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Concurrent with copayment changes, formulary status for certain drugs was modified. From 1998 to 1999, the formulary status for loratadine plus pseudoephedrine Claritin-D ; and fexofenadine plus pseudoephedrine Allegra-D ; was changed from nonpreferred to preferred; the single agent formulation of each, loratadine or fexofenadine, remained preferred tier-2 copay ; drugs throughout the 2-year period. In addition, triamcinolone nasal spray was converted from preferred status in 1998 to nonpreferred tier-3 copay ; status in 1999. The changes in formulary status of these 3 agents accounted for less than 24% of the overall prescription utilization for LSAs and NSs combined Table 1 ; . Nonetheless, a subanalysis was conducted, excluding those medications that changed formulary status, to assure minimal influence on overall results. LSAs included in the analysis were the brand-name products for loratadine Claritin ; , loratadine plus pseudoephedrine Claritin-D ; , fexofenadine Allegra ; , fexofenadine plus pseudoephedrine Allegra-D ; , and cetirizine Zyrec ; . NSs were included in this analysis since they are considered reasonable therapeutic alternatives for LSAs and included the brand-name products for flunisolide, budesonide, fluticasone, triamcinolone, and beclomethasone.25 The data were also combined for the entire cohort to assess the overall effect of the copay change between 1998 and 1999. Cost was defined as the amount of money paid including a dispensing fee ; by the health plan to the pharmacy for each prescription dispensed before consideration of member cost-share. A 2-sample t test was used to assess differences after the copayment increase and across therapeutic categories for the following variables: mean age, mean prescriptions per patient per month PPPM ; , and mean number of study prescriptions PPPM. A chi-square test was used to assess gender differences between therapeutic groups and the percent of new versus refill prescriptions within the 2 groups after copayment increase. A paired t test was used to test differences between the mean number of prescriptions dispensed per year study drug ; , mean drug costs per patient both study drug and all other drugs for allergic rhinitis patients ; , and PPPM all drugs for allergic rhinitis patients ; drug costs, mean copayments, and the per-member-per-month PMPM ; cost to the health plan. A 2-tailed significance level of 0.05 was used to determine statistical significance. Data management and statistical analyses were performed using SAS Cary, North Carolina ; version 8.0.26 II Results Of the approximately 15, 000 members enrolled in the single large public employer health plan, 8, 643 nonfederal members were continuously enrolled from January 1, 1998, to December 31, 1999. A total of 2, 150 patients 24.8% of continuously eligible members ; received either 1 or more prescriptions for an LSA N 1, 931 ; and or an NS 688 ; during the 2 years Table 2 a total of 469 patients 5.4% of eligible members and 21.8% of and acyclovir.
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At Wu's request, Kendra disappeared into the yard for a div. She tried to recover some of the manicured landscaping with only a few hand tools but it was a futile task and she knew it. Still, it gave her something to do besides worry. The dirt and grime felt good. She threw herself into pulling weeds and straightening bricks and didn't notice the passage of time until Doctor Wuu called for her. She rose, aching from exertion, and went inside to wash her hands and get a glass of water. Wuu was waiting for her in the living room, seated relaxed and comfortably in the chair across from the couch. She'd pulled it a bit closer. "Where's Marta?" she asked. "Upstairs meditating. It went well, for a first session. She's very strong and I think she'll be fine. It also helps that she's military. For most survivors, we let them take control of the situation and make them feel secure. For military personnel, it sometimes, and in this case is, easier and faster to put them back into a disciplined system. The structure reassures them that order still exists and helps them deal with the attack as a failure of the system; anarchy, if you will. "A large part of her problem is the cultural perception, that somehow she has been grievously hurt by this. The physical injuries from the rape were actually not bad, compared to say, the damage to her face and left knee. The psychological injury shouldn't be that bad--she was unconscious for most of it, although there is still sensory input while unconscious. "Her greatest trauma comes from having not put up a fight. She's a rated master in unarmed combat and this made her feel totally helpless and insecure. That we can deal with. And it ties in to the cultural perception again--you may have noticed that most people here have trouble using the word 'rape.' Which is not to say that it is wrong for it to be considered a disgusting crime, but there is a lot of emotion attached to just using it." Kendra asked, "So what about the attitude I grew up with? That you accept that it happens, but doesn't demean you? That the real loser is the attacker?" Wuu ran a hand through her thick silver-black hair. "Not being demeaned by it is healthy. Realizing that the attacker is lashing out against his own insecurities is healthy. But I have a fundamental problem with accepting that it happens. It is a terrible thing. "The problem between the two of you is that she rightly perceives it as an act thoroughly insulting and degrading in intent. Her attackers were telling her that she was merely a thing to vent frustration on, in a very intimate fashion. You perceive it as revealing their helplessness and rage at the situation. You are both correct. But you both need to see the other side of the equation." She continued, "I'm not suggesting you should feel as violated by your attack as she does by hers. You obviously are coping better in that regard. But you should consider that the motive of the attackers was to degrade you thoroughly, to show contempt for you. "Now, legally, rape is awkward in the Freehold. Without an actual criminal code, it is hard to quantify the damage done in financial terms, as with robbery, arson or even murder. The victim is left alive, frequently with only minor physical injury. What is the loss? This runs into collision with the moral outrage at the concept. It happens rarely here, because this is a more civilized society. Its rarity and the higher standards of personal responsibility make it far more offensive. So we juggle the minor legal issue with the huge moral issue. "As far as the two of you, " Wuu said, "Marta sees that you are coping better, ignoring that her circumstances were far different, from her perspective, than yours. She knows you and aldactone!
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