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GTMRx News Brief

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09May 23

News Brief | May 9, 2023 | Most payers have outcomes-based contracts with PBM

Most payers have outcomes-based contracts with PBM About 58% of payers had at least one outcomes-based drug contract with a PBM in 2022, according to an Avalere Health survey. Of the payers that had at least one outcomes-based contract, over 35% had more than 10. The top therapeutic areas were cardiology and endocrinology. Most (74%) of plans with at least one outcomes-based contract said that they prefer contracts with both claims-based and clinical outcomes. In fact, 53% said they don’t…

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11Apr 23

News Brief | April 11, 2023 | New drug shortages skyrocketing

New drug shortages skyrocketing Drug shortages are growing dramatically. For example, children's flu medications, common antibiotics, and ADHD treatments are getting harder to buy, according to a report from the Senate Homeland Security and Governmental Affairs. It finds that the number of new drug shortages rose by 30% between 2021 and 2022, an increase that has had "devastating consequences" for patients and doctors. Towards the end of 2022, nearly 300 individual drugs were considered in short supply, affecting treatment for…

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14Mar 23

News Brief | March 14, 2023 | Pharmacists want the option to keep delivering CMM virtually

Practice Transformation Getting the medication information right Do you have the information you need to get the medications right? Pharmaceutical companies’ medical information professionals can be a valuable resource. The non-profit phactMI represents MI professionals across the pharmaceutical industry; it works to make it easier for health care professionals—especially pharmacists--to access unbiased, evidence-based information. To that end, phactMI created the Drug Information Database, a “one stop shop” that enables users to search across manufacturers to access information more quickly and…

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28Feb 23

News Brief | February 28, 2023 | Data privacy: FTC fines GoodRx $1.5M; CMMI responds to Executive Order on Lowering Drug Costs

Practice Transformation February full of deals Last week, UnitedHealth Group closed its $5.4 billion acquisition of the home health and hospice provider LHC Group. LHC will be folded into Optum supporting UnitedHealth’s plan to make Optum the entry point for patients. Modern Healthcare reports. Also last week, Amazon completed its $3.9 billion acquisition of primary care chain One Medical; the deal gives Amazon a network of more than 220 medical offices in 27 markets across the US, according to Healthcare…

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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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