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Washington State Drops Budget Provision That Would Have Cut Medicaid Pharmacy Payments
Washington state lawmakers this week eliminated a budgetary proposal that would have reduced Medicaid payment rates to pharmacies to the lowest levels in the country, the AP/Spokane Spokesman-Review reports. The provision would have reduced the payment rate from 86% to 80% of the average wholesale price of branded drugs. It had been approved by the state House and Gov. Chris Gregoire (D) and was intended to address the state"s $9.3 billion shortfall for the current fiscal year.The state"s Department of Social and Health Services moved to make the rate change on April 1, but pharmacy operators and a person living with HIV/AIDS brought a suit in federal court in Tacoma, Wash., and a judge blocked the change. According to the judge"s order, the plaintiffs likely could prove that their best interests had not been sufficiently considered and that the proposal would diminish the quality of Medicaid care in the state. Walgreen had stated that if the rate change occurred, 44 of its 111 stores in the state would no longer be able to fill Medicaid prescriptions. Other pharmacies made similar arguments. The state prepared an argument on behalf of the rate cut, but later decided against it.Along with eliminating the payment reduction, state legislators added a provision that a DSHS analysis is required before rates can be lowered in the next budget, as well as one placing a 2% cap on any future rate cuts. DSHS spokesperson Jim Stevenson said the agency had not started to analyze what would be required to get a rate cut approved, but added, "I think we"re at a stage where we"re going to have to do it soon if we want to get ready for July 1," the start of fiscal year 2010 (AP/Spokane Spokesman-Review, 5/13).
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Large, Long-Term Study Shows Avandia Has No Increased Overall Cardiovascular Risk Compared To Other Commonly Used Diabetes Medicines
Clinical trial results presented today at the American Diabetes Association annual meeting show that overall rates of cardiovascular hospitalization and cardiovascular death are similar in patients taking Avandia (rosiglitazone) compared to those receiving metformin and sulfonylurea.
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How Superbugs Control Their Lethal Weapons

It appears that some superbugs have evolved to develop the ability to manipulate the immune system to everyone"s advantage. A team of researchers at The University of Western Ontario, led by Joaquin (Quim) Madrenas of the Robarts Research Institute, has discovered some processes that reduce the lethal effects of toxins from superbugs, allowing humans and microbes to co-evolve. This discovery may lead to novel alternatives to antibiotics that specifically target the toxic effects of these superbugs. The findings are being published in the journal Nature Medicine and are available online today. Madrenas holds a Canada Research Chair in Immunobiology and is a Professor of Microbiology & Immunology, and Medicine at the Schulich School of Medicine & Dentistry at Western. He also is head of Immunology at Robarts Research Institute and Director of the FOCIS Centre for Clinical Immunology and Immunotherapeutics. Staphylococcus (staph) aureus is the leading cause of infections in hospitals and the second most common cause of infections in the general population. By itself, it is linked to more than half a million hospital admissions a year in North America with estimated costs of more than $6 billion per year. Among the many weapons produced by this superbug, the most potent and lethal ones are known as superantigens. These lethal weapons cause massive and harmful activation of the immune system that leads to Toxic Shock Syndrome (TSS). TSS is a very serious disease that carries a high mortality, for which we do not have a specific treatment. Scientists have been puzzled as to why, when the body is directly exposed to the TSS toxins, a human can die within hours whereas individuals may carry toxin-producing staph and not get sick or die. What has the staph bug got that prevents the immune system of the host from being kicked into high gear? Madrenas and his collaborators at Western, Calgary and Chicago have identified the process that allows the bug to stay in the body without causing that massive activation of the immune system. The secret lies in molecules found in the cell wall of staph. These molecules bind to receptors known as TLR2 on immune cells of the host triggering the production of a protein called IL-10, an anti-inflammatory molecule that will prevent TSS. "It is clear that staph superbugs have developed strategies to control the toxicity of its lethal superantigen toxins, thereby preventing TSS. We believe that this is an important mechanism that warrants continued investigation. It also illustrates that evolution may operate not only by competition but also by networking ultimately leading to peaceful co-existence" says Madrenas. Based on these studies, Madrenas and colleagues have developed a computer model that will help predict the outcomes of encounters between staph and a host, and will reveal new aspects of these encounters. The multidisciplinary team led by Madrenas includes David Heinrichs, Ewa Cairns, Mansour Haeryfar, and John McCormick of the Departments of Microbiology and Immunology, and Medicine at The University of Western Ontario, as well as Paul Kubes from the University of Calgary and Gary An from Northwestern University in Chicago. The research was funded by the Canadian Institutes of Health Research and the Kidney Foundation of Canada. Kathy Wallis University of Western Ontario


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