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Recommendations In light of these findings, we offer the following recommendations: That an initiative should be launched to design a national essential medicines list for the United States and a system to guide its use. That, given the structure of the American health system and the recent innovations to drug benefits management made in the private sector, the initiative should involve a mix of private as well as public entities. That, given the potential for controversy and conflict of interest, the process must be as explicit and open as possible. That list development should start with an existing evidence-based formulary rather than with an effort to identify common conditions. That, if the list is intended for the Medicare population, careful consideration be given to the clinical issues involved in providing care for the aging population. That, if there is a program of patient cost sharing attached, it should be a reference-based or similar system that provides full reimbursement only for essential drugs, but allows exceptions when they are deemed clinically necessary. Also, if the patient is willing to pay more or the manufacturer is willing to lower the price of the drug to match the price of the essential agent, the program should allow free access to comparable agents that are not on the list. That it may be better to call the list a "preferred" drug list rather than an "essential" drug list. That careful attention should be paid to the numerous potential barriers to the effective development and implementation of an essential medicines list that were identified in this report, including the interests of important stakeholders. That, in particular, extensive education programs tailored for the public and for physicians should accompany the process. A major aim of these programs should be to counter the likely perception that this is a new effort to ration care. The private market will ration care if left do so, with the result being the gaps in coverage and escalating costs that are currently manifest and raloxifene.
Molecular epidemiology of clinical Cryptococcus neoformans strains from India Jain N., Wickes B.L., Keller S.M., et al.; J. Clin. Microbiol. 43 11 5733-5742 ; , 2005 [B.C. Fries, Department of Medicine, Division of Infectious Diseases, Albert Einstein College of Medicine, 1300 Morris Park Ave., Bronx, NY 10461, United States] Romano C., Ghilardi A., Massai L.; Mycoses 48 5 343-346 ; , 2005 [C. Romano, Via Monte Santo, 3, 53100 Siena, Italy] De Capriles C.H., Mata- Essayag S., Azpir z A., et al.; Rev. o Latinoam. Microbiol. 47 1-2 11-20 ; , 2005 [C.H. De Capriles, Secci n de Micologa M dica, Institute de Medicina Tropical, o e Ciudad Universitaria, Apartado Postal 47423, Caracas 1041, Venezuela] Lupi O., Tyring S.K., McGinnis M.R.; J. Am. Acad. Dermatol. 53 6 931-954 ; , 2005 [Dr. S.K. Tyring, 2060 Space Park Dr, Houston, TX 77058, United States] 2094, for instance, fda.
References: 1. Data on file, searle. 2. Merlotti L, Roehrs 1, Koshorek C, itt al. The dose effects of zolpidem on the sleep of healthy normals. J Clin Psychopharmacol. t989; 9; 9-t4. 3. vogel GW, 5charf M, Walsh I, et al. Effects of chronically administered zolpidem on the sleep of health insomniacs. Sleep Research. t989; t8: 80. Abstract. 4. Scharf MB, Mayleben DW, Kaffeman M, et al. Dose response effects of zolpidem in normal geriatric subjects. J Clin Psychiatry. 1991; 52: 77-83. Walsh JK, 5vhweitzer PK, 5ugerman JL et al. Transient insomnia associated with a 3-hour phase advance of sleep time and treatment with zolpidem. J Clin Poychopharmacol. t990; tO: 184-t89. 6. Oswald I, Adam K. A new look at short-acting hypnotics. In: 5auvanet JP, Langer 51 Morselli PL ads. lmidazopyridines in Sleep Disorders. New York, NY: Raven Press; t988: 253-259 and efavirenz.
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