Practice Transformation
Integrating pharmacists into primary care: Four questions
Integrating pharmacists into primary care can bring tremendous benefits, but an Advisory Board survey found that only about half of primary care clinics have dedicated pharmacy support, though this person may be shared across multiple sites. To help other practices make the transition, the Advisory Board suggests four questions for PCPs to ask: What is your program’s primary goal? Who is the pharmacist’s end customer? Where should you locate pharmacists? How should you approach staffing considerations? (Advisory Board)
Docs overwhelmed by patient messages
Doctors say they’re overwhelmed by the volume of digital messages they’ve received from patients during the pandemic, and for good reason. The number of messages increased by over 150% and remained high throughout 2020, according to Epic data. Improvements could help support at-home health care initiatives. “You want to be able to message with your patients electronically before you start installing remote patient monitoring, or using wearables that automatically send you oxygen stats,” says Dr. A. Jay Holmgren, at the Center for Clinical Informatics and Improvement Research at the University of California San Francisco. (The Verge)
Commentary: Medication Optimization: Integration of Comprehensive Medication Management into Practice
Unlike MTM, CMM has a well-defined process of care, with assessment tools available to ensure consistent application of the process. Although MTM was linked to Medicare Part D and is traditionally intended for high-risk patients who are receiving multiple medications, CMM is intended to be used in all patients. CMM has the opportunity to be incorporated into value-based payment models. (American Health & Drugs Benefits)
Commentary: Insurer/PBM tactic worsens mental health
Stop non-medical switching, Dr. Rimal Bera, clinical professor of psychiatry at the University of California at Irvine writes in Modern Healthcare. Too often, health insurers and pharmacy benefit managers use coverage changes “to drive stable patients from the medication they’re taking to one that’s more profitable for the health plan.” Insurers and PBMs should be held accountable for ensuring patients’ mental health conditions can get the treatments their providers recommended. “When health plans insert themselves into treatment decisions, they only worsen the mental health crisis–at a cost to everyone involved.” (Modern Healthcare*)
Evidence & Innovation
Inaccessible pharmacies
The pandemic has highlighted how pharmacies make it difficult for many to access pharmacy services, the New York Times reports. Perhaps most significant is that there’s no national standard for accessible labeling or packaging. Prescription labeling has long been an issue for the over 12 million people who have serious difficulty seeing—and for anyone who can’t understand the small text on most prescription bottles and accompanying pamphlets. In addition, services such as drive-thru COVID-19 testing and pharmacy pickup windows are not always feasible for people with visual impairment or other disabilities. (New York Times*)
Policy Solutions
Millions of adults can’t afford prescriptions
An estimated 15.5 million adults under 65 and 2.3 million seniors were unable to pay for at least one doctor-prescribed medication in their household, according to a new study from West Health and Gallup. “Prescription drugs don’t work if you cannot afford them,” Dan Witters, Gallup senior researcher, said in a prepared statement. “Across multiple studies, we are measuring adults from all age, race and ethnic groups, political parties, and income levels [that] are reporting that they are struggling to afford medications. And amidst these reports are strong and consistent sentiment for more government action to rein in costs.” (Physicians Weekly; West Health announcement)
Who pays for mandated workplace testing?
The Biden administration is mandating that workers at large companies get vaccinated or submit to regular testing. But who will pay for the testing? It largely depends on the employer, the New York Times reports. Federal law requires insurers to fully cover the tests ordered by a health care provider, but routine workplace tests are exempt. (New York Times)
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In Case You Missed It!
As a leader in the health care field, your opinion on serious issues facing the field today is crucial to the work we do. We’ve developed a quick five-minute survey to gather feedback on issues in health care and the pharmaceutical world today and where they’re headed; we’d be grateful for your participation.
On Thursday, September 30 from 2:00-3:00 pm ET, The Primary Care Collaborative will be hosting “Primary Care: A Team Sport?” Team-based care is a necessary feature to achieve comprehensiveness and equity, among other principles. In a practice setting, leaders need to assess how a team meets patients’ needs and consider related logistical, infrastructure and payment frameworks. Who are the players on a primary care team, from physicians, nurses and other clinicians to behavioral health specialists, pharmacists and care coordinators? How can team members play well together and provide high-quality, comprehensive and equitable care for their patients? Who leads the team, and does leadership shift depending upon the context? What is the latest evidence about what contributes to team effectiveness? They will explore these questions and more with a diverse panel of experts on team-based care.
Advocacy in Action
GTMRx is pleased to announce that we have launched our Advocacy Letters and Policy Documents page on the GTMRx website. Advocacy is a core component of the GTMRx Institute’s mission, and our policy positions are aimed at advancing acceptance and recognition of the importance of creating a systematic, evidence-based approach to medications and their rational use through CMM in practice. To advance our efforts, comments are submitted to the Centers for Medicare and Medicaid Services (CMS), members of Congress, the Administration, and other public sector payers (OPM) as appropriate.
- GTMRx September 13, 2021 comments on Medicare Physician Fee Schedule Letter to CMS about Payment Mechanisms for Medication Management Services through the proposed Medicare Physician Fee Schedule (CMS-1751-P)
Leadership from GTMRx’s PGx Payment and Policy Taskforce and Payment and Policy Solutions Workgroup have created 5 policy recommendations on PGx + CMM that policymakers should consider to ensure that patient medications are managed safely and effectively based on the unique characteristic of an individual patients’ genetic profile, including:
- Add the assessment of patient medications and drug-gene interactions to Medicare (Welcome to Medicare visit) and Medicaid benefits,
- Require CMS to reimburse preemptive multi-gene panel testing as one single test with one standard compensation code,
- Require CMS to reimburse members of the care team trained to evaluate/manage all medications based on patient’s genotype, multi-drug interactions, Rx metabolism, etc.,
- Direct the National Quality Forum (NQF) to review and make recommendations on drug-gene interaction efficacy and safety checks prior/post admin of drugs within CMM,
- Recommend the U.S. Preventive Services Task Force evaluate evidence of PGx testing and CMM, for drugs with known drug-gene interactions, as a preventive health care practice that addresses patient outcomes/medical expenditures and that should be covered by ACA plans.
In addition to development of Vaccine Confidence Leagues (VCLs) and community-building activities, the task force’s recommendations include:
- Accelerated approval of vaccines
- Public education
- Payment reform
- Improved vaccine access for primary care practices
- More effective immunization information systems (IIS)
- No cost-sharing for certain patients
- Enhanced diversity, inclusion, and equity
Find the report Frequently Asked Questions here.
Read the report here.
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