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A long time ago in an internet far, far away I utilized a thing called MySpace. In the beginning it was good. As time passed it was attacked by spam and too many people taking pictures of themselves in the mirror. It wasn't the worst thing in the world, but there was one feature that caused me to stop frequenting it: My blog. In the early days of me filling the internets with my thoughts, it used to be through MySpace. As my frustration grew with the limited access for outsiders and whole posts being lost in internet space, I eventually came to know Blogger. Then Facebook came along and stole my heart. Why is this important to you? Because, you may not be aware that there have been previous blog posts not on this blog. And, you may not be aware that I have set next Tuesday as the day I delete my MySpace account, denying you the opportunity to ever see those blog posts again (no need to cry about it). For this reason I am including this link for you to check out the previous blog posts before they are gone. I promise that if you read them, your eyes will probably still work afterward.

As an added service to you, I will be posting highlights from the former blog up until next Tuesday. I figured that today I would begin with the blog post that started it all:

Wednesday, August 03, 2005

Current mood: curious
What branch of the service did General Mills serve in? I bet that he was involved in preparing meals in some sort of capacity. I also think that he somehow became a 4 star general and utilized that in his future profession as a restaurant critic. We can probably thank him for the whole star grading system. Along with his many magically delicious breakfast cereals. Why isn't this guy featured on the History Channel?

Wednesday, August 10, 2005

Current mood: cynical
Is it just me, or do these ads for medicine keep getting more and more ridiculous? "Hi, I have genital herpes" Really, thanks for sharing that with the whole world. I know that you are an actor, but now you will be known as the actor from the herpes commercial. That isn't even the worst. Do you ever listen to all the possible side effects of these drugs? "Some of the side effects of this bowel medication may be worse diarreah, bloody stool, serious itching, and possible death" How many people are thinking that their diarreah is so bad that they are willing to risk death to get their bowels back to normal? And finally what about those erectile dysfunction drugs? The ad says "erections lasting longer than 4 hours should seek immediate medical attention" Their are so many wrong things about that statement. First of all, who sets a timer when the troops start to stand at attention. Secondly, I would think that the possibility of having to go to the emergency room with that problem would be embarassing enough to deter people from using the drug. Can you imagine that conversation:
Receptionist: What are you here for today sir?
Mr. Over 4 hours: I really don't want to say it out loud.
Receptionist: Well then just lean over the counter and whisper your problem to me.
Mr. Over 4 hours: I am trying, but I can't get close enough.
Receptionist: Why, is something in your way? Oh, now I see the problem. Go sit down and put a coat in your lap. The doctor will see you in a minute.

And then I am thinking what the doctor is going to do.
Doctor: O.K. Mr. Over 4 hours, don't worry I have seen this problem before. Go sit in room 4. Nurse, go get the video of the 300 pound guy eating Fritos in the nude for Mr. Over 4 hours to watch in room 4.

Local health plan makes big splash in national pool

Local health plan makes big splash in national pool

Rockledge, FL (November 2, 2010) — Health First Health Plans (HFHP) today announced their rankings as one of the highest-rated Medicare health insurance plans in the nation. Health First Health Plans ranked number #20 among Medicare Advantage Plans in the National Committee for Quality Assurance (NCQA) Health Insurance Rankings — Medicare 2010-2011.

NCQA is an independent, not-for-profit organization dedicated to assessing and reporting the quality of managed care plans to help consumers, employers, and others make informed healthcare choices. NCQA’s Health Insurance Plan Rankings have been widely recognized since 2005 as a valuable measure of clinical performance and customer satisfaction. More than 300 Medicare health plans across the nation were reviewed and evaluated with only 183 ranked based on customer satisfaction, prevention, and quality.

“This is an enormous achievement for our health plan,” said Lisa Slattery, Director of Quality Management. “Health First Health Plans has a long-standing commitment to excellence in quality and service, and we continually strive to raise the bar so we can better serve our members.”

For many Americans who will be choosing health plans during open enrollment season, the timing of this release could not be better. HFHP’s commercial plans ranked #80 out of more than 300 plans that submitted data. NCQA ranked 237 participants in NCQA’s Health Insurance Rankings —Private 2010-2011 category.

Only one other plan in Florida ranked higher for both commercial and Medicare products. All rankings are displayed online at www.ncqa.org.

“We are very proud of our employees, providers, and partners who do their best every day to provide a health plan of this caliber,” Slattery said.

About Health First Health Plans

Centrally located in the Suntree area, Health First Health Plans currently has nearly 60,000 members, including 23,000 Medicare members. Serving residents of Brevard County and part of Sebastian in Indian River County for 14 years, Health First Health Plans was founded as part of Health First, Inc. a not-for-profit family of healthcare services that also includes Cape Canaveral online pharmacy, Holmes Regional Medical Center, Palm Bay Hospital, Health First Physicians,as well as the new Health First Viera Hospital and Medical Plaza that are scheduled to open April 2011. For more information about Health First Health Plans, visit www.HealthFirstHealthPlans.org or call 321-434-5665.

Maternal health- how policies can be ineffective
Geeta Bhen was in her third trimester when I met her in Undithal. When she saw me standing at her doorsteps to meet her, she smiled with the little energy she had and placed a rectangular mat on the floor for me to sit on.

I had come to her house to learn about women’s health and to assess the implementation of the ICDS, a program that provided heath services to pregnant women and infants. As part of my work, I would visit the houses of pregnant or nursing women in Undithal to ask them if they had received iron folic acid cheap viagra (IFA).

Geeta Bhen had received IFA cialis, and she enthusiastically showed me the full set of 90 tablets that an ICDS worker had given her. But before I moved on to my next question, I took a second look at her tablets. Not one had been eaten and I wondered why.

She placed her gungat (veil) over her head shyly as she responded to my question. Geeta hadn’t taken the tablets because
she did not know what they were for and she was scared she would fall sick if she took them.

In India, I met many other women like Geeta who had been recipients of tablets, pills or vaccinations but did not understand their purpose. In essence, for Geeta, simply receiving tablets did not necessarily translate to positive health outcomes; there often were gaps in communication or there simply was no communication.

On the one hand, pills were passed out, boxes were checked, and that often was enough to keep the policymakers satisfied. But this, in itself, wouldn't necessarily result in a healthier society.

Now, as we approach 2015, we have two major Millennium Development Goals related to maternal and child health:

  • GOAL 4: Reduce the under-five mortality rate by two-thirds
  • GOAL 5: Reduce the maternal mortality by three-fourths
If we move forward by passing laws- simply passing out tablets, giving out nutritional packages, or performing vaccinations- how helpful will this ultimately be?

By doing so,
do we end up viewing people as targets or goals rather than people with needs, emotions, fears, and beliefs?

In the face of huge public health goals, is it possible to move forward without de-humanizing the beneficiary?

I'll end this post with a few pictures of the women of Undithal. They cannot be viewed simply as numbers, targets, or figures. These are women who move, who breathe, who speak, who question, and who fight back.

Drug Plans
Prescription Drugs are the most expensive part of any benefits plan. Prescription Drugs typically account for 60-70% of all health care expenses, and account for the majority of cost increases. In order to combat the explosive growth in drug costs carriers have come up with several strategies, most of which, revolve around controlling which drugs are covered and which are not.

Brand Name Drugs

Just like the name implies these are drugs made by big name pharmaceutical companies. They fall under brand names like Viagra, cialis and Levitra. We see ads on TV, brochures in doctors’ offices and generally know what they are called but not what they do. (ask your doctor if is right for you! )

Because of the marketing blitz and patent periods (the time when no other company can produce a similar chemical agent) the big drug companies can charge whatever they want. Brand name drugs tend to be very expensive, not necessarily because they work any better but because they are SOLD better.

Most cost saving measures have targeted Brand Name Drugs. By avoiding brand names plans can avoid the cost of all that marketing and hype, reducing costs substantially.

Generic Alternatives

Often made in the very same factory as brand name drugs, generics are typically bough in huge bulk orders by either provincial or federal agencies. Because the generics lack the little logo stamp and occasionally use less expensive fillers they can cost up to a half as much as the same brand name drug. Generics are mandated by law, to provide the exact same medicinal ingredients, in the exact same dosages and of the exact same quality as the brand name. Generics, for all intents and purposes ARE the brand name drug, for only half the cost.

While the medicinal ingredients are mandated by law the fillers and binders aren’t; occasionally people will find they are sensitive to side effects from the generic when they are not sensitive to the brand name. This can usually be traced to a difference in fillers or psychosomatic response. For these people drug plans typically allow for a “no substitutions” clause. If the doctor writes “No substitutions” on the script the drug plan will cover the cost of the brand name drug.

Lowest Cost Alternative (LCA)

A newer and more aggressive plan of attack on drug costs, LCA goes beyond substituting brand for generic form, and actually replaces the whole ingredient with another designed to do the same job. LCA looks not at the drug being prescribed but the ailment being treated. Take depression as an example, Prozac has been around for years, it is inexpensive and effective at the treatment of depression. Wellbutrin is another drug designed to treat depression, however, it is about 5 times the cost of Prozac. Wellbutrin has the added benefits of reduced side effects, fewer drug interactions and less complications, so doctors will often prescribe Wellbutrin over Prozac. A Lowest Cost Alternative plan will look at the problem of depression, and determine that while Wellbutrin is indeed a method of solving the problem it is substantially more expensive than good old Prozac. The LCA plan will decline the claim for Wellburtin, and prompt the pharmacist to dispense one of the less expensive alternatives which are covered by the plan.

LCA plans receive a substantial rate reduction, as well as a huge amount of flack from members. I have on several occasions had employees screaming at me over an LCA drug plan. The fact that they cannot receive the drug prescribed by their physician drives them crazy. Again for these people a plan can have a No Substitutions clause which allows the generic or Brand name drug to be claimed.


 Most plans work on a formulary basis, a formulary is just a list of drugs to be covered. Simple examples of active formularies are drug plans that do not cover lifestyle drugs such as: anti-smoking drugs, fertility drugs, or prescription weight loss medication. More aggressive formularies resemble the Lowest Cost Alternative plans but are even more restrictive, they also tend not to allow a “no-substitutions” clause. That is, if a drug isn’t covered, no amount of fuss from your doctor will get it covered.

Formulary plans are designed to use the cheapest drug possible to treat any one given malady. Typically there is ONE single drug for each medical condition. Members are allowed to purchase a non-formulary drug, however, they tend to either be reimbursed at a lower level, or only the cost of the listed drug is covered, any additional cost is born by the plan member.

A new, kinder, gentler formulary plan is referred to as a Conditional Formulary. Pioneered by Green Shield of Canada this is a very restrictive formulary which has several hoops plan members can jump through to get their drug of choice. You have to play the insurance companies game to get the drugs. The plan starts off very restrictive, most claims occur without incident; however, once a member has a problem with a formulary drug, they can apply for an alternative. Once approved, the more expensive alternative is covered and hopefully fixes the problem with the first drug, perhaps there are lesser side effects. If this second drug still is unsatisfactory a second application can be made for a higher tier of coverage. More expensive drugs are made available at this tier and again the process is repeated until a satisfactory drug of the lowest cost is found. The core idea is to cover the cheapest drug that works. If it doesn’t work you can try a more expensive one until either a working drug is found or you reach the top tier where the most expensive drugs are covered.

By starting at the bottom price wise, and moving up only when necessary, huge costs savings can be found. Administration, paperwork and frustration are the trade off for these savings.


Which plan is best for your group depends on your budget, your drug claims history and your benefits philosophy. Obviously not everyone wants to put their members into a position of jumping through hoops with a conditional formulary, then again having conditional coverage is better than none at all.

Other than Brand Name drugs, all of these strategies require a drug card. Drug cards are where the plan design and formulary are held. While a drug card increases the cost of a benefits plan due to an increase in claims, the cost savings from drug control are starting to offset the cost.

TL;DR you might be able to lower your drug costs by using generic, lowest cost alternative, or conditional formularies.

Lupin gets USFDA approval for diabetes drug
NEW DELHI: Drug maker Lupin today said it has received tentative approval from US health regulator for its generic Metformin Hydrochloride extended-release order cialis, used in the treatment of diabetes, in the American market.

The company's US arm Lupin Pharmaceuticals Inc has received approval from the US Food and Drug Administration for Metformin Hydrochloride extended-release cheap cialis in the strengths of 500 mg and 1000 mg, Lupin said in a statement.

The company's product is generic equivalent of Andrx Labs LLC's Fortamet 500 mg and 1000 mg tablets and is indicated as an supplement to diet and exercise to improve glycemic control in adults with type 2 diabetes mellitus, it said.

Commenting on the approval, Lupin Pharmaceuticals CEO Vinita Gupta said: "This product approval demonstrates our commitment to enhance our generic pipeline, leveraging our development and manufacturing strengths in extended-release dosage forms."

The company believes it is the first applicant to file an abbreviated new drug application for Fortamet 500 mg and 1,000 mg and that could translate into 180 days of marketing exclusivity for its product.

"Upon receiving final approval by the FDA, Lupin believes that the 500 mg and 1,000 mg strengths of its product will be entitled to 180 days of marketing exclusivity," it said.

As per IMS Health data, annual sales for Fortamet in the US stood at USD 83 million for the 12 months ending December, 2010, it added.

Shares of Lupin were today trading at Rs 411.90 on the Bombay Stock Exchange in the late afternoon trade, up 0.99 per cent from its previous close.


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