Gender-Specific Medicine: Part 2

This week we continue to look at gender medicine- how diseases may manifest themselves differently, and how medications may affect differently- depending on whether you are male or female.

An editorial in Nature in 2010 urged us to “put Gender on the Agenda,” as increasingly we are seeing from research results that there are distinct gender-based differences in disease incidence and activity, and treatment methods, especially medication. Cancer, for example, is the second leading cause of death among women and men, (Anderson, R.N., Deaths: Leading Causes for 2000. National Vital Statistics Reports. 2002, National Center for Health Statistics: Hyattsville, MD), however mortality rates and the disease course differ according to gender.gender

In looking at cancer, we see that in general, more women are screened but more men are diagnosed, and that “The gender differential in cancer incidence rates is comparable to ethnic and racial disparity in magnitude, and yet, most studies fail to look for it.” That is beginning to change with recent studies and clinical trials seeking to reduce disparities by including more women.

If we look at lung cancer specifically, Lynne Eldridge, M.D. comments: “There are differences between the way men and women develop lung cancer as well as their response to treatment. These differences are helpful to note, especially when women look at statistics regarding lung cancer survival. Statistics usually lump men and women together, but for women, the chances of survival are higher at all stages of the disease. We are just beginning to learn how genetic and hormonal influences play a role in the development of lung cancer and what might explain these differences. How do men and women differ in the development of, and response to, lung cancer?”

What accounts for these differences? Hormones? The environment? Genetics? Differences in how we react to medications? All of these can be factors, and many are being explored through gender-based studies.  This new research is fascinating and we promise to bring you updates!

Gender-Specific Medicine

“Women are from Venus, Men are from Mars.” “Women think differently than men.”

These viewpoints appear to be widespread and popular, fueling spirited and on-going debate in the media and the arts, but what about healthcare and medicine?

Most medical research over the years has focused on white men as subjects, and results were then extrapolated to include everyone else. From an ethical perspective, there were some humanistic reasons for this, e.g., protecting women and children from experimental research that may not have benefited them. In many cases, however, research focused on those in positions 4.10.13genderof power. This situation is slowly but surely changing, and we are now witnessing the rise of Gender Medicine.

A very interesting article in Clinical Chemistry and Laboratory Medicine, entitled “Gender Medicine: A Task for the Third Millennium,” defines gender-specific medicine as the study of how diseases differ between men and women in terms of prevention, clinical signs, therapeutic approach, prognosis, and psychological and social impact. They focus on five major fields of medicine: cardiovascular disease, pharmacology, oncology, liver diseases and osteoporosis.

For example heart disease has mostly been studied in men, but we do know that cardiovascular diseases are the top causes of mortality and disability in women. Further, research results reveal that risk factors, clinical manifestations and the influence of medications all can differ depending on whether you are male or female. The authors purport that “sex-related differences in pharmacokinetics (what the body does to the drug) and pharmacodynamics (what the drug does to the body) are also emerging. This is important information given that efficacy and side effects of prescribed medications may differ according to gender. It is also important information to be considered in the development of new drugs.

In our next post, we will examine further the issue of gender differences in medicine. We would love to hear your thoughts on this topic!

The Lowdown on Specialty Drugs II: Biosimilars and How to Get Your Insurance Company to Cover the Costs

Biosimilars are defined as “similar versions of an existing biological medicine by a different manufacturer.” Biosimilars may be used to treat difficult-to-manage conditions including rheumatoid arthritis, multiple sclerosis, chronic pain, HIV and cancer, among other conditions. Because they are more complex and more difficult to manufacture than other pharmaceuticals, rigid compliance to regulations and quality control are crucial to avoid contamination and drug shortages. Their complexity also means that they are more expensive for the patient.

A recent article by NBC News suggests that “the number of patients who could benefit from these more sophisticated therapies will only continue to grow, in some cases by 15% annually.” But how will we afford them?

medicineChanges are afoot in many health insurance plans, and some new rules state that any cost-savings must be weighed against severe health consequences, particularly where obtaining prior approval (an often lengthy process) or “step therapy” where a number of cheaper drugs are tried before moving on to more expensive ones. Seth Ginsberg, of the New York-based Global Healthy Living Foundation, says: “Insurance plans should not come between the patient and the doctor who is right there with them, deciding what the best course of treatment is.”

As well, the Affordable Care Act will provide some relief in 2014 when insurers will be required to restrict out-of-pocket costs, including for prescription drugs.

 

What can you do in the meantime? Kathleen Kingsbury of Reuters has these suggestions:

  • Contact the drug manufacturer directly and inquire about their Patient Assistance Program for your medication. They may be able to help you maneuver the insurance approval process.
  • Ask your doctor’s practice administrator for help. Health plans often require prior authorizations and the paperwork can be daunting. Be polite and persistent.
  • Make sure your health history, including prescribed medications, is well-documented. Ask your physician or nurse practitioner to assist you in pulling together your health record.
  • Ask your doctor for assistance and advice regarding authorizations.
  • Ask your employer for help if you have a health insurance plan through your workplace.
  • Appeal if you are denied.
  • Pay attention to deadlines.
  • Keep detailed records of all correspondence.

 

What has your experience been with obtaining biologics? What advice do you have? Please share with us!

 

The Lowdown on Specialty Drugs

Healthcare costs continue to be a concern, despite efforts underway to reduce them through healthcare reform initiatives.  One area, in particular, is worrying patients and physicians alike: specialty drugs or biologics. An article in Workforce Management reports that specialty drugs “make up about 17% of employers’ total drug costs, even though just 1% of the workforce takes them.”  Reuters reports that “approximately 57 million Americans rely on specialty drugs,” with the average prescription costing $1,766.00 in 2011.

03.27.13“Specialty drugs are high-cost drugs used to treat complex or rare conditions, such as multiple sclerosis, rheumatoid arthritis, hepatitis C and hemophilia. The drugs are often self-injected or administered in a physician’s office or through home health services,” according to Wellmark. Specialty pharmacies specialize in the delivery and clinical management of specialty drugs.  It is reported that the average cost per specialty medication is $2,000.00 per month, 10 times greater than that for nonspecialty medications, according to the 2012 Specialty Drug Benefit Report by the Pharmacy Benefit Management Institute, a research organization in Scottsdale, Arizona.

Why do specialty drugs cost so much? Workforce Management reports that “overall pharmacy spending is relatively low because of the number of drugs available in generic form, but specialty medications are derived from living organisms and have no substitute, unlike most drugs which are made chemically.”  The complexity involved in manufacturing biologics stems from the fact that these medicines are derived from living cells grown in vitro in a highly controlled environment. The risks for contamination, counterfeiting and drug shortages is higher as well.

But there are new developments that may make it easier and more affordable for patients to obtain their specialty drugs. In our next post, we will discuss the advent of “biosimilars,” and include tips on getting your insurance company to cover the costs of your biologic medications.

 

Health Insurance at 26 : What Are My Options?

The passing of the Affordable Care Act has implemented a number of changes to American healthcare. Many of these changes directly affect families, the elderly, and people with pre-existing conditions, leaving many of 20-somethings wondering “What does this mean for me?” One major impact of the new law is that young adults can stay on their parents’ healthcare plan until age 26. Before the passing of the Affordable Care Act children could only stay on their parents’ insurance up to age 19, with exceptions for full-time students. Since the law has been enacted, over 3 million young adults have gained insurance.3.20.shrug

As a recent college graduate, I took full advantage of the new law and remained on my parents’ insurance until 26. After that I had options – lots of options – most of which I knew very little about (sound familiar?). I did know that as a Massachusetts resident I had to be insured, or I would face an increase on my taxes.

The first option was to wait for an open enrollment period and get back on my parents’ plan after age 26. For some this may be the best bet. Your coverage will remain largely the same, but the price may be higher than anticipated. Your parents will need to inquire about this process through their work, but it should be a fairly simple process. However, insurance companies are not obliged to offer this, so for some this may not be an option.

puzzledMy second option was to get insured through the state – what is commonly referred to as Medicaid. This option is much more cost-effective, but usually provides less extensive coverage with higher co-pays. We list contact information for each state’s Medicaid program on the NeedyMeds website. If you currently do not have many medical expenses and are in good health, this will probably be the most cost-effective choice.

The third option was to get health insurance through my employer. The coverage and cost of employer-provided insurance varies greatly depending on where you work. Some employers offer expensive insurance with great coverage, while others offer the bare minimum. After discussing what they had to offer for insurance with my employer, and comparing that coverage with my other options, I ultimately decided to go the employer-insurance route.

Another new feature of the Affordable Care Act is the creation of Health Insurance Exchanges. These marketplaces for insurance will not be in effect until 2014 and will help streamline the process of comparing and deciding upon insurance.

But why should I visit the doctor? Regularly visiting your doctor is extremely important to maintaining good health – even for those of us under 30. Diabetes and heart disease, among other serious illnesses, can be spotted ahead of time by your doctor. Taking charge of your healthcare now can seriously benefit your long-term health.