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More than 2 million Americans take epoetin products. In fact, Epogen, Procrit and Aranesp have been among the best-selling drugs in the U.S. Medicare spends more on Epogen annually — $2 billion — than it spends on any other drug under Medicare Part B. So when studies came out in 2006 that seemed to indicate a link between higher doses of the drugs and health complications for patients, health care industry groups and government bodies responded. An array of FDA advisory committee and congressional hearings has taken place this year. CMS has tightened its monitoring and reimbursement policies, and some plans have followed suit with policy changes. And results from a Sept. 11 FDA meeting on the use of epoetin products in chronic renal failure patients have the potential to impact the situation even more. But an uproar from physicians and even some payers — many of which perceive the restrictions as ones based strictly on financial concerns — has greeted these guideline modifications. Amid this controversy, what should plans do with their coverage and their management of these drugs? And how, specifically, should they do it? Hear two industry leaders give you details on effective health plan strategies for managing epoetin products, including:
HELEN SHERMAN, R.Ph., Pharm.D., is senior director of pharmacy services and chief pharmacy officer at The Regence Group's RegenceRx, a not-for-profit PBM whose evidence-based research program makes it a national leader in assessing the value of medications, reducing pharmacy trends and increasing generic utilization. Regence serves about 2.6 million members of Blue Cross/Blue Shield plans in Oregon, Washington state, Utah and Idaho. Dr. Sherman, who joined RegenceRx in 1996, is responsible for the company's scientific review process, and also develops educational information/tools for consumers and doctors and facilitates benefit design. She has more than 20 years of experience in managed care, retail, hospital, home care and community research settings. Dr. Sherman earned her bachelor's degree in pharmacy from Oregon State University and her Pharm.D. from Purdue University, and she is a member of the Academy of Managed Care Pharmacy. MICHAEL JOSLIN is chief operating officer of CareCore Oncology and executive vice president of CareCore National, LLC (CCN). CCN is a specialty benefit management company focused on the appropriate management of radiology, cardiology and oncology services. CCN contracts with payers to manage these services for more than 25 million lives. Earlier this year as president of OncoMetrix, Inc., Mr. Joslin orchestrated its merger with CCN. Prior to joining OncoMetrix in 2004, Mr. Joslin was executive vice president of CuraScript Oncology and was a principal in CuraScript Pharmacy, Inc., located in Orlando, Fla.
Financial and operations executives; strategic planners; product development, contracting and marketing executives; and pharmacy and medical directors at
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