Category Archives: Providers

posts about provider related issues and treatment modalities

ACR Poster on Gout Treatment Costs

In late 2013, Aaron Davis presented his poster on Gout treatment costs and regional variations.  Contact me if you want a copy.  Slide1


The burden of poor patient compliance in CVD risk and diabetes – an M2 whitepaper

In association with our partners at MEMOTEXT, Metabolic Markets has produced a whitepaper review on the clinical and economic burden of poor patient compliance in cardiovascular disease risk and diabetes.  Click HERE to access the whitepaper.

Some important data points about patient compliance in diabetes

  • Patients with medical possession ratios less than 80% had 2.5 times the risk of hospitalization for reasons either directly related to diabetes or to cardiovascular disease6
  • Increased antidiabetic MPR was the strongest predictor of decreased total annual healthcare costs, 8.6% to 28.9% decrease in annual total healthcare costs in annual total healthcare costs for every 10% increase in MPR 7
  • Each additional prescription fill by users of older (metformin or SFU) antidiabetes agents reduced hospitalization risk by 0.3%, reduced the number of hospital days by 0.04 days, and reduced Medicare spending by $71 per refill8

Read our work. Call us to discuss.  Our partner MEMOTEXT is the best in patient adherence technology to address the needs of manufacturers and payers.




MEMOTEXT® and Metabolic Markets, LLC announce strategic partnership


MEMOTEXT and Metabolic Markets have entered into a strategic partnership, integrating MEMOTEXT’s best-in-class patient adherence platform into the Metabolic Markets’ client offerings.

“Patient compliance and adherence has long been one of the biggest challenges in chronic disease management.  MEMOTEXT’s unique, customized programs aimed at individualizing and increasing patient engagement, result in improved compliance and provide significant value to the healthcare system by reducing the overall impact and increased positive patient outcomes” stated Metabolic Markets partner Dr. Damon Tanton.

MEMOTEXT CEO Amos Adler commented, “Integrating Metabolic Markets clinical and health system expertise further enhances the delivery of MEMOTEXT’S adherence solution to patients, health care providers and payers.  We look forward to expanding the utilization of MEMOTEXT’s platform throughout the health care continuum with the Metabolic Markets partnership.”

Metabolic Markets will promote { MEMOTEXT’s patient compliance platform across its client base of manufacturers, managed care organizations and government health systems.


MEMOTEXT® integrates behavior modification, patient education and real-time patient support into the everyday lives of patients. This approach improves adherence using interactive multimedia assessment and telecommunications tools.

About Metabolic Markets

Metabolic Markets is the first strategic sale/marketing/reimbursement consulting company to focus on the unique commercial challenges in diabetes, obesity and other metabolic disorders.

Metabolic Markets was founded by Aaron Davis and Dr. Damon Tanton under the belief that bringing commercial and clinical expertise together in a focused consultancy will deliver enhanced value to clients, improving access and increasing treatment modalities in the global healthcare crisis of diabetes and obesity.

DIABETES: We can’t stop it, we can only hope to contain it?

To steal a line from former Sportscenter anchor Dan Patrick, that is the feeling I have after reading some great work this week by Health Affairs and their January issue dedicated to  the multi-factorial challenges involved in addressing diabetes, from prevention to treatment.  Heatlh Affairs social media editor Chris Flemming has a very good summary of the issue, if you don’t have several hours to dive into this subject.   Health Affairs also sponsored a day long symposium on the challenges earlier this week, you can catch a feeling of the proceedings via their twitter feed HERE.

So what does it all mean?   Of all the articles and discussions, Richard Kahn’s work and comments seemed the most rationale and realistic: prevention programs are  challenging and expensive to implement, the data is mixed as to their actual long term impact, and we can do more treating the people we know have diabetes.  His comments I believe lead into the “Quality Care/ACO” discussion.  The role of Medicare bonus STAR payments for achieving quality metrics in diabetes care management and in Part D for compliance will focus on treatment, and increasingly  the private sector are evaluating these metric in making health care plan choices for their employees.


Vivus, Qnexa, and re-arranging the deck chairs?

Vivus announced today the preliminary results of a retrospective database review on topiramate exposure during pregnancy.  In short, it potentially links topiramate exposure during pregnancy to an increased risk of oral clefts.  Consequently, Vivus has stock has dropped 17%.

So what does this mean for Qnexa?  We knew there would be a REMS program, but does this increase the REMS requirements?  Will the FDA not approve Qnexa for use in women of child-bearing age?  Does this call for a closed distribution approach?  Will the FDA demand a “named patient” program?  Or program that requires only “approved physicians” to prescribe Qnexa?  Most importantly, even if Vivus produced the most advanced risk mitigation program ever, will the FDA take enough  of a chance to approve Qnexa?  Or is the risk of just one oral cleft offset any chance for approval?

As this is a time of reflection, I have some compassion for the FDA with respect to obesity agents.  They are under political pressures to approve something, but the agents in front of them, are not great advances and have considerable safety concerns.  Where does this leave the FDA?  And where does this leave industry in a search for obesity treatments?

Late January 2012 will be a busy, busy time for the FDA, pharma and lunch caterers

As we mentioned earlier, January 28, 2012 is the FDA action date for both the new SGLT-2 agent, dapafligozin as well as exenatide once weekly.  A few days ago, Takeda announced that the FDA has given them an action date of January 25, 2012 for alogliptin and the FDC alogliptin/pioglitizone.

The FDC of an glucose dependent insulin stimulating agent of a DPP-IV paired with an insulin sensitizer is a physiologic combination.  Mix in the pending patent expiry for pioglitizone in 2012, it is a well played franchise extension maneuver.  It will be interesting to watch how Takeda prices the FDC, if they “give away” the pio portion, or do they ask for a premium over the current DPP-IVs.

It will be a very busy time for the FDA to move all of these agents through the process by end January.  Two agents (dapa & exenatide QW) have some distinct safety baggage, and this is Takeda’s second time down the aisle with the FDA for alogliptin.  Will anyone take a bet on if the FDA starts the year with a clean sweep of approvals, rejections, or a mixed bag?  See the poll for your predictions….

Is the DPP-IV battle shaping up to be “what combination can you develop?”  We have Juvisync (sitagliptin + statin), alogliptin+pioglitizone, and the other DPP-IV manufacturers have an arsenal of hypertension and cholesterol agents at their disposal.  Mix-in depression, erectile dysfunction, Alzheimer’s, we could be looking at a multitude of combination therapies with a DPP-IV for years. I’m no product development / toxicologist guy, and I am sure there are limitations, but I would assume that the relatively benign profile of DPP-IVs and now with years of patient experience, may lead it to be the backbone of multiple different combinations that address the various co-morbid conditions of diabetes.

Drop me a line, let’s discuss

People see what they want to see, and physicians aren’t pushing the issue

A recent emergency room survey of patients found that only 19% of patients with a self-characterized “unhealthy weight” had ever discussed weight with their health care professional.  You can read the US News & WR article here.

As we have seen time and time again, generally speaking there is a very odd dynamic between provider and patient when it comes to weight issues.  Without doing an exhaustive pub-med search, I will guess that the data will suggest both providers/patients have their heads in the sand about weight, both providers/patients are frustrated, and consequently, an unwritten rule of the provider / patient relationship is “I know you are heavy, you know you are heavy. I know that you know you won’t likely do anything about it, so we are all going to not talk about it.”  Am I too cynical?


Aloha from the Metabolic Markets Blog

The partners of M2 will be monitoring clinical, business and regulatory events in the Metabolic arena. We will be commenting unabashedly. Mark to favorites, and contact us anytime for a discussion.

Metabolic Markets is Launched!