FROM THE TEAM
Balancing the Approach
Diet and exercise. It has never ceased to amaze me just how many different conditions have these two non-pharmacological alternatives considered an integral part of their prevention and management. Diabetes, high cholesterol, high blood pressure, arthritis and musculoskeletal ailments, stress, depression, insomnia, certain types of cancer, and this list goes on, all have established guidelines which include the benefits of healthy eating and regular physical activity. And this list doesn’t include the obvious role of diet and exercise in weight management and obesity.
This will not be news to many of you. We are inundated with the results of new studies and reports released in the media almost weekly touting the virtues of a healthier lifestyle. This message is further reinforced in our articles this month on the new Canadian Lipid Guidelines, and the DREAM trial investigating the use of Avandia® in the prevention of diabetes. Medical experts maintain that diet and exercise have just as key a role in the prevention and management of these conditions as drug therapy.
While a necessary focus in drug plan management addresses the “supply” side of the equation through plan designs, formularies, cost-sharing strategies with plan members, and related strategies, I would argue that not nearly enough is being done to address the “demand” side of plan utilization. Organization-level programs and educational initiatives to improve the eating habits and activity levels of employees and their families will not just benefit the drug spend for diabetes by reducing blood glucose levels or for high cholesterol by reducing LDL levels. They will address the management (and associated costs) for all of the acute and chronic conditions mentioned above. Most of our clients have Cardiovascular-related conditions and Mental Illness as their top two cost categories with respect to drug plan spending. Although the drug therapy for these areas is very different, both are benefited by adopting a healthier lifestyle.
Of course, participation by plan members is the key. Plan sponsors looking at plan design changes intended to contain costs may balance such a perceived “take away” from plan members with the introduction of a parallel strategy that enhances opportunities for programs that focus on an active, healthy lifestyle at no cost to the members. Thus, plan management strategies that address both supply and demand should be developed together, and not be considered mutually exclusive.
To pass along any comments on Cubic Health Monthly, or to see back issues of our publication, please visit our website at http://www.cubichealth.ca.
Sincerely,
Chris von Heymann
Senior Vice President, Consulting Services
| LATEST NEWS |
Progress Report Released from the National Pharmaceuticals Strategy
On Thursday, September 21, the National Pharmaceuticals Strategy Progress Report, compiled by provincial health ministers and presented to a meeting of first ministers this summer, was released in Toronto.
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| DRUG & DISEASE NEWS |
Update on Canadian Lipid Recommendations
On Thursday September 7th, 2006, the Canadian Cardiovascular Society released updated “Recommendations for the Diagnosis and Treatment of Dyslipidemia and Prevention of Cardiovascular Disease”.1 This update, published in the Canadian Journal of Cardiology, builds upon the last set of recommendations published in October of 2003.
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A DREAM or a Nightmare for Plan Sponsors
A team of international investigators, lead by researchers in Hamilton, Ontario published a landmark trial in the Lancet journal on September 23rd, 2006. The diabetes reduction with ramipril and rosiglitazone medication, or DREAM trial, looked at the effects of two medications on reducing the onset of diabetes or death in patients that are in a “pre-diabetic” state. Ramipril (Altace®), a blood pressure lowering agent from the ACE-Inhibitor drug class, was not found to have an impact on progression to diabetes or death. Rosiglitazone (Avandia®), on the other hand, had substantial impact on these endpoints. This commentary will focus on the results of the study regarding the latter.
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New Concerns with the Use of Stimulants in Treating ADHD
Health Canada has recently revised its prescribing and patient information for all therapies used to treat attention deficit hyperactivity disorder (ADHD) because of the potential to cause rare psychiatric side-effects such as agitation and hallucination in children. Health Canada announced that all drugs used to treat ADHD will carry new labels in December.
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NOC Watch:
Myozyme® (glucosidase acid alpha)
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| FOR THE PLAN SPONSOR |
Plan Sponsors Concerned with Drug Plan Costs Yet Unable to Make Plan Design Changes – What Now?
A very common scenario we encounter, especially with plan sponsors who deal with union-based plans, is that they understand drug plan costs are increasing at an alarming rate, have a desire to control the problem, yet are unable to consider any meaningful plan design changes. This may be due to existing collective bargaining agreements or related union contracts, or senior management’s unwillingness to wade into contentious issues such as modifying employee benefits.
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September 2006
Issue No. 16 |
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QUICK FACTS
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14%: Percentage of Canadian adults clinically obese in 1978/79
23%: Percentage in 2004
30%: Percentage of American adults clinically obese in 2004
3%: Percentage of Canadian children aged 2 to 7 clinically obese in 1978/79
8%: Percentage in 2004
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