State Sets COX-2 Restrictions
Louisiana physicians now must document a specific medical need in order to prescribe cyclooxygenase-2 inhibitor (COX-2) drugs to Medicaid patients. Starting last month, Medicaid is filling COX-2 prescriptions only when medical need for these medications over an alternative pain reliever, such as ibuprofen, can be demonstrated. “This is an aggressive, responsible approach to patient safety that will ensure better health outcomes for our Medicaid recipients,” Fred Cerise, M.D., secretary of the Louisiana Department of Health and Hospitals, said in a statement. Under the new policy, a Medicaid patient cannot have a prescription for any such drug filled without documented medical justification from the prescriber. Kaiser Permanente recently made a similar move when it placed a 6-month moratorium on the dispensing of valdecoxib (Bextra) because of safety concerns.
Milk's Role in Children's Bone Health
Physical activity and a healthy diet do more to build strong bones in children and young adults than drinking milk does, according to research published in the March issue of Pediatrics. “To build strong bones and healthy bodies, children need exercise, sunshine, and a diet rich in fruits and vegetables that helps them maintain a healthy body weight,” Amy Lanou, Ph.D., the lead author of the study and nutrition director of the Physicians Committee for Responsible Medicine, said in a statement. But the analysis was dismissed by the National Dairy Council and the International Dairy Foods Association as “an opinion piece by three representatives of an animal rights organization that has only a 5% physician membership.” The groups said the study authors ignored decades of research endorsing dairy's role in bone health. They also pointed to consensus in the scientific and medical community, including the current calcium policy statement of the American Academy of Pediatrics.
Pay-for-Performance Principles
Any pay-for-performance program should offer voluntary physician participation and foster the relationship between physician and patient, the American Medical Association asserted in a new set of principles for such programs. Such programs should also use accurate data and fair reporting, provide program incentives, and ensure quality of care, the AMA stated. If done improperly, “some so-called pay-for-performance programs are a lose-lose proposition for patients and their physicians, with the only benefit accruing to health insurers,” AMA Secretary John H. Armstrong, M.D., said in a statement. Both public and private-sector groups have started offering incentive payments to physicians based on performance appraisals. Before taking on such reforms, however, Congress should try to fix Medicare's flawed payment formula, according to recent AMA testimony.
Cost of New Drug Benefit
National health care spending costs will remain stable during the next 10 years, though public programs will account for half of total spending, in part because of the new Medicare Part D prescription drug benefit, according to a report by the Centers for Medicare and Medicaid Services. The agency claims the drug benefit—which kicks in next January—is expected to “significantly” increase prescription drug use and reduce out-of-pocket spending for older patients without causing any major increase in the health care spending trend. However, the new benefit will result in a significant shift in funding from private payers and Medicaid to Medicare. Medicare spending is projected to grow almost 8% in 2004 and 8.5% in 2005, because of several changes in the program under the Medicare Modernization Act, such as positive physician updates and higher Medicare Advantage payment rates.
Clinical Trial Registry Legislation
Sen. Chuck Grassley (R-Iowa) and Sen. Christopher Dodd (D-Conn.) have introduced legislation to require drug makers to register clinical trials about prescription medicines. The bill is similar to legislation Sen. Dodd introduced in the last Congress, but it stipulates that
Views on Physician-Assisted Suicide
More than half of physicians in a national survey say they believe it's ethical to assist a patient in committing suicide. Approximately 57% of the 1,000 physicians surveyed in the national poll said it was ethical, and 39% said it was unethical. In addition, 41% of the physicians surveyed would endorse the legalization of physician-assisted suicide under a wide variety of circumstances, 30% support its legalization in a few cases, and 29% oppose legalizing it in all cases. Although many physicians supported physician-assisted suicide as public policy, the results were mixed when it came to whether they would personally assist a suicide. The survey was conducted by HCD Research, a marketing and communications research company, and the Louis Finkelstein Institute for Religious and Social Studies.