescribers. In the near future TAP will also have a portal for the patient to be included and gain access to pharmacy records and conversations. With that on the horizon here at BioPlus, a new study in the Annals of Internal Medicine caught my eye. Researchers from Harvard Medicine School conducted a one-year evaluation of the effect of patient access to EHR notes through a secure portal.

By; Amanda Brown, Director of Rx Coordinators at BioPlus Specialty Pharmacy

Back in 2003, when I joined BioPlus Specialty Pharmacy, the specialty pharmacy industry was a niche industry on the verge of erupting onto a bigger stage. In the nine years since then, I’ve had a front row seat to the outpouring of novel biotech medications that are offering new hope to people with complex, chronic conditions.

In 2003, specialty drugs accounted for just $25 billion in drug expenditures. Today, that number has ballooned up to more than $50 billion (according to 2010 statistics) and comprises nearly 20 percent of the total pharmaceutical revenue. Specialty pharmacy is predicted to make up approximately 40 percent of 2020 drug spending by health plans.

By: Dr. Stephen Vogt

In last week’s blog, I discussed a new report from the Agency for Healthcare Research and Quality (AHRQ) that reviewed evidence from 68 scientific articles in an effort to determine which interventions are most effective in improving medication adherence.

This report noted that effective interventions include case management education, reminders, pharmacist-led approaches, decision aids, reducing out-of-pocket expenses, improving prescription drug coverage, and collaborative care. Furthermore, the report noted that the first three in that list have the strongest evidence for effectiveness.

The gap between expected medication effectiveness in treating a disease and its real-world effectiveness is generally accounted for by patient adherence. In other words: medications can’t work in patients who don’t take them. Patient non-compliance with a treatment plan is fairly common. According to research, up to 30 percent of prescriptions simply never get filled by patients. Furthermore, when looking at patients with chronic diseases, half of medications are not taken as prescribed.

By; Stephen Vogt, PharmD

While everyone agrees that better medication adherence would improve treatment outcomes and save money—what isn’t so clear-cut is which methods are the most effective to achieve this goal. The Agency for Healthcare Research and Quality (AHRQ), which is part of the U.S. Department of Health & Human Services, recently stepped into this discussion.

Reports released by AHRQ have the goal of improving health care quality in the United States. Recently the AHRQ sponsored a report based on new research about medication noncompliance. According to this new report, when it comes to patient medication compliance, the interventions with the most effective results are:

By: Kathy Norris, Patient Care Manager at BioPlus Specialty Pharmacy

“You care because you ask.” This response came to me from a patient who I had just scheduled for her monthly medication delivery. The medication treated her chronic disease, but unfortunately, the side effects from this medication can be almost as difficult to deal with as the disease itself.

As a Patient Care Manager, my team and I make hundreds of calls every day to patients. In many of these calls, we ask the same series of questions. While these necessary and important questions may become routine, the responses from the patients are different every time.

Generally, at the beginning stages of treatment, the monthly calls to our patients tend to be shorter since most patients haven’t yet started to experience any side effects. Questions are asked and answers are given: it’s quick and to the point. Over time, monthly calls to the same patient may result in longer calls as we hear increasing details about medication side effects, especially if the call happens on a day that a patient feels unwell or in low spirits.

By: Dr. Stephen Vogt

As politicians ramp up efforts for greater voter turnout in next month’s election, it turns out that a little trick from cognitive psychology applied in get-out-the-vote drives might also work to increase medication compliance in patients.

So what’s this intersection of voting behavior and medication adherence all about? Todd Rogers, Ph.D., an Assistant Professor of Public Policy at Harvard University, set up one of the few controlled, randomized trials related to voting to test the theory that asking people about their plans for a particular behavior could increase follow through.

By:  Sharon O. Ferrer, Director of Pharmaceutical Contracting

The specialty pharmacy market is a competitive and growing industry due to the dynamics of the pharmaceutical industry’s shifting focus from traditional brand-name drugs to specialty drugs. In 2011, according to a drug trend report from Express Scripts, specialty drug spending increased to 17.6 percent of total pharmacy costs. It is projected to grow even more in the next few years: 19.0 percent in 2013 and 22.0 percent in 2014.

Most specialty pharmacies primarily dispense self-administered products, such as oral drugs and injectables. However, other pharmacies have specialized in specific disease states that include infusion products, such as IgG and clotting factor for hemophilia.

At BioPlus we specialize in all three medication types:

• Orals
• Self injectables
• Infusion products

By: Stephen C Vogt, PharmD

Have you heard the buzz lately about vitamin B12 and hepatitis C? After a pilot study reported that vitamin B12 improved hepatitis cure rates, some of my patients have been asking whether vitamin B12 injections could up their chances of curing their hepatitis C virus (HCV) infection.

The recent study I mentioned, which was published in Gut, found a 34 percent increase in HCV sustained viral response rate (e.g., cure) when monthly vitamin B12 injections were added to the standard HCV treatment. This vitamin B12 benefit was most prevalent in carriers of the genotype 1 virus, which happens to be the most common type of HCV in the United States.

But you might want to hold on before you ask your doctor for a “vitamin B12 shot.” There are reasons to be skeptical of this promising vitamin benefit…and, by training, I am always skeptical:

By: Barbara Weller, Vice President of Finance

When a loved one is sick with a life-threatening illness, knowing that there are treatments available is comforting. Live-saving treatments priced out of the budget however, is less than comforting. Many chronic and life-threatening diseases require medications costing thousands of dollars. Most families find that their insurance does not cover all of the costs associated with these very expensive medications. Costs can accumulate from extremely high copayments and deductibles as well as other out of pocket expenses. And what about patients who do not have any insurance coverage at all? The added stress of the financial aspects of treatment can be devastating.

Patient financial assistance programs do exist. Yet most patients don’t know where or how to access these programs. After locating available programs, patients will need to navigate seemingly endless paperwork and red tape and wait to hear if their request will be granted. Once again, the stress level and burden of an already suffering patient elevates. Even after all of that, not every patient will be accepted in the assistance program. The truth is that funding is not guaranteed.

By: Dr. Stephen Vogt

In last week’s blog (The Future of Medication Adherence, Part 1), medication adherence trends affecting the future of medication adherence were examined, including the changing role of pharmacists, emerging technology, and regulations. This week’s blog will continue by rounding out four more trends that will shape patient care in the future.

Incentives for Change

The entire healthcare industry has shifted focus over the years from acute care to chronic disease management. In the process, there is a rising awareness that chronic care management and patient outcomes are deeply related to treatment adherence. Physician payments are being linked to patient outcomes and even patients themselves are offered incentives from health plans and PBMs to remain adherent to treatment.

Medication adherence results in an extra $290 billion in costs, due to unnecessary hospital admissions, doctor visits, and lab tests, as well as impacting quality of life for patients. BioPlus Specialty Pharmacy always has our eye to ways to improve patient adherence, since better adherence leads to the best possible treatment outcomes for all of our patients.

A new study by McKesson – a company supplying health information technology, medical supplies, and care management tools – details medication adherence trends that will affect medication adherence strategies in the future. I’ll take a look at these trends, today and next week, in a two-part blog.

The Role of the Pharmacist

The impact of the pharmacist in the medication adherence equation has never been more important – and it continues to grow. Today’s pharmacists are more directly involved in patient interactions, giving them a unique opportunity to deliver adherence support. This is certainly true at BioPlus, where our clinical pharmacists are involved and connected to our patients every step of the way during treatment. Our pharmacists provide counseling about drug therapy management, clinical monitoring, tips to stay adherent, patient education about adverse reactions, and drug utilization reviews.

By: Steven C Vogt, PharmD

Multiple sclerosis (MS) is a progressive disease; slowing the advance of this disease improves quality of life for patients. Learning stress management techniques can be just as effective as medications for delaying MS progression in some patients, says David C. Mohr, Ph.D. and fellow researchers at Northwestern University’s Feinberg School of Medicine in Chicago.

Dr. Mohr’s research, published earlier this summer in the journal Neurology, took a look at the progression of disease in 121 people with relapsing forms of MS. Half of these patients took part in a thorough stress management program that included 16 sessions with a therapist over half a year’s time. The other half of the patients served as a control group; they were put on a waiting list for almost a year before they were offered a five-hour workshop on stress management.

The stress management meetings focused on problem-solving skills, relaxation, increasing positive activities, and enhancing social support. Additional, but optional, coursework on the topics of fatigue management, anxiety reduction, pain management, and insomnia treatment were offered to these patients. Patient health was followed for another five to six months after the stress management sessions ended.

By: Murali Sastry, Director of Payer Contracting

Each month, the average specialty pharmacy handles a couple of thousand patient referrals, but ends up filling just 37 percent of these prescriptions. To understand this disconnect between a referral and a filled script arriving on a patient’s doorstep, let’s first take a closer look at the specialty drug marketplace as a whole.

The latest numbers for the specialty drug market show that this category racks up $46 billion dollars, which accounts for 17 percent of the U.S. total drug spend. Although the majority of specialty drugs are dispensed via specialty pharmacies, any licensed pharmacy can dispense this drug classification as long as they have access to these drugs from either a manufacturer or wholesale distribution channel.

As a result, numerous pharmacies with specialty drug capabilities compete to dispense these expensive therapies. Pharmacies dispensing these drugs are operated by such organizations as health plans, independent specialty pharmacies, retail pharmacy chains, and Pharmacy Benefit Managers (PBMs).

By: Claire D. Jakobson, Vice President of Reimbursement 

Most people don’t think much about their healthcare coverage – whether it’s Medicare, Medicaid, or a private carrier – it’s just a card they carry around in their wallet that they pull out now and again when needed. However, from working in this field for over twenty years, the ever increasing complexity of the healthcare coverage maze that this wallet card represents continually astounds me.

So what really goes on “behind the scenes” that ends with necessary medications being shipped to a patient’s door? From the patients’ point of view, it all starts with a phone call letting them know that their doctor has sent BioPlus Specialty Pharmacy their information so we can provide their medication. Within a few days, a Patient Care Coordinator will call the patient to ask a few questions, set up the shipment, and, voila, the medication shows up at their doorstep.

Patients facing serious, complex, or chronic diseases truly benefit from a team of professionals – as well as family and friends – working and rooting for their best possible health outcome. There are several varieties of team approaches, including one called the “medical home” healthcare model. The goal of all team approaches is to integrate medical care so all the various players know what is going on.

Recently, Elizabeth Lin, M.D. and her colleagues from Group Health in Seattle, examined the benefits of the medical home approach for patients with complex diseases, including diabetes, heart disease, and depression.

Her study involved 214 patients with multiple health conditions to see if a team approach could achieve better health outcomes. In this study, a nurse care manager worked closely with the patients’ physician, the patients themselves, and other key players during disease treatment. The nurse utilized patient-centered goals to establish treatment targets for each individual patient.

Over the years, many of my hepatitis C patients have asked if milk thistle would provide additional benefit during treatment of their hepatitis C virus (HCV) infection. Since this herb doesn’t have any side effects (aside from a mild laxative effect in a small number of people), I’ve been open to my patients using it if they wanted. However, I’ve been waiting for more definite human clinical research with this herb before going so far as recommending it to my patients. And now, it seems, some interesting evidence has finally been published – although it unfortunately does not come out in support of this herb.

The milk thistle research of Michael Fried, M.D., from the University of North Carolina at Chapel Hill, and colleagues was published recently in the Journal of the American Medical Association. Dr. Fried concluded that milk thistle wasn’t significantly different from a placebo for the liver health of chronic hepatitis C patients.

By: Dr. Stephen Vogt, PharmD

Until a cure for hemophilia is discovered, the next best thing is giving clotting factor regularly to prevent bleeding – rather than waiting for “on demand” clotting factor after bleeding starts. This preventive use of clotting factor is known as prophylaxis. Prophylaxis aims to bring hemophilia from a severe state down to a moderate state and prevent joint bleeds and chronic joint damage.

Although there’s been a building wave of support for prophylaxis in hemophilia from many health care professionals – some proponents even date back to 1958 – the ball really got rolling after the 2007 Joint Outcome Study, published in the New England Journal of Medicine, came out in support of the use of prophylaxis in hemophilia.

This month, researchers from Duke University Medical Center in North Carolina report on how the treatment landscape for hemophilia has changed since the Joint Outcome Study. This data gathered from U.S. Hemophilia Treatment Centers shows that 55 percent of physicians have increased prescriptions for prophylaxis since the Joint Outcome Study.

By Stephen Vogt, PharmD

At scientific meetings, one of my favorite things is attending the poster sessions and reading the research abstracts. I always find nuggets of information that cause me to think and ponder. Such was the case at this year’s Digestive Disease Week (DDW) meeting in San Diego. DDW is the largest international gathering of physicians and researchers in the field of gastroenterology, hepatology, endoscopy, gastrointestinal pathology, and gastrointestinal surgery.

What caught my eye, in particular, at this meeting was a research abstract from Stephan Vavricka, M.D., chief of the Division of Gastroenterology and Hepatology at Triemli Hospital in Zurich and his colleagues that could provide new insights into the prevention and treatment of inflammatory bowel diseases (IBD). Inflammatory bowel diseases, which include Crohn’s disease and ulcerative colitis, affect millions of people worldwide. While it is known that certain dietary additives, hormone replacement therapy, and oral contraceptives can cause IBDs to flare in some people, there are many times that the instigator of a relapse is unknown. Dr. Vavricka’s research suggests one more trigger to add to the list of relapse triggers: high altitude.

By: Kimberly M. Hicks, PharmD M.H.A.

It’s a tough road from diagnosis to treatment, but many hepatitis C patients – in spite of this path of uncertainty – step up to the challenge and say with unrelenting courage: “Let’s Do This.”

As a clinical pharmacist providing drug therapy management and counseling to hepatitis C patients, I am often astonished at my patients’ courage during the treatment process. To be blunt, the side effect profile of hepatitis C treatment is generally grueling. Yet time and again I see patients committed to doing whatever it takes to combat this virus.

Suffering Side Effects for the Chance of a Cure
Hepatitis C patients can suffer for weeks from flu-like symptoms which sometimes make it extremely difficult to even get out of bed. Additionally, some patients experience numerous sleepless nights due to insomnia caused by the treatment. Then, when you add on long days of fatigue, shortness of breath, and weakness caused by anemia, you can see what a challenge treatment can be for patients. Emotionally, many patients endure days of anxiety, depression, and frustration. Despite all of this, I am amazed by how many patients stick with their treatment regimen and remain steadfastly committed to their journey to better health.

By Dr. Stephen Vogt

Surescripts, which is a nationwide network connecting the computer systems of physicians and pharmacies, recently released their annual report on e-prescribing. This survey offers a snapshot of the state of e-prescribing in today’s medical world.

The numbers – which are based on the survey’s 2011 data – speak for themselves:

• 317,000 physicians e-prescribed; this is an increase of 67 percent from the prior year.
• 58 percent of office-based physicians e-prescribe.
• 570 million e-prescriptions were sent to pharmacies.
• The number of e-prescriptions rose by 75 percent.
• 36 percent of all prescriptions dispensed were sent as e-prescriptions (up from 22 percent in the prior year).
• Smaller practices are more likely to e-prescribe than larger practices.
• Among specialty groups, internists, family physicians, cardiologists, and endocrinologists are most likely to e-prescribe (75 percent of them do it).

by Dr. Stephen Vogt

Here I am, back on my soapbox, calling for people to get screened for the hepatitis C virus (HCV). More than 3 million Americans are infected with this virus and a majority of these people don’t even know it! It’s to those estimated 1.6 million infected but undiagnosed people that I plead with, once again, to get screened.

HCV can lead to scary consequences such as cirrhosis, liver failure, and liver cancer. The sooner one’s infection status is known, the sooner treatment can begin. Today’s treatments – with the FDA’s approval of protease inhibitors last year – offer the unprecedented potential of a meaningful cure for up to 70 percent of those infected with HCV. But that cure can’t be realized if someone doesn’t know they are infected.

Everyone age 40 and older should be screened for the hepatitis C virus, as well as (of course) anyone with a risk factor for HCV or potential exposure to this disease, such as:

By:  Russell Gay, Chief Strategic Officer at BioPlus Specialty Pharmacy

Many people wonder how a specialty pharmacy is different from any other kind of pharmacy. Let me share the story of a multiple sclerosis (MS) patient, Michael, to illustrate the true value of a specialty pharmacy.

Michael wakes at 5 a.m. He feels the burning heat that never departed from the Louisiana afternoon. He stirs slowly in his dark bed away from the sheets that inflame his skin. He tests muscles with sloth-like movements and feels the fatigue that rest won’t vanquish. He rolls and reaches for his shirt…“must get up”…he slips his trembling 33-year-old hand heavily into the sleeve. With sweat beading on his brow, Michael rolls and reaches for the other sleeve. He grimaces as he raises his arms, but then falls back into the pillow: maybe no shirt today.

The mercies of the day—reading the paper, sipping coffee, visiting with friends, or working—all come under the category of “we’ll see how I feel.” Michael keeps his lifeline of supplies on his cluttered nightstand: his TV remote, pills, and phone. It could be worse. He remembers the first time his leg melted into the pavement, worrying about being alone, not being able to check on the smoke alarm, and the time his multiple sclerosis drugs didn’t arrive.

By: Steven C. Vogt, PharmD

My mother was recently diagnosed with a 7 mm breast lesion that is a ductal carcinoma. In preparing for surgery, I reviewed her medicines and dietary supplements. Mom is a very health conscience 84-year-old and she follows a wholesome diet and has an active lifestyle.

Not surprisingly, I recommended that she suspend her daily aspirin before the surgery. Next, I noted that she takes an omega-3 fish oil supplement. Since this can increase the risk of bleeding, I also had her stop this supplement prior to her surgery.

Whether or not my mother will need radiation or chemotherapy won’t be known until after her surgery. But the possibility got me thinking. Fish oils are widely used as an anti-inflammatory. In fact, according to a survey earlier this year of 10,000 supplement users, fish oil ranks as the number one most popular supplement. Clearly, lots of folks – which presumably include cancer patients – are taking this supplement. Since cancer patients read my blog, I wanted to pose a question to my blog audience: “Did you know that fish oil could reduce the effectiveness of chemotherapy?”

By: Monica Morgan, PharmD, Clinical Pharmacy Specialist at BioPlus Specialty Pharmacy

At the start of therapy with BioPlus and at each and every refill, I ask my patients “what other medications are you taking?” Does that seem a bit much? Well, let me tell you a story…

One of my patients once called me to report a non-stop, hacking cough. He was really getting annoyed with it. In fact, he’d been to his primary care physician numerous times to address it and was given all sorts of cough medicines. Nothing seemed to do the trick.

Taking each and every pill at the right time, every time is not as easy as it sounds. Most patients treating a disease find it hard to remember to take their medications completely in accord with the care plan. In fact, forgetfulness is one of the top barriers to compliance, especially for complex or chronic conditions. Simply reminding patients to take their medications is a more powerful solution than many people realize, according to a review of the research in medication adherence published recently in the Journal of the American Medical Informatics Association.

Electronic reminders – the kind that don’t require any direct contact between the prescriber and the patient (which would be cost prohibitive) – are increasingly used by the health care system with the goal of improving medication adherence. Electronic reminder use is particularly prevalent for patients who are on long-term medications. These types of reminders are thought to be more effective than passive medication “reminder packaging.”

By: Sofia Rasmussen

You can barely search for a drug online without finding them; scores of gaudy online pharmaceutical stores promising drugs at unrealistic prices that are difficult to find elsewhere. Many medical doctors and doctors of nursing practice warn that the online pharmaceutical world is rife with scam artists, and while the convenience is a real benefit, patients should carefully vet any site they buy from. Common questions include; Are these drugs safe? Will buying them affect pharmaceutical companies negatively? Will it affect patients negatively? Who certifies these drugs, to be sure that what is listed on the bottle actually is inside?

Typically, the answers are no and yes, in that order. The Mayo Clinic warns that many of the drugs purchased from dubious online companies use alternative ingredients without stringent quality controls. Some skip out on the active ingredients altogether to save money, creating nothing more than a placebo effect. You may spend money on these drugs and end up no worse off than feeling like an idiot, but a much worse ending is possible, as unregulated amounts of active agents or contaminated supplies can be a deadly combination for many patients. 

By: Shelley Moore, R.N., National Director of Hemophilia at BioPlus Specialty Pharmacy

Last week, I met a young family who just had their first baby boy. He was about six weeks old and as adorable as any other little boy could be. What I knew and the family knew, but others cannot visibly see, is that he has severe hemophilia A. This diagnosis came as a shock to the family, particularly since they have no family history of bleeding disorders.

The mom is a schoolteacher and the father is a local police officer and Afghanistan war veteran. How poignant that both parents of this child have chosen careers in service to others. This young couple -- who are just starting their family while serving their community -- are now faced with a diagnosis that will impact their entire lives. They are struggling to understand the diagnosis and what it will mean to their family and feel uncertain about how to manage this lifelong condition.

By: Nick Maroulis, Pharm.D.

It’s only a few days until the first-ever national “Hepatitis Testing Day” in the United States. As this day approaches (May 19th, 2012) I can’t help but think of the millions of Americans who do not know that they have chronic viral hepatitis. I hope that as many of them as possible participate in free screening events available in their areas.

Imagine how an individual who gets screened on May 19th and is positive for the hepatitis C virus (HCV) will feel. After the diagnosis, our hypothetical patient will need to move forward with decisions for treatment. This is generally a time for research, with lots of online reading and talking with other hepatitis C patients who are in treatment or have completed treatment.

In the future will your doctor prescribe gut bugs to treat type 2 diabetes? It’s not as far-fetched as it sounds. More than 400 different species of bacteria call the human gut “home.” These colonies of gut flora can contribute to the health of the host in numerous ways, such as limiting the growth of harmful bacteria, aiding the digestive process, producing certain vitamins, and boosting immune function. In fact, the varied roles of intestinal bacteria are so important that it is considered a “microbial organ.”

And now the latest research from the International Liver Congress 2012, which was the 47th annual meeting of the European Association for the study of the Liver, suggests that transplanting gut flora could even affect the course of several diseases, namely type 2 diabetes and non-alcoholic fatty liver disease.

A group of French researchers found in a 16-week animal model study that transplanting gut bacteria prevented the development of diabetes and non-alcoholic fatty liver disease. This benefit of gut microbiota was independent of obesity. The study involved two groups of germ-free mice who each were transplanted with gut microbiota. One of the groups received gut microbiota from mice exhibiting insulin resistance and liver steatosis. The other group received gut microbiota from normal, healthy mice. All mice were then fed a high-fat diet.

Interferon has been a blessing to those with hepatitis C – since it is part of the current gold standard triple therapy that results in successful treatment of this disease in 70 percent of cases. But it certainly comes with a dark side. Side effects from interferon can feel like having a bad case of the flu, along with depression and nausea. These side effects can be so severe that many patients give up on treatment.

Imagine successful hepatitis C treatment without interferon. This may soon be a reality. Decision Resources, one of the world’s leading research and advisory firms for pharmaceutical and healthcare issues, predicts that an interferon-free treatment (based on a combination of a new medication from Gilead along with the long-relied on hepatitis C medication ribavirin) will be available to patients by 2014 and soon after become the gold standard of hepatitis C treatment.

If this Gilead medication does not come to fruition, there are other interferon-free treatments in the works, including one from Abbott Laboratories. The Abbott four-drug cocktail does not contain interferon and is testing very well (90 percent cure rate in patients treated for the first time).

In just a few weeks, my son Josh will graduate from medical school and head off to the Mayo Clinic in Rochester to spend three years training in internal medicine. His final clinical rotation in medical school will be hepatology. I may be biased, but I believe he saved the best for last. Last night, during our regular weekly call, we discussed his patients. Six hepatitis C patients visited him in clinic earlier that day. He was surprised that the doctor did not want to treat their viral infection, but instead choose to keep the patients naïve and wait for “the new drugs.” I’ve been treating hepatitis C for 20 years and it seems like we are always waiting on “the new drugs.”

The current three drug regimen for hepatitis C brings about a 70 percent cure rate, however the side effects are horrible and the physician must contend with many drug-to-drug interactions. The doctor working with Josh explained that with these side effects, he simply can’t get his patients to complete the therapy.

I have heard this many times from other doctors and a variety of clinics. I’m here to say that the current therapy – although far from ideal – can be successfully completed by patients. In fact, we have an excellent completion rate in BioPlus patients being treated for hepatitis C. Consider our latest internal statistic for hepatitis C compliance, which includes all therapies, even the new triple therapies:

POSTED BY DR. STEPHEN VOGT ⋅ APRIL 9, 2012 

Patient education is one of the keys to optimizing patient adherence. In short: the more patients know about their disease and medication treatment plan, the more likely they are to adhere to their treatment.

Patient concerns about side effects are a significant barrier in patient adherence. Here at BioPlus Specialty Pharmacy, we know that the onset of treatment is the ideal time to set the stage for understanding the side effects of any new therapy. A survey by Harris Interactive found that 45 percent of patients reported not taking their medication due to concerns about side effects. [i]   Medications with bothersome side effects are more likely to be filled less frequently and are discontinued more often.[ii]   Another study showed that women with concerns about the adverse effects of their medicine were strongly associated with poor adherence.

Some people have wondered if providing patients with information about possible adverse effects could backfire and decrease adherence. However, the research clearly shows that this concern is unfounded.[iii]

By: Victoria Toews, MPH

BioPlus Specialty Pharmacy

Food and comfort go hand-in-hand. When a loved one is gravely sick or recovering from an illness or injury, our first inclination is to bring over some comfort foods. Before you head to the kitchen, you may want to consider – especially if the person is ailing – whether your comforting foods are healing or hurtful.

Surely if there is ever a time a body needs healthy food, it is when it is sick. But all-too-often the comfort foods that are served up in times of trouble are things like sticky buns, tuna casserole, cheesy lasagna, ribs, or macaroni and cheese.

As you can see from this list of favorites, most “comfort” foods are high in fat, sodium, sugar, or just plain nutritionally void. For a loved one in recovery, these foods, while given out of love, can actually delay the healing process. But this doesn’t mean you can only share carrot sticks and tofu with your loved ones. There is actually a place where good taste and good health meet up; healthy versions of comfort foods do exist.

Chronic diseases affect nearly half of the population, yet physician shortages and unbalanced distribution of health care providers mean that as many as 56 million Americans do not have adequate access to primary health care in their communities. An elegant solution to this problem is suggested in a report entitled “Improving Patient and Health System Outcomes through Advanced Pharmacy Practice” presented by the U.S. Public Health Service to the U.S. Surgeon General. The easy fix, they conclude, is to expand the role of pharmacists in the delivery of health care.

This report outlines a solid case for why pharmacists should be more integrated into the patient care process. In fact, as the report notes: there is already extensive performance data demonstrating that “patient care services delivered by pharmacists can improve patient outcomes, promote patient involvement, increase cost-efficiency, and reduce demands affecting the health care system.” I couldn’t have said it better myself.

POSTED BY DR. STEPHEN VOGT ⋅ MARCH 12, 2012

Medication adherence is the most important predictor of patient outcome. Poor compliance to a prescribed treatment plan not only affects the individual patient, but affects the entire healthcare system. Improving medication adherence can result in substantial cost savings and improved outcomes, which are topics that I covered in my recent blog “Knocking Down Adherence Barriers” and in a blog last year “What You Don’t Take Can’t Help You.”

A white paper called “Blueprint for an Effective Cross-Cultural Medication Adherence Program,” looking at key factors contributing to medication non-adherence in U.S. ethnic minority patient populations, recently caught my eye. This paper correctly pointed out that a comprehensive adherence program needs to go beyond cost barriers and socio-economic obstacles to consider how culturally unique issues influence medication adherence.

 POSTED BY DR. STEPHEN VOGT ⋅ MARCH 5, 2012

Hepatitis C has pulled into the lead, but it’s not good news for anyone. New data confirms that hepatitis C causes more deaths in the United States than HIV. Hepatitis C deaths are expected to rise even higher, unless more people get tested and treated for this disease.

After reviewing 22 million death certificates from one recent seven-year period, researchers from the U.S. Centers for Disease Control and Prevention (CDC) found that while HIV deaths went down and deaths from hepatitis B stayed about the same, deaths from hepatitis C have increased dramatically. This study, published in the Annals of Internal Medicine, also notes that the vast majority (75 percent) of hepatitis C-related deaths occur in Baby Boomers.

The hepatitis C virus (HCV) is the most deadly type of hepatitis, which, if not treated, can lead to liver cirrhosis, liver cancer, and even the need for a liver transplant. It’s also the most common blood-borne chronic viral infection, affecting 3.2 million Americans. Baby Boomers (those born between 1945 and 1964) who injected or snorted drugs in their youth may have been infected with the hepatitis C virus, yet not know about their infection status even today. This is because hepatitis C, which has been called the “silent epidemic,” can lay dormant for up to 20 years. All Baby Boomers should be screened for HCV; that is the only way we can turn the tide of this epidemic of HCV-related deaths.

POSTED BY DR. STEPHEN VOGT ⋅ FEBRUARY 27, 2012 ⋅

Baby Boomers have one more item to add to their to-do list, and it’s an important one: get screened for the hepatitis C virus (HCV). More than 3 million Americans are infected with HCV, but the vast majority of them don’t know it.

In my blog last May, Call for Wider Hepatitis Screenings, I first pointed out the need for all Baby Boomers to get a HCV screening. At the risk of sounding like a broken record, I continued this call for a change in screening policy in several more blogs (Doing Nothing is Not an Option blog and The Road to Wellness Begins in Just 20 Minutes blog).

It looks like my message is finally getting out. If you watched the NBC Nightly News a few days ago, you might have heard Brian Williams sharing the story of a Baby Boomer diagnosed with hepatitis C and her journey of getting treatment. The story wrapped up with the same message I have repeated so many times now: everyone age 40 and older should be screened for the hepatitis C virus.

POSTED BY DR. STEPHEN VOGT ⋅ FEBRUARY 20, 2012

It doesn’t matter how good a medication is for treating a disease, it can’t work if a patient doesn’t take it. There are many barriers that can get in the way of a patient complying with their treatment plan. This “medication adherence” topic was the focus of a seminar earlier this month hosted by the HealthCare Institute of New Jersey and the New Jersey Health Care Quality Institute.

Patients with chronic diseases are particularly likely to face multiple obstacles to medication compliance — including cultural, financial, and educational barriers. Tom Hubbard, a senior program director from NEHI (formerly the New England Healthcare Institute) suggested that adherence could be enhanced by improving patients’ drug regimens and addressing patient behavior.

POSTED BY DR. STEPHEN VOGT ⋅ FEBRUARY 13, 2012 ⋅