Medicaid managed care: disparities in the use of thiazolidinediones compared with metformin.

OBJECTIVE: To identify patient characteristics that are associated with the incidence of thiadolidinediones (TZDs) or metformin prescnbing in Medicaid managed care plans. RESEARCH DESIGN AND METHODS: We utilized a retrospective cohort study design. Two-and-one-half years of prescription claims of Medicaid managed care organizations (MCOs) patients who were new utilizers of metformin or TZDs were analyzed using univariate, bivariate and multivariate models. Multivariate logistic regression models were built to assess the combined effect of all variables on the likelihood of incident use of TZDs or metformin. RESULTS: Claims for 3,041 patients were analyzed for the period between January 15, 2000 and June 15, 2002. African Americans and urban residents were less likely to be started on TZDs (OR = 0.678, 95% C1 = 0.830-1.206; OR = 0.579, 95% CI = 0.479-0.699, respectively). Advanced age, preexisting comorbidities and diabetes complications, and prior use of other oral diabetes drugs or insulin were predictors of increased likelihood of TZD initiation. CONCLUSIONS: Race, age, residential setting, preexisting comorbidities and diabetes complications, other oral diabetes drug use, and insulin use are statistically significant predictors of initial prescribing of TZD or metformin in a Medicaid MCO population. Findings can potentially inform the management of diabetes in managed care so as to improve outcomes.

Formulary decision-making considerations: COX-2 inhibitors.

When deciding the formulary status of a drug, Pharmacy & Therapeutics Committees must consider clinical efficacy, safety, financial implications, MCO population demographics, and other formulary options currently available. Differences in safety and effectiveness among drug classes and among drugs in the same class commonly take precedence over all other considerations, including economic ones. Particularly in light of recent events, the case of the cyclooxygenase-2 inhibitors for the treatment of arthritis yields interesting perspectives into formulary decision making.

Clinical and economic evaluation of gatifloxacin and levofloxacin.

Antibiotics represent a relatively high drug cost component for the average institution. There are numerous antibiotic agents available for many indications so the choice of agents for which to provide coverage becomes complicated. The two fluoroquinolones levofloxacin (Levaquin, Ortho-McNeil Pharmaceuticals Inc.) and gatifloxacin (Tequin, Bristol-Myers Squibb) are similar in many respects yet have enough differences to allow for debate in preferring one over the other. However, overuse of these antibiotics is leading to a growing concern of bacterial resistance. This review discusses the factors that formulary decision makers consider when contemplating coverage of these drugs and explores where population-specific information would benefit this process. Both clinical and economic issues are raised in this review.