Of interest:
Aetna to End Payment for a Drug in Colonoscopies – New York Times: “Aetna, one of the nation’s largest private health plan managers, is the latest insurer to clamp down on the use of a powerful anesthetic during an increasingly common form of colon cancer screening.”
This insurer’s reaction to the use of anesthesiologists to administer propofol for colonoscopy is of interest to me because of my work with AQUAVAN over the years. At Guilford Pharmaceuticals (and then MGI Pharma after their acquisiton of Guilford) I directed the first in man study of AQUAVAN and worked on trials on and off through the recent NDA filing. AQUAVAN, as a prodrug of propofol, is not expected to require the same FDA mandate for administration by an anesthesiolgist that propofol does.
AQUAVAN is a prodrug of propofol, extending its action enough to make it a better sedative and a less powerful anesthetic. It’s an interesting, perhaps unique example of how making a drug worse for one use makes it more suitable for another.
This Times article doesn’t mention the alternatives like AQUAVAN or midazolam, but with pressures like this on physicians from insurers and pressures from patients for comfort during procedures, I expect that AQUAVAN will find its niche as a sedative for procedures. Eisai is now in the process of acquiring MGI, so AQUAVAN’s future now rests with them.
