In a crowded field of companies marketing web-based handheld devices that allow physicians to perform a myriad of functions, ePocrates Inc. is trying to differentiate itself by offering less than its competition. That is, its idea is to ease physicians into using web-enabled devices with a package of prescription drug information.

Entrepreneur Jim Sweeney, credited with founding the home infusion therapy industry, heads up CardioNet Inc., a start-up that aims to provide real-time cardiac monitoring, so patients can get prompter treatment. The CardioNet system senses and transmits cardiac events automatically, an important feature, since 40% of heart attack victims aren't even aware that they are experiencing some form of life-threatening event.

There was a time when managed care tried to control drug spending through strategies that compromised physician prerogative. But growing consumerism and the healthy US economy has led to questioning of managed care practices. New physician-driven organizations are looking at drug costs as part of a broader disease management agenda, while PBMs are taking a more doctor-friendly approach.

Just over a year ago, the acquisition of managed care specialist ValueHealth by hospital giant Columbia/HCA seemed a match made in heaven--and a new way of thinking about the way to put pharmacy benefit management in context after the failed drug company acquisitions of 1993-4. Now Columbia is spinning ValueRx off. The new deal makes Express Scripts the largest independent PBM in the country and both solidifies and diversifies its customer base. But it also likely spells the end to the PBM alliances of the past several years.