Nexium is the purple pill that you’ve seen on TV, a proton pump inhibitor to treat acid reflux disease. AstraZeneca sold $4.6 billion dollars worth of this medication in 2005. In July 2005, TRICARE, the Defense Department’s health care program for military retirees and active duty dependents, reclassified Nexium as a non-formulary drug on the ground that cost effective alternatives like now over the counter Prilosec were readily available.

Today UnitedHealthcare, the Nation’s second largest health insurance company, announced that it will stop covering Nexium on the same ground. According to the Associated Press report, UnitedHealthcare took the action because it “had expected costs in the category to slow after generic and over-the-counter versions of Prilosec, the predecessor drug to Nexium, became available in 2003. But that didn’t happen” — possibly because of aggressive advertising of the drug particularly at the time when Prilosec, another AstraZeneca product, lost its patent protection. UnitedHealthcare expects to cut its proton pump inhibitor expenses in half as a result of this and related actions.

Following up on Sen. George Voinovich’s (R – Ohio) August 22 announcement, Senator Tom Carper (D Del.) and Sen. Voinovich yesterday introduced the Federal Employees’ Electronic Personal Health Records Act of 2006, S. 3846. According to Senator Carper’s press release, “The legislation would require all insurance carriers that contract with the Federal Employees Health Benefits Program to make an electronic health record available for every FEHBP enrollee.”

The National Cancer Institute has released its annual cancer status report with these significant findings:

The long-term decline in overall cancer death rates continued through 2003 for all races and both sexes combined. The declines were greater among men (1.6 percent per year from 1993 through 2003) than women (0.8 percent per year from 1992 through 2003), although rates for men remain 46 percent higher than for women. Death rates decreased for 11 of the 15 most common cancers in men and for 10 of the 15 most common cancers in women. The authors attribute the decrease in death rates, in part, to successful efforts to reduce exposure to tobacco, earlier detection through screening, and more effective treatment, saying that continued success will depend on maintaining and enhancing these efforts. “The greater decline in cancer death rates among men is due in large part to their substantial decrease in tobacco use. We need to enhance efforts to reduce tobacco use in women so that the rate of decline in cancer death rates becomes comparable to that of men,” said Betsy A. Kohler, President of the North American Association of Central Cancer Registries, Inc (NAACCR).

Other noteworthly findings were a leveling off of the breast cancer incidence rate over the period 2001 – 2003, ending a string of increases that began in the 1980s and an increase female thyroid cancer incidence rates.

Dr. Mark McClellan, the Adminstrator of the federal government’s Centers of Medicare and Medicaid Services, announced that he is resigning his position in October. No successor has yet been announced.

The Federal Workforce and Agency Organization Subcommittee has posted complete information about Friday’s health information technology hearing on its website. This is the Subcommittee’s fourth hearing on this topic since July 2005. Steve Barr reports in his Federal Diary column of today’s Washington Post that Subcommittee Chair Jon “Porter [R Nev.] also hopes to mark up a bill [H.R. 4859] that would create electronic health records for the 8 million Americans covered by the federal employee health insurance program.”

The House Federal Workforce and Agency Organization subcommittee held a special hearing in St. Louis, Missouri, yesterday. At the hearing, OPM Deputy Associate Director Daniel A. Green informed the attendees that “OPM’s chief priority in the health care arena was to work to implement the President’s recent executive order to expand the information and options available to federal employees.” OPM has posted its executive order implementation steps on its website, which recently received a facelift.

I watched Dr. Stephen Rosenberg of the National Cancer Institute on Good Morning America today. As I noted in the blog yesterday, Dr. Rosenberg’s miraculous gene therapy cured two out of seventeen potentially fatal melanoma cases. In his interview this morning, Dr. Rosenberg explained that the treatment was administered two years ago, and since then his team has strengthened the treatment and moreover has adapted the therapy to fight other potentially fatal cancers. He is waiting for Food and Drug Administration approval to test the therapy on other types of cancer.

Premier, Inc., is an alliance of inpatient facilities that has team up with the Centers for Medicare and Medicaid Services (CMS) on a pay-for-performce pilot called the Hospital Quality Improvement Demonstration. Premier reported on the pilot’s results today.

According to Premier’s analysis, if all pneumonia, heart bypass, heart attack (acute myocardial infarction), and hip and knee replacement patients nationally received most or all (76 to 100 percent) of a set of widely accepted care processes in 2004, it could have resulted in nearly 5,700 fewer deaths; 8,100 fewer complications; 10,000 fewer readmissions; and 750,000 fewer days in the hospital. In addition, hospital costs could have been as much as $1.35 billion lower. While the study findings from patients receiving care for pneumonia, heart bypass, heart attack and hip and knee replacement procedures are extremely positive, the findings from heart failure patients demonstrate a need for continued evaluation into the relationship between improved process delivery and outcomes.

The complete report is available here.

As I predicted, Judge Stein did issue this afternoon a preliminary injunction barring further Apotex sales of its generic version of the anti-coagulant drug Plavix. However, the Judge denied Bristol Myers motion for an order requiring a recall of the generic Plavix pills that already have been distributed. (Sanofi-Aventis v. Apotex, Inc., Civil Action No. 02-CV-2255 (SHS) (S.D.N.Y.) The Judge’s order can be immediately appealed to the U.S. Court of Appeals for the Second Circuit. Absent a successful appeal, the injunction will remain in force until the end of the patent dispute. The trial is set for January 2007.

CBS Marketwatch had reported a significant drop in brand name Plavix sales preceding the issuance of this order. As I previously mused, the Court’s order is similar to closing the barn door after the horse is gone as massive quantities of the generic Plavix are now on the market.

The August 31, 2006, issue of the New England Journal of Medicine includes a study on U.S. health care spending since 1960. The report, prepared by a Harvard economist, a Veterans Affairs Department public health expert, and a University of Michigan research physician “compared gains in life expectancy with the increased costs of care from 1960 through 2000.” The report surprisingly concludes that “On average, the increases in medical spending since 1960 have provided reasonable value” in terms of increased life span. The study has attracted a lot of press attention.