Medicare prescription drug cards: effectiveness for patients with glaucoma.

OBJECTIVE: To assess the level of discounts on glaucoma medications provided by the Medicare prescription drug card program. METHODS: We compared the cost of a 1-month supply of 10 brand-name drugs and 1 commonly prescribed combination of drugs purchased at retail cash price, Medicare card-discounted price, and online price. Retail cash prices were collected through a telephone survey of 36 chain pharmacies in 4 states. Card-discounted prices were obtained from an online database updated weekly by Medicare for each drug, drug card, and state in our survey. Prices for drugs purchased online were collected from a leading online drugstore not affiliated with any retail stores that were included in the telephone survey. RESULTS: Card-discounted prices for each drug ranged between 13% and 25% lower on average than retail prices. However, drugs purchased online were cheaper on average than drugs purchased with cards for 7 of the 10 medications surveyed. CONCLUSIONS: Drug cards provide significant discounts over retail prices. However, cards may be a secondary option to online purchasing, which may be cheaper and may offer seniors more flexibility to switch between glaucoma therapies. Ophthalmologists can take simple steps to guide seniors to the optimal purchasing option for a given drug in their region.

Endovascular treatment of vertebral artery origin lesions.

Endovascular management of vertebral artery stenosis has been shown to have significantly better outcomes than surgical therapy or medical therapy alone. The average mortality is zero and morbidity is about 1%. There is a 97% procedural success rate. The issue is a restenosis rate that is between 30% and 41%. This article will discuss the indications, procedure, and treatment options.

Embolization for intractable epistaxis.

It is estimated that 60% of the population experiences epistaxis at least once in a lifetime, and that approximately 6% of these patients require treatment. We discuss the risks and benefits of an endovascular approach in our experience. We believe this option is often offered too late. By following basic rules the procedure is very safe and highly effective.

Pain reduction in osteoporotic patients with vertebral pain without measurable compression.

INTRODUCTION: Non-compression osteoporotic vertebral pain (NCOVP) can also cause pain and severe immobilization, such as typical vertebral compression fracture (VCF). The aim of this study was to evaluate whether patients with NCOVP refractory to medical treatment and severely affecting normal daily activities could be offered therapeutic benefit with percutaneous vertebroplasty. METHODS: We conducted a retrospective review of the records of consecutive percutaneous vertebroplasty procedures performed at our institutions during a 28-month period to define a population of patients who suffered from severe NCOVP. Nine such patients were identified based on physical examination, computed tomography, magnetic resonance (MR) imaging, and bone scans. Initial clinical outcomes were assessed by comparing quantitative measurements of pain (10-point scale) and mobility (5-point scale) 1 day before the operation with those 1 day post-operation. A second follow-up took place between 2 weeks and 1 month after the operation, with a third follow-up between 6 and 10 months post-operative. Biopsy was taken in each case. RESULTS: Each patient demonstrated point tenderness over radiographically normal-shaped vertebra. Every patient showed a low signal on T1W images, and seven cases showed a high signal on T2W images inside the vertebra, indicating bone marrow edema. All patients experienced a reduction in pain and an increase in mobility after percutaneous vertebroplasty, with a mean pain reduction of 7.0 points and an average improved mobility of 2.8 points. Biopsy results indicated necrotic and/or degenerative changes in eight cases. CONCLUSION: The clinical outcomes of our patients suggest that NCOVP, mainly verified by abnormal MR signals and biopsy results, can be successfully treated by percutaneous vertebroplasty.