Each month, we round up the latest FDA approvals and regulations to give you an expert take on what you need to know.
Updates to Management Guidelines for Patients with Atrial Fibrillation
The American College of Cardiology and the American Heart Associated along with the Heart Rhythm Society released their updated guidelines for Atrial Fibrillation (AFib) in January.1 As with any revision to published guidelines, new medications which have been approved since the previous version are generally included. What makes these updates more unique is there is a significant shift in the standard of care of these patients. Newer anticoagulants are being recommended for certain patients over warfarin which has been the standard of care for decades. These newer anticoagulants such as Xarelto (rivaroxaban), Eliquis (apixaban) and Pradaxa (dabigatran), have been shown to be at least as effective as warfarin without some of the side effects and the need for routine blood draws and frequent dosage adjustments. This change to the guidelines may have a financial impact on the pharmacy budget as warfarin is available generically while the newer agents are brand name. This trend toward the newer agents had been occurring for several years now but with these updates, the guidelines officially support what is already occurring in the marketplace.
Cancer Death Rates Continue to Fall
The American Cancer Society released their 2018 report on new cancer incidence, mortality and survival rates. Good news is that for the last 25 years the death rate from cancer has declined.2 Many factors may be impacting these numbers including lifestyle modifications (decreased incidence of smoking), earlier diagnosis and improved screening as well as the advancement in chemotherapy products. Obesity related cancers (uterus, pancreas) continue to trend up along with liver cancer. Hepatitis C was responsible for an increase in liver cancer but now over 1/3 of the liver cancers are associated with obesity. Cancer is still the second leading cause of death in the US exceeded only by heart disease. 2
Report on Spending Within Type 1 Diabetes
The Healthcare Cost Institute released a report in January highlighting the costs associated with managing type I diabetes.3 From 2012 to 2016, average costs per type I diabetes member rose from $12,467 to $18,494. This number reflects both pharmacy and medical spend. The largest increase was in the costs associated with insulin. This accounted for 31% of the total healthcare spend and doubled from $2,864 in 2012 to $5,705 in 2016. Insulin spend accounted for more spend than any other category including prescriber visits and hospitalizations. The insulin utilization during the same time frame only increased by 3% with price inflation being almost fully responsible for the increase.3 These numbers do not account for rebates or any member coupons.