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The use of co-pays to help offset the cost of health care in correctional facilities and to deter abuse of medical services by inmates is common today although there is a debate about the real financial benefit to the jurisdiction due to the amount of staff time required to process payments, staff time spent processing grievances protesting co-payments, and the large amount that is often never collected. Despite the actual benefits, many jails implementing co-pays report having a noticeable drop in request for medical services and medications. Revenues generated from co-pays the past thee years at the ACDF have generated a modest amount of money. From FY 03 through FY 05, a total of $14, 674.21 $5, 813.19 was collected in FY 05.
Initial regimen was modified in 22 35% ; of the patients. Clarithromycin, cyclines, and rifampin were the most commonly prescribed antibiotics. Cure was observed for 55 87% ; of the patients. Failure was related to deep structure involvement 3 of 45 patients; P .04 ; but not to any antibiotic regimen. All strains showed the same susceptibility pattern without acquired resistance. The 90% minimum inhibitory concentrations of rifampin and rifabutin were far lower 0.5 and 0.06 g mL, respectively ; than the 90% minimum inhibitory concentrations of clarithromycin 2 g mL ; and the cyclines minocycline, 4 g mL; and doxycycline, 8 g mL.
Rifaximin tablets Xifaxan Salix ; Xifaxan, a non-systemic antibiotic and structural analog of rifampin, is indicated for the treatment of patients aged 12 years and older ; with travelers' diarrhea caused by noninvasive strains of Escherichia coli. Rifaximin Xifaxan ; also has a Food and Drug Administration FDA ; orphan status designation for the treatment of hepatic encephalopathy. Documents summarizing clinical information on Xifaxan and its place in therapy were reviewed. One member noted that there are still concerns with the use of fluoroquinolones and effects on the cartilage in pediatric patients and stated that Xifaxan may fill an unmet need in that regard. Another member noted that Xifaxan will be a second-line option for hepatic encephalopathy because of ototoxicity issues with neomycin. He stated that the data with inflammatory bowel disease Crohn's disease in particular ; are not yet mature, but in a few years the place in therapy for this drug could expand in that area. A member stated that one issue is how this drug will play out with resistance patterns. Xifaxan is indicated for the primary pathogens that cause traveler's diarrhea, but not the whole group of pathogens that can cause the condition. This could potentially be problematic, especially for cases with more severe diarrhea in which Xifaxan is not likely to work. Thus, fluoroquinolones play a more important role in the treatment of traveler's diarrhea than does Xifaxan. If Xifaxan were to be the first-line treatment for travelers' diarrhea, then the patient needs to understand the difference between invasive diarrhea, for which this product will not work, and non-invasive diarrhea, for which Xifaxan will work. So this member stated that the place in therapy for Xifaxan is in flux and more will be known after a period of a year or so post-marketing. This member also noted that Xifaxan is related to rifampin and that the potential impact of Xifaxan on rifampin resistance is not yet fully known. Given the presence of slight amounts of systemic absorption with Xifaxan, concerns were raised about the use of this type of antibiotic as monotherapy because resistance to rifampin when used as monotherapy develops very quickly. Conclusion: Xifaxan is considered a product whose safety and efficacy demonstrate that it is a therapeutic alternative to other currently available therapies. About by a multitude of conditions triggered by the body's immune response to infection. By that evening, Maggie was hardly recognizable, even to her family. Normally a very slim person, Maggie ballooned to more than 200 pounds as her body could no longer eliminate fluid. Her eyes were so swollen the lids would not cover them. Her organs had begun to shut down as her condition rapidly deteriorated. Finally, she was placed on a ventilator and sedated into an artificial coma to minimize the work required of the body to maintain itself. The attending physician told Maggie's parents she had only a 10 percent chance of surviving. However, he was aware of Lilly's investigational drug for severe sepsis. Believing Maggie might be helped by Lilly's clinical study drug, the physician immediately contacted the company. Lilly researchers obtained the necessary approvals for compassionate use of the experimental drug, and within 14 hours, Maggie's doctor began an infusion of rhAPC that would continue for the next 96 hours. The rapidity of Maggie's response to rhAPC, now known as Zovant, was astonishing. Within 48 hours, her blood pressure improved and her lungs were clear. And, she continued to progress as her vital functions began to work on their own over another seven weeks in the hospital. Once at home, Maggie worked for a year to regain her strength and the normal use of her muscles. She is now totally recovered and will graduate from college in the spring. "I've always been a compassionate person, " she said. "But I'm more so now. Thank God, there were people working for me at Lilly. And they work so hard--I never realized how much it takes to make a new drug. But it pays off. I'm proof that it pays off. "People call me `Miracle Maggie.' It was a miracle--I was almost gone. But, I'm back and risperidone.
Receiving pyrazinamide rifampin 13% ; as compared to isoniazid 4% ; . The risk of severe hepatotoxicity requiring hospitalization was 5% 2 of 43 patients ; in the pyrazinamide rifampin group prior to the more intensive monitoring. We have seen no cases of severe hepatotoxicity since we began more intensive monitoring that we implemented 12 months prior to the revised recommendations of the CDC. Hepatotoxicity in our setting was higher than previously reported. The risk for hepatotoxicity appeared to be higher in nonblacks, although the number of patients is too low to make a general statement. Alcohol use was more prevalent among patients receiving pyrazinamide rifampin, although not statistically significant. In our study, patients who acquired hepatotoxicity while receiving pyrazinamide rifampin were not rechallenged with these medications. Alcohol was felt to be a contributing factor in 2 of patients who acquired hepatotoxicity. Isoniazid was not offered to patients who acquired hepatotoxicity on the pyrazinamide rifampin regimen. Due to the cases of severe hepatotoxicity documented with pyrazinamide rifampin regimen, we do not recommend rechallenging after the ALT level has normalized. Twenty-three case reports of severe liver toxicity with the pyrazinamide rifampin regimen have been reported to the CDC.5, 6 A case was defined as liver injury leading to hospital admission or death. Five of the patients reported by the CDC acquired hepatotoxicity during the second month of therapy, but the true onset of hepatotoxicity is unknown since liver function testing was not routinely performed. In our study, hepatotoxicity tended to occur within the first month of therapy, usually between week 2 and week 4. We contend that more frequent monitoring in the first month would detect patients with hepatotoxicity. RCT, double-blind, placebocontrolled, crossover Ten patients with functional dyspepsia and 10 healthy individuals as controls. Study of symptomatic responses on pressure variations during progressive gastric distensions and roxithromycin, because rifampin coumadin.

Take isoniazid and rifampin on an empty stomach one hour before or two hours after meals.

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Southern.IML Pathology are pleased to announce the appointment of Professor Norman Carr. He will be working four days a week as a diagnostic pathologist in the Wollongong Lab and on day a week as Professor of Anatomical Pathology at the University of Wollongong. He comes to us from Southampton General Hospital, England, where he was a Consultant Pathologist and Deputy Director of Medical Education for the University of Southampton. His experience includes the full range of diagnostic surgical pathology. In addition, he has performed about 700 autopsies. Norman's special interest is in gastrointestinal pathology, and he has over 30 research publications in the field. He has also contributed to textbooks of gastrointestinal pathology and co-authored a pathology text for medical students and reboxetine.

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Subsistence agriculture. Main crops: maize sorghum rapoko legumes round nuts, cow peas, castor beans, sugar beans ; relatively new crop ; sunflowers cash-crop? ; Vegetable `Gardens', belonging to women who also generally control the returns from any sales.

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Despite last year's challenging transition to new software, the STS General Thoracic Surgery Database continues to grow both in number of cases and participants.While the new software brought attendant costs and new learning requirements, the fee structure was changed for Database participation to reduce the cost for participants who have only one or a few surgeons. For information about the fee structure, contact Gerry Tarafa at gtarafa sts . In close collaboration with the Duke Clinical Research Institute, we developed a risk model for the most common major procedure--lobectomy for lung cancer.We decided to start with a model for prolonged postoperative length of stay PLOS ; for lobectomy 14 days ; to capture the important complications that lead to major morbidity and mortality. Given our still somewhat limited dataset, with a discharge mortality of less than 2%, modeling of mortality would be more problematic and thus we concentrated on a global marker for complications which are, of course, relatively more common ; , similar to the STS Adult Cardiac Surgery Database.The good news at this point is that the STS participants all cluster fairly close together, with relatively low rates on this measure of complications. The new PLOS risk model is included in the fourth harvest conducted in 2006 ; General Thoracic Surgery Database Report. The General Thoracic Surgery Database Task Force is working on the next version of the Database with the goal of making the data collection form easier for data managers to complete. Plans call for eliminating some data fields that seem unnecessary, potentially changing the procedure section to a CPT the AMA Current Procedure Terminology ; based system, and adding some fields to better capture the intensity of work and quantitate complications.The Adult Cardiac Surgery Database was used successfully this past year to document the work that is performed by surgeons in the recent 5-year review of the RUC Relative Value Update Committee ; .The real data from the Database was then used to correctly calculate the RVUs Relative Value Units ; involved in the procedure not surprisingly, many procedures were incorrectly undervalued ; . This is an excellent example of the importance of having an accurate and complete Database.We will also be adding fields concentrating on quality process measures, as CMS the Center for Medicare and Medicaid Services ; is starting "pay for reporting" and "pay for performance" measures. The Database still has a fair proportion of incomplete data fields, sometimes for especially important variables, such as performance status and 30-day mortality. It is very important that a careful search for all data be made and then entered correctly, even if it takes more than one session of data entry. For example, when we were modeling morbidity after lobectomy, we were missing about 20% of the pulmonary function data, which weakened our analysis.We all must do better in this regard.To emphasize the importance of a complete dataset, each report for the fourth harvest conducted in 2006 ; includes information on missing key data fields from your site and compares this information to the STS dataset as a whole. We would like to hear from you. As the STS General Thoracic Surgery Database matures, consider submitting a request for clinical research based on your hypothesis. Let us know how the General Thoracic Database should evolve as we prepare the next version you can e-mail Cam Wright at cdwright partners , or contact Gerry Tarafa at 312 ; 202-5833 or gtarafa sts and zerit.
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FIG. 2. Amino acid substitutions conferring rifampin resistance in C. trachomatis. Positions in RpoB resulting in resistance to rifampin of clinical isolates of M. tuberculosis 7, 10, 18, ; and S. aureus 16, 17 ; as well as laboratory isolates of S. aureus 9 ; are shown within the conserved regions of RpoB known to be involved in resistance to rifampin. The C. trachomatis mutated RNA polymerases are as follows: * , single amino acid changes reported previously; * , single changes observed in this study; * , double amino acid changes from this study; * , triple amino acid changes from this study. The sequence of the rifsmpin binding site determined from the X-ray crystal structure with Thermus aquaticus RpoB is shown. The residues known to contact rifampun are shown with a grey background and are conserved in all sequences shown.

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His main research interests are concerned with the functional consequences of metabolic and nutritional disturbances in health and disease, with specific interests in obesity, diabetes, cardiovascular disease and exercise.

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2. Berman D, Iskandrian A, Verani M, Johnston D, Parry J, Quinn J, Dixon M, Orlandi C. Effect of Body Mass Index on Side Effects During Adenosine Stress Testing. JACC 1998; 31: 166A Kang X, Berman DS, Lewin HC, Harris M, Van Train K, Friedman JD, Hachamovitch R, Germano G. Localization of Coronary Stenoses by Stress Myocardial Perfusion SPECT. JACC 1998; 31: 260A Kang X, Berman DS, Kimchi EY, Cohen I, Lewin HC, Friedman JD, Hachamovitch R. Maximal ST Depression During Exercise Does Not Localize Myocardial Ischemia. JACC 1998; 31: 267A Kang X, Berman DS, Kimchi EY, Cohen I, Lewin HC, Friedman JD, Hachamovitch R. Prognostic Value of a Normal Myocardial Perfusion SPECT in Patients Undergoing Coronary Angiography. JACC 1998; 31: 409A Berman DS, Hachamovitch R, Shaw L, Lewin HC, Iskandrian AE, Bateman T. Prognostic Risk Stratification With SPECT Imaging: Results From a 20, 340 Patient Multicenter Registry. JACC 1998; 31: 410A Hachamovitch R, Berman D, Lewin H, Cohen I, Friedman J, Germano G. Incremental Prognostic Value of Gated SPECT Ejection Fraction in Patients Undergoing DualIsotope Exercise or Adenosine Stress SPECT. JACC 1998; 31: 441A Kimchi EY, Kang X, Lewin HC, Friedman JD, Germano G, Hachamovitch R, Berman DS. Effect of Chamber Size on Accuracy of Dual Isotope Myocardial perfusion SPECT. JACC 1998; 31: 519A Lewin H, Hachamovitch R, Miranda L, Friedman J, Cohen I, Kang X, Berman DS. The Natural History of Patients with Very Abnormal Stress Myocardial Perfusion SPECT. J Nucl Med 1998; 39: 3P Kang X, Berman DS, Lewin HC, Cohen I, Miranda L, Friedman JD, Hachamovitch R, Germano G. Serial Changes on Myocardial Perfusion SPECT in Patients Undergoing Medical Therapy or Revascularization. J Nucl Med 1998; 39: 31P Germano G, Kavanagh PB, Waechter P, Areeda J, Sharir T, Lewin HC, Berman DS. A New Automatic Approach to Myocardial Perfusion SPECT Quantitation. J Nucl Med 1998; 39: 62P Lewin H, Hachamovitch R, Germano G, Friedman J, Cohen I, Kang X, Berman D. The Impact of Gated SPECT on Rate of Early Refrral to Catheterization following Myocardial Perfusion SPECT. J Nucl Med 1998; 39: 87P Sharir T, Bacher-Stier C, Dhar S, Lewin HC, Friedman J, Germano G, Berman DS. Post Exercise Regional Wall Motion Abnormalities Detected by Tc-99m Sestamibi Gated SPECT: A Marker of Severe Cronary Artery Disease. J Nucl Med 1998; 39: 87P. Accepted tuberculosis treatment ; — rifampin, isoniazid, and pyrazinamide combination is indicated in the initial phase of the short-course treatment of all forms of tuberculosis and tegaserod and rifampin.
Before taking tiazac, tell your doctor if you are using any of the following drugs: amiodarone cordarone, pacerone cimetidine tagamet, tagamet hb cyclosporine gengraf, neoral, sandimmune dexamethasone decadron, hexadrol digoxin digitalis, lanoxin, lanoxicaps lovastatin mevacor midazolam versed ; or triazolam halcion rifampin rifadin, rimactane, rifater ; or rifabutin mycobutin st.
Monday, January 29, 8: 30 Location: Primrose Ballroom, Palm Springs Convention Center The 2007 Symyx High-Throughput Achievement Award will be presented to David J. Mathre, Executive Director of Process Research with Merck Research Laboratories, for his commercial contributions in the fields of catalysis, process development and pharmaceutical development, and his advancement of R&D execution methodologies in the fields of automated parallel chemistry and informatics. A David J. Mathre $15, 000 contribution, given in Dave's name, will be awarded to the chemistry department headed by Professor J.D. Roberts at the California Institute of Technology, Berkeley, California. The High-Throughput Achievement Award demonstrates Symyx Labs' commitment to the field of high-throughput chemistry and recognizes individuals for their contribution to the field based on demonstrated and sustained scientific and commercial product performance. This is the second of these awards, honoring individuals whose work has a transformational effect on R&D in their industry. The 2006 award was presented to James Stevens of The Dow Chemical Company for his commercial contributions in the field of polyolefins. For the 2008 award, an independent committee has been established to create a nomination process open to both Symyx and non-Symyx customers. This group will formalize the rules and regulations for the award and act as the winner selection committee. The current committee members are: Bob Coraor, American Chemistry Society, Steve Hamilton, Association for Laboratory Automation, and Henry Weinberg, Chief Technology Officer, Symyx Technologies and zelnorm.

Chlamydia preparation no. No. of passages, mutation s ; MIC g ml ; of: Rifampib Rifalazil. DRUG NAME RESPAHIST RESPAIRE-120 RESPBID RESPIROL RESURGEX REXATAL REZINE RHINATATE RIFAMPIN RIMACTANE RINADE-BID RINDAL-HD RMS-SUPPOSITORY ROBAFEN AC ROBAFEN-DAC ROBOMOL 500 ROBOMOL-750 R-O-LACTULOSE ROMILAR AC ROMISULF ROMIXEN 500 RONDAMINE RONDAMINE-DM ROSE-40 ROXICODONE ROXILOX ROXIPRIN R-TANNAMINE R-TANNAMINE PLUS R-TANNATE RU-TUSS 800 RU-TUSS 800 DM RU-TUSS JR. RX-OTIC RYNA-MINE RYNA-P.E.C. RY-TUSS SALFLEX SALINE SALSALATE SALSITAB SANFED A SELEGILINE HCL. View isi citation publication history issue online: 15 dec 2006 home list of issues table of contents article abstract annals of the new york academy of sciences volume 53 terramycin page 253-265, september 1950 to cite this article: henry welch 1950 ; absorption, excretion, and distribution of terramycin annals of the new york academy of sciences 53 2 ; , 253– 26 doi: 1 1111 j 49-663 195 tb4215 x prev article next article abstract absorption, excretion, and distribution of terramycin henry welch 1 federal security agency, food and drug administration, washington, c. Isoniazid and rifampin resistance in Mycobacterium tuberculosis : a blind study at reference laboratory level. J Clin Microbiol 35, 719723. Wagner, E. G. H. & Simons, R. W. 1994 ; . Antisense RNA control in bacteria, phages and plasmids. Annu Rev Microbiol 48, 713742. Wards, B. J. & Collins, D. M. 1996 ; . Electroporation at elevated temperatures substantially improves transformation efficiency of slow growing mycobacteria. FEMS Microbiol Lett 145, 101105.

J.F. Contrera et al. Regulatory Toxicology and Pharmacology 38 2003 ; 243259 Table 5 continued ; Code 561 130 928 Name Mestranol Metformin Methacrylonitrile Methyleugenol Methythiouracil Metronidazole $ Nadolol $ Nefazodone Nitrophenylenediamine p-nitrosodiphenylamine N-nitrososarcosine $ $ Omeprazole o-Nitrotoluene Oxaprocin $ $ Penicillin V Pergolide Phenobarbital $ p-Nitrotoluene $ $ Ranitidine $ Riddelline Tifampin $ $ Scopolamine Simvastatin Spirapril Streptozocin $ Tocainide $ Tramadol Triethanolamine $ $ Venlafaxine MR 40 Pos Pos Neg Pos Pos Pos Neg Neg Neg Neg Pos Pos Pos Neg Neg Pos Pos Neg Pos Pos Neg Pos Pos Pos Neg Pos Pos Neg Neg Pos Neg Pos Pos Neg Pos Neg Pos Pos Neg Pos Pos Pos Neg Neg Neg Q2Plus Pos QMR 41 NC NC QFR 13 NC NC 108 9 11 QMM 21 NC NC and risperidone. PASCALE H. LANE Department of Pediatrics, University of Nebraska Medical Center, Omaha, Nebraska 68198-2169.
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To significant reductions in the meanSEM number of allergen-induced sneezes HHA, 2.7 0.6; RA, 6.6 2.1; P .03 ; , congestion score HHA, 2.30.5; RA, 3.40.5; P .01 ; , and secretion weight HHA, 26.94.4 mg; RA, 38.65.0 mg; P .048 ; Table ; . Hot, humid air in an environmental chamber had no effect on the mean SEM number of allergeninduced sneezes HHA, 3.3 0.9; RA, 5.3 1.3; P .15 ; , secretion weight HHA, 37.6 5.2 mg; RA, 35.9 4.5; P .65 ; , or albumin level HHA, 0.177 0.037 g L; RA: 0.2220.030 g L; P .10 ; , but it led to significant reductions in the mean SEM allergen-induced congestion HHA, 1.20.4; RA, 3.60.6; P .002 ; and pruritus HHA, 0.70.3; RA, 2.3 0.5; P .002 ; scores Table. Ratio 11 ; . If rifampin MIC of 1 mg liter for Mycobacterium tuberculosis which allows protein binding in vivo [11] ; is assumed, the median ratio of the AUC0 MIC in this study was 25.62 for patients who received approved products. This is severalfold lower than the estimated levels required for optimal efficacy 11 ; . Furthermore, in keeping with the findings of several other studies with tuberculosis patients 4, 7, 20, ; , low peak concentrations in comparison to the published reference range 18 ; were demonstrated in the majority of patients. Autoinduction of rifampin's metabolism is expected to result in lower levels after repeated doses 9, 24 ; , and this might explain in part the relatively low concentrations in the patient studies. However, other factors may be important, as the levels reported differ between patient populations 26 ; . The majority of patients achieved levels of isoniazid, pyrazinamide, and ethambutol within or above the expected ranges. This contrasts with the findings of two African studies: Choudri et al. demonstrated peak isoniazid levels 3 mg liter in 89% of patients 4 ; , and Tappero et al. found that low concentrations of isoniazid and ethambutol were common 26 ; . Furthermore, Peloquin et al. 19 ; showed that substantial proportions of patients with HIV infection had isoniazid and ethambutol levels below the recommended ranges, and Zhu et al. found that ethambutol levels 2 mg liter occurred frequently 29 ; . Differences in patient characteristics, dosing practices, and methods of pharmacokinetic evaluation may account for the discrepancies. One participant in our study who had very low levels of all four drugs Cmax values for rifampin, isoniazid, pyrazinamide, and ethambutol were 0 mg liter, 0.49 mg liter, 1.47 mg liter, and 0.16 mg liter, respectively ; and from whose sputum drug-sensitive organisms were recurrently isolated after 5 months of treatment may represent an important minority of patients at high risk of treatment failure. Interestingly, she had few of the risk factors for low drug concentrations identified in this study. Important differences in the rifampin and isoniazid concentrations were achieved between patients who received single drug formulations and those who received FDC products. Although insufficient single drug and FDC products were represented in the study to confirm whether the finding of lower concentrations in the FDCs can be generalized, it indicates that differences between pharmaceutical products have a marked effect on the bioavailability of the drugs in patients. The FDC products used by the patients in this study had undergone and passed in vivo bioequivalence testing in studies with healthy volunteers before their registration approval by the national regulatory authority and were used well before their expiry dates with a median time to expiry of 39 months ; . Questions therefore arise about the effectiveness of bioequivalence testing prior to product registration, ongoing quality assurance procedures for the monitoring of subsequent batches, and the storage conditions of products prior to their use 23 ; . HIV infection was an important determinant of the concentrations of rifampin and ethambutol. Although there are several other reports of low rifampin levels in patients with HIV infection, the 39% reduction in the AUC08 for rifampin associated with HIV infection should be confirmed in a larger study. The 27% reduction in the AUC08 for ethambutol in HIV-infected patients was similar to that observed by Zhu et al. 29 ; . None of the HIV-infected patients had diarrhea, and. Cefadroxil, trimethoprim either lincomycin, 250mg and bactrim, rifampin, minocycline, chloramphenicol into tequin, minocycline and ceftriaxone, linezolid includes rocephin, carbapenem. Adhd medications prescriptions for children ages 2 to 4 increased almost 300% between 1991 and 199 the quick fix. NSAIDs and COX-2 inhibitors In addition to their use for acute treatment, NSAIDs and COX-2 inhibitors are sometimes used for prophylaxis. Their efficacy is not as well-established as the other agents described above, but they may be useful in patients with comorbid arthritis or stroke. As mentioned previously, these products carry the risk of gastrointestinal side effects and should be avoided in patients with GI risk factors.

Uses: this is an antifungal medication used to treat fungal infections of the fingernail or toenail. Study funded by the National Institute of Mental Health is the Clinical Antipsychotic Trials of Intervention Effectiveness project CATIE ; .52 Once results from this study are available and analyzed, we may have a better understanding of the issue.

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Lower than competitors, prompting federal officials to respond that prices would come down in subsequent weeks. That has been borne out. We examined the lowest-priced Medicare discount cards not accounting for any special discounts ; available to our typical beneficiaries on May 3 and again on June 1. The number of cards reporting prices on the CMS website increased significantly over that period. For example, our Mrs. Jones of Brooklyn had fourteen Medicare card options for her drug set when the price finder was launched on May 3. A month later, she had thirty-three cards to choose from. The surge of new cards that have become available to seniors has already bred competition and driven down prices. The best Medicare cards for our three Brooklyn seniors in June were on average 3.5 percent lower than their best options in early May.25 Seniors are already getting better deals than our first look at prices, one month ago, suggested. This is a result of competition among Medicare drug cards and the influx of new plans that offer deeper discounts. The initial pricing decisions by card sponsors reflected the substantial costs and uncertainty associated with the new Medicare market. Although many sponsors have experience with private discount card programs, the requirements of the Medicare program are more costly and less familiar to them. Greater customer support is necessary, for example, and sponsors must develop secure ways of administering the cash subsidy component of the program. Those requirements add significantly to the cost of operating the card plan. Sponsors may charge an annual enrollment fee which can be no higher than $30 ; , but that revenue offsets only a small part of the cost. The remainder must be recouped through higher prescription prices. Uncertainty about how competitors would price their cards also contributed to prescription prices judged by some as too high initially. We should begin to see card sponsors competing for enrollment by more aggressively bidding down prices and offering better customer service which might simply mean offering more pharmaceuticals at discounted prices ; . Some consolidation may be.

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P. K. RANGACHARI Department of Medicine, Intestinal Disease Research Hamilton, Ontario L8N 325, Canada.



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