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GTMRx News Brief

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23Jan 23

News Brief | January 23, 2023 | PGx-enriched CMM: Considerations for employers

Practice Transformation Look out, drug chains: Mark Cuban has only just begun Mark Cuban wants to lower drug prices even further and expand his online pharmacy's customer base. These plans could pose a major threat to CVS and Walgreens, TheStreet reports. And he’s in it for the long run. "Our goal isn't to make a lot of money or sell the company," Cuban tells TheStreet. "Our mission is to be the low-cost provider of every medication we are allowed to sell. That's not…

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13Dec 22

News Brief | December 13, 2022 | Proposed rule would reform prior authorization

Practice Transformation MyChart message fees passed on to patient? Cleveland Clinic began billing for certain Epic MyChart messages in November; now, at least seven other health systems have followed suit. But, as Becker’s Hospital Review reports, what remains uncertain is how long Medicare will cover these charges and whether most commercial insurers will pay at all. Ge Bai, PhD, of Johns Hopkins says the price for commercially insured patients likely depends on the health plan. Some patients could pay as much as…

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08Nov 22

News Brief | November 7, 2022 | CMS makes big changes to Medicare ACOs

Practice Transformation Americans give health care cost and equity low scores A plurality of Americans gives the U.S. health care system overall a poor or failing grade, and most rank affordability and equity the same way, according to the West Health-Gallup 2022 Healthcare in America Report. Care quality scored somewhat better. In all, 21% of U.S. adults grade the health care system with an "A" or a "B," 34% with a "C," and 44% with a "D" or an "F." Grades…

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01Nov 22

News Brief | November 1, 2022 | Bodenheimer: Fund primary care, add nurses and pharmacists to the team

Practice Transformation Ads: direct consumer to prescriber It’s not only patients and providers who benefit from online prescribing; so do a growing number of drug companies. They connect people scrolling their sites with a virtual prescriber. This “powerful mashup” of telehealth and DTC advertising worries policy experts, who fear that gaps in regulatory oversight leave patients vulnerable, STAT reports. It blurs the boundaries between manufacturer and prescriber,” says Nathan Cortez, a health law expert at Southern Methodist University. That makes it difficult…

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25Oct 22

News Brief | October 24, 2022 | Providers still leaving the profession, report finds

Practice Transformation AMA to take on senior polypharmacy Following up on recommendations from the AMA Senior Physicians Section, AMA delegates recently adopted “Reducing Polypharmacy as a Significant Contributor to Senior Morbidity.” It directs the AMA to work with appropriate stakeholders such as pharmacists, EHR vendors, PhRMA and AARP to, among other things, encourage physicians and their teams to initiate discussions with patients on improving their medical care through the use of only the minimal number of medications needed to optimize their…

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11Oct 22

News Brief | October 11, 2022 | OIG: $18B wasted on drugs with no proof of value

Practice Transformation Team-based care begins with the patient In a Pharmacy Times interview, Michael S. Barr, MD, MBA, MACP, FRCP, Executive Physician Advisor, GTMRx Institute, discussed the importance of collaboration among physicians, other clinicians and pharmacists in delivering comprehensive medication management. “It starts with the person needing the care…[and] includes understanding that well organized team-based care is the best way to approach patient needs, especially those who have challenging situations or complex clinical conditions.” Such an approach begins with each member acknowledging their respective…

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13Sep 22

News Brief | September 13, 2022 | Underappreciated CMM is the missing ingredient to value-based models

Practice Transformation Underappreciated CMM is the missing ingredient to value-based models Comprehensive medication management is the missing ingredient in value-based models, but despite evidence supporting its effectiveness and value, it remains underappreciated and underused, a group of GTMRx leaders write in Health Affairs Forefront. They highlight the evidence for CMM, including how it supports all five elements of the Quintuple Aim—including the newest aim, equity. Their a call to action: Align on the standardized definition of CMM “to promote well-defined CMM…

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02Sep 22

Press Release | GTMRx to CMS: MA needs to support team-based, interprofessional care that includes CMM

GTMRx to CMS: MA needs to support team-based, interprofessional care that includes CMM Coalition submits comments to enhance Medicare Advantage Tysons Corner, VA — Sept. 1, 2022: Wednesday, the Get the Medications Right™ (GTMRx) Institute submitted comments urging the Centers for Medicare & Medicaid Services to support value-based payment models that incentivize team-based, interprofessional care that includes comprehensive medication management (CMM) services provided by clinical pharmacists working in collaboration with clinicians. The GTMRx Institute is a non-profit coalition of 1,700 members focused on ensuring optimal use…

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30Aug 22

News Brief | August 30, 2022 | PBMs concern “even free-marketeers”

Practice Transformation Amazon to shutter Amazon Care Say “goodbye” to Amazon Care. The virtual and in-home health service, initially created for Amazon employees will be gone by the end of 2022. Amazon Care currently has six corporate customers including Hilton, Silicon Labs and Amazon-owned Whole Foods. Workers were told the service was shutting down because those customers did not see the value in the service, the Washington Post reports. Modern Healthcare notes that the decision comes just weeks after the company said it would…

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16Aug 22

News Brief | August 16, 2022 | Drug reform passage is just the beginning

Practice Transformation To improve population health, invest in primary care Investing in primary care is the key to improving population health and reducing disparities, according to the authors of a Health Affairs Forefront post. ”Strengthening primary care benefits everyone by improving overall health and lowering health care costs. By improving how the health care system connects with patients, generalists and specialists can support the patients who need them most, when they need them the most. This will make our health care system…

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02Aug 22

News Brief | August 2, 2022 | GTMRx provides insights to HHS to strengthen primary care

Practice Transformation Texas NAMI head: End nonmedical switching Health insurers and PBMs are making the current mental health crisis through “nonmedical switching”—moving stable patients from their current medication to one that may not work as well for them, writes Greg Hansch, LMSW, of the National Alliance on Mental Illness of Texas. “As a result, a patient with a mental health disorder who was stable on his or her current medication may be forced to switch to a different medication regardless of…

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19Jul 22

News Brief | July 19, 2022 | Fendrick: Rethink prior authorization

Practice Transformation Safety-net providers worry about loss of 340B discounts Hospitals and clinics that serve low-income patients say drug manufacturers have threatened their financial stability by dramatically cutting back participation in the 340B federal discount program. “They are killing health centers,” said Jangus Whitner, who runs the pharmacy program for PrimaryOne Health, a multisite community health center. PhRMA spokesperson Nicole Longo disagrees: “There is very little to no evidence that 340B is helping patients access medicines, and that’s a big…

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12Jul 22

News Brief | July 12, 2022 | NYC to offer Paxlovid, bypassing pharmacies

Practice Transformation NYC to offer Paxlovid, bypassing pharmacies New York City plans to start offering Paxlovid at "mobile test-to-treat sites" across the city, bypassing pharmacies; which is the fist of its kind, Bloomberg reports. Currently, people who test positive for COVID-19 and are eligible for Paxlovid can fill their prescriptions at the nearest pharmacy. Mayor Eric Adams said the service targets inequity in getting Paxlovid, according to Bloomberg. A recent study found that the drug is inaccessible to more than 26 million people…

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05Jul 22

News Brief | July 5, 2022 | Finding non-opioid options for chronic pain

Practice Transformation Why mental health carveouts are so bad The current push for primary care physicians to provide mental health care has tremendous support; it could enhance whole-person care and address the shortage of mental health providers. But, as Kaiser Health News points out, there’s one problem: Many insurers have “carved out” behavioral health benefits. Patients typically don’t even know whether their insurance plan has a carve-out until they end up with an unexpected bill. “It’s the patients who end up with…

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28Jun 22

News Brief | June 28, 2022 | CVS hiding the generics?

Practice Transformation CVS hiding the generics? A recently unsealed whistleblower suit claims that CVS Health subsidiaries coordinated to prevent members from accessing generic drugs, according to Stat News. The whistleblower, Alexandra Miller, says that when she reported the behavior to a superior, she was told that the company had decided the benefits of the alleged scheme outweighed the likelihood of being caught. Specifically, she claims that the SilverScripts Part D subsidiary, the Caremark PBM and the retail pharmacies worked together to…

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21Jun 22

News Brief | June 21, 2022 | Colorado to hospitals: No transparency? Then no debt collections

Practice Transformation Can Oracle create a national EHR database? Just after closing the deal to acquire Cerner, Oracle—or more specifically, board chair and chief technology officer Larry Ellison–said the company would create a national health records database. “We’re building a system where all American citizens’ health records not only exist at the hospital level, but they also are in a unified national health records database.” Health IT experts have been expressing doubts, however, pointing out that for decades, public and private…

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14Jun 22

News Brief | June 14, 2022 | JMCP: Sustaining CMM in the pharmacy setting

Practice Transformation JMCP: Sustaining CMM in the pharmacy setting What is needed to sustain CMM in the community pharmacy setting? HealthPartners shared its insights, based on decades of experience. Among other things, the authors stressed the importance of differentiating CMM from other services and providing support for pharmacies doing CMM. They also discussed the influence payment models have on sustainability. “CMM in community pharmacies shows promise for being a sustainable practice model. However, increased reach and performance of networks, as…

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07Jun 22

News Brief | June 7, 2022 | AMA won’t support opioid training legislation

Practice Transformation Telehealth boom opened the door to hybrid models Telehealth is increasingly incorporated in hospitals’ digital roadmaps, according to speakers at the annual HIMSS health care conference. That’s good news for proponents of hybrid care models, who cite the value of meeting patients. The use of hybrid models aligns with the shift to value-based care, Healthcare Dive reports. If providers have a certain amount of funds to take care of a specific population, instead of being paid on a per-visit basis,…

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31May 22

News Brief | May 31, 2022 | Employers lack transparency into specialty drug outcomes

Practice Transformation Employers lack transparency into specialty drug outcomes A Pharmaceutical Strategies Group report finds that specialty drugs continue to be a top focus for plan sponsors, at least in part because of costs. And as it stands, sponsors don’t have much insight into the impact of such drugs. “More than 80% of plan sponsors have access to reporting on their total healthcare costs,” PSG’s Tracy Spencer said in a prepared statement. “However, clinical outcomes of adherence, persistency and clinical…

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24May 22

News Brief | May 24, 2022 | Hospitals harm seniors; medication problems top cause

Practice Transformation Hospitals harm seniors; medication problems top cause One in four older Americans covered by Medicare experienced some sort of harm during hospital stays in October 2018, according to a report from the HHS Office of Inspector General. About half those cases involved adverse events that led to longer stays and sometimes permanent harm or death. By far, the most common type of harm event was related to medication (43%), followed by patient care (23%), procedures and surgeries (22%)…

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