New Rx, policies benefit women’s health

A wave of new drug introductions and healthcare policy changes has had a significant impact on women’s health care over the past year.



The changes — from better therapies to treat a wide range of conditions to new ways of thinking about how to provide certain types of care — have affected every aspect of women’s health.



Contraception



Nowhere has this been more evident than in the area of contraception, where a provision in the Affordable Care Act mandates that insurers cover the full cost of birth control medications and the removal of restrictions on emergency contraception have increased the number of women visiting community pharmacies.



Great strides also are being made in other areas critical to maintaining women’s health.



Osteoporosis



In bone health, for instance, there has been a flurry of drug-related activity aimed at helping alleviate osteoporosis in postmenopausal women.



Pfizer’s Duavee (conjugated estrogens and bazedoxifene) was approved by the Food and Drug Administration last year for both moderate to severe vasomotor symptoms associated with menopause and prevention of postmenopausal osteoporosis.



In addition, Merck said it will seek approval of odanacatib this year after completing clinical trials in 2013. The drug increases bone mineral density by inhibiting cathepsin K, an enzyme that breaks down bone and cartilage. Researchers say that odanacatib could be a major breakthrough in treating osteoporosis, noting that during the trials, a data safety monitoring committee shut down the study after finding that the drug was so much more effective than a placebo that it should be given to all study participants.



Meanwhile, Amgen and UCB Pharma’s romosozumab, designed to inhibit osteoblast activity, is in the midst of a phase-3 clinical trial that is comparing its efficacy with alendronate, one of the main osteoporosis treatments for the past two decades. The drug is an antibody that targets sclerostin, a protein that inhibits bone formation. Researchers said monthly injections of romosozumab have been shown to increase patients’ spine density by an average of 10%.



Generics also continue to play a central role in the osteoporosis market. Among the latest drugs to join the fray is Mylan’s risedronate sodium tablets USP, 150 mg, the generic version of Warner Chilcott’s Actonel tablets. Indicated for the treatment and prevention of osteoporosis in postmenopausal women, the drug debuted in June 2014.



Community pharmacy advocates and educators say that pharmacists can play an additional role in controlling bone density decay by encouraging patients to use nutritional supplements to increase their calcium and vitamin D intake to the respective 1,000 mg to 1,200 mg and 800 IU to 1,000 IU per day recommended by the National Osteoporosis Foundation earlier this year.



HPV



As community pharmacists continue to become more involved in patient care, more people are turning to their neighborhood pharmacy for vaccinations, including immunizations for the human papillomavirus, or HPV. Public health officials say these immunizations are especially critical in helping to control the spread of sexually transmitted infections, or STIs. They note that nearly 80 million of the more than 110 million STIs currently in the United States are caused by HPV, making it the most common STI in the country.



Pharmacists can play a crucial role in curbing the spread of STIs by emphasizing that patients get the full course of HPV treatment. Too many women, experts say, do not get the second or third dose of the vaccine. However, because patients’ immunization records are rarely shared with community pharmacies, pharmacists are often powerless to help increase the adherence rate for completion of HPV immunization.



Hormone replacement therapy



While HPV vaccinations are aimed primarily at younger patients, a fourth pillar of pharmacies’ role in women’s health — hormone replacement therapy, or HRT — caters to older patients.



After years of debate, most healthcare providers agree that women who are not at increased risk for breast cancer or heart disease can benefit from HRT. Therapy, they say, should start before age 60 years, last for up to five years and deliver bioequivalent estrogen and micronized progesterone in the lowest effective dose.



However, research also has shown that women receiving HRT face an increased risk of stroke. Health officials recommend that pharmacists managing a woman’s hormone replacement care stress the importance of additional preventive measures, including taking two low-dose aspirins a day while on hormone therapy and getting between three-and-a-half and five hours of moderate exercise a week to reduce the added stroke risk.



To help women sort through HRT risks and the array of other health issues they face, many retailers are offering detailed educational brochures in their pharmacies and extending pharmacy hours.



“Walgreens female consumers are particularly savvy and many will do research before making health decisions,” said company spokeswoman Markeisha Marshall. “That’s why we make women’s health and family planning information easily accessible through comprehensive in-store brochures and online resources.”