Commentary on Current Trends in Rising Drug Costs and Reimbursement Below Cost.

PURPOSE: To quantify prescription drug price increases over a span of 3 years (2012-2015), as well as extrapolate current reimbursement rates expected by independent retail pharmacies. In addition, we investigate potential reasons for these increasing drug costs. DESIGN: Descriptive analysis. METHODOLOGY: National average drug acquisition costs (NADAC) data published by the Centers for Medicare & Medicaid Services were examined. Specifically, December 2012, 2013, and 2014, and July 2015 NADAC files were analyzed to identify generic and branded products with the highest percentage price increases. Percentage price differences were also calculated for 17 first-in-class drugs and their "me-too" competitors. The margin and margin percentage were calculated for claims adjudicated through four major payers. RESULTS: The top 50 generic drug price increases ranged from 474% to over 18,000% from December 2012 to July 2015. The top 50 branded drug price increases ranged from 63% to 391% during the same time period. The percentage price difference for the first-in-class drugs versus their me-too analogues ranged from -2.3% to 61,259%. The margin for generic drug claims adjudicated ranged from -$237.11 to-$1,105.96. The margin for branded drug claims adjudicated ranged from $272.42 to $360.17. CONCLUSION: Several potential reasons for the surge in prescription drug prices include manufacturer competition, industry consolidation, and capitalization on me-too drugs. This increase has compelled PBMs, health plan sponsors, and retail pharmacies to find novel ways to turn a profit, often at the expense of the consumer. Although there are no immediate solutions, legislation regulating PBM functions and the use of therapeutic interchange programs may offer health plans some assistance in managing drug costs.

Acoustic properties of plates with unevenly distributed macroperforations backed by woven meshes.

A hybrid model describing the acoustic properties of plates with macroperforations that can be unevenly distributed on the plate surface and backed by woven or precision woven meshes with microscopic perforations is proposed. The plate perforations may be of circular or rectangular shapes. Since the perforated plate may not necessarily be considered as an equivalent fluid, its impedance is calculated by the Maa model [Noise Control Eng. J. 29, 77-84 (1987)], whereas the Johnson-Champoux-Allard model [J. Appl. Phys. 70, 1975-1979 (1991)] is used for the mesh, considered as an equivalent fluid. A simple model for the elementary cell of the mesh structure is proposed in order to calculate parameters that can be considered as the thermal characteristic length Λ' and the viscous characteristic length Λ. An effective airflow resistivity is introduced to account for the increase of particle velocity through the mesh placed behind the carrying macroperforated plate and is used in the transfer matrix approach to obtain the impedance of the whole multilayer system. The hybrid model seems to represent a good approach of this multilayer system. The theoretical predictions are compared with experimental measurements.

Primer estudio de Enterobacter sakazakii en alimentos en Cuba / First study on Enterobacter sakazakii in foodstuffs in Cuba

Enterobacter sakazakii es uno de los microorganismos patógenos emergentes que han hecho su aparición en los últimos años, fundamentalmente como contaminante ocasional de las fórmulas infantiles en polvo. En países en vías de desarrollo no existen suficientes investigaciones sobre este microorganismo, en Cuba este constituye el primer estudio realizado. Conocer la presencia de E. sakazakii en muestras de leche en polvo de importación. Se analizaron 60 muestras de leche en polvo, entera y descremada, provenientes de nueve países, se siguió la técnica recomendada por autoridades reguladoras de EE.UU., con la inclusión de pruebas bioquímicas convencionales como alternativa antes de aplicar el sistema de identificación API 20E. Se empleó el agar hierro Kligler y el agar citrato de Simmons; en aquellas cepas con imagen sugestiva de Enterobacter se comprobó la obtención de triptofano a partir de indol, reacción de Voges Proskauer y rojo de metilo, descarboxilación de lisina y ornitina, dihidrólisis de la arginina, producción de ácido de sacarosa, dulcitol, adonitol, rafinosa y sorbitol. Se obtuvo crecimiento de enterobacterias en 26 muestras. Una sola cepa dio resultado presuntivo de E. sakazakii por pruebas bioquímicas, la misma se confirmó por API 20E para 1,6 por ciento de positividad. En general la calidad microbiológica de las muestras de leche estudiadas fue buena. La técnica empleada para determinar E. sakazakii en muestras de leche en polvo, con la inclusión de pruebas bioquímicas convencionales, es factible de realizar en Cuba, para minimizar los costos asociados a la utilización de API 20E. Sería importante continuar estos estudios en áreas hospitalarias, especialmente aquellas donde se preparan fórmulas lácteas para recién nacidos(AU)

Enterobacter sakazakii is an emerging pathogen that has been isolated in milk powder preparations for infant in the last few years. Practically there is no research works about this microorganism in developing countries; in Cuba this is the first study. To detect the presence of E. sakazakii in imported milk powder samples. Sixty samples of whole and skimmed powdered milk imported from 9 countries were analyzed. Before applying API 20E Kit, the recommended technique by US regulatory bodies including conventional biochemical tests was used. Kligler´s iron agar and Simmons´s citrate agar were employed; other tests such as obtaining of triptophane from indole, Voges Proskauer reaction, methyl red, lysine and ornitine decarboxylation, arginine dihydrolysis, production of sucrose acid, dulcit, adonit, raffinose and sorbitol were performed in presumptive Enterobacter strains. Enterobacteria were isolated in 26 samples. Just one strain was classified as E. sakasakii using the traditional biochemical tests and further confirmed by API 20E for 1.6 percent possitivity of the sample. Generally speaking, the microbiological quality of powered milk samples was good. The technique used to determine E. sakazakii in powered milk samples, including conventional biochemical tests, is feasible to be performed in Cuba in order to reduce costs inherent to the use of API 20E. It is important to conduct these studies in hospital settings, particularly in those areas where milk formulae for neonates are prepared(AU)

Primer estudio de Enterobacter sakazakii en alimentos en Cuba / First study on Enterobacter sakazakii in foodstuffs in Cuba

Enterobacter sakazakii es uno de los microorganismos patógenos emergentes que han hecho su aparición en los últimos años, fundamentalmente como contaminante ocasional de las fórmulas infantiles en polvo. En países en vías de desarrollo no existen suficientes investigaciones sobre este microorganismo, en Cuba este constituye el primer estudio realizado. Conocer la presencia de E. sakazakii en muestras de leche en polvo de importación. Se analizaron 60 muestras de leche en polvo, entera y descremada, provenientes de nueve países, se siguió la técnica recomendada por autoridades reguladoras de EE.UU., con la inclusión de pruebas bioquímicas convencionales como alternativa antes de aplicar el sistema de identificación API 20E. Se empleó el agar hierro Kligler y el agar citrato de Simmons; en aquellas cepas con imagen sugestiva de Enterobacter se comprobó la obtención de triptofano a partir de indol, reacción de Voges Proskauer y rojo de metilo, descarboxilación de lisina y ornitina, dihidrólisis de la arginina, producción de ácido de sacarosa, dulcitol, adonitol, rafinosa y sorbitol. Se obtuvo crecimiento de enterobacterias en 26 muestras. Una sola cepa dio resultado presuntivo de E. sakazakii por pruebas bioquímicas, la misma se confirmó por API 20E para 1,6 por ciento de positividad. En general la calidad microbiológica de las muestras de leche estudiadas fue buena. La técnica empleada para determinar E. sakazakii en muestras de leche en polvo, con la inclusión de pruebas bioquímicas convencionales, es factible de realizar en Cuba, para minimizar los costos asociados a la utilización de API 20E. Sería importante continuar estos estudios en áreas hospitalarias, especialmente aquellas donde se preparan fórmulas lácteas para recién nacidos.

Enterobacter sakazakii is an emerging pathogen that has been isolated in milk powder preparations for infant in the last few years. Practically there is no research works about this microorganism in developing countries; in Cuba this is the first study. To detect the presence of E. sakazakii in imported milk powder samples. Sixty samples of whole and skimmed powdered milk imported from 9 countries were analyzed. Before applying API 20E Kit, the recommended technique by US regulatory bodies including conventional biochemical tests was used. Kligler´s iron agar and Simmons´s citrate agar were employed; other tests such as obtaining of triptophane from indole, Voges Proskauer reaction, methyl red, lysine and ornitine decarboxylation, arginine dihydrolysis, production of sucrose acid, dulcit, adonit, raffinose and sorbitol were performed in presumptive Enterobacter strains. Enterobacteria were isolated in 26 samples. Just one strain was classified as E. sakasakii using the traditional biochemical tests and further confirmed by API 20E for 1.6 percent possitivity of the sample. Generally speaking, the microbiological quality of powered milk samples was good. The technique used to determine E. sakazakii in powered milk samples, including conventional biochemical tests, is feasible to be performed in Cuba in order to reduce costs inherent to the use of API 20E. It is important to conduct these studies in hospital settings, particularly in those areas where milk formulae for neonates are prepared.