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News Brief | November 10, 2023 | GTMRx Institute joins business and health leaders to call for PBM reform
GTMRx Institute joins business and health leaders to call for PBM reform On November 8 the GTMRx Institute joined a coalition of employers, health care providers and patient advocates in urging Congress to support strong PBM reforms this year. In a letter to Senate leadership, the coalition outlines several needed reforms, including commonsense changes to hold PBMs accountable to fair market practices when partnering with employers, the largest customers of PBMs. “PBM transparency alone is NOT enough, but it is…
News Brief | October 10, 2023 | Some states establish Rx affordability boards
Some states establish Rx affordability boards At least seven states have set up prescription-drug affordability boards to lower costs for a potentially broader set of prescription medicines, and more states could follow as some officials have expressed interest in establishing similar programs. Some of the boards have much more leeway than Medicare in selecting drugs for cost reviews. In several states, including Colorado and Maryland, the boards have the authority to set upper payment limits for drugs. Yet unlike the…
News Brief | September 12, 2023 | AI-based “credit score” for drug use draws criticism
AI based "credit score" for drugs draws criticism Narx Scores and similar tools help clinicians review controlled substance prescriptions. They influence the prescribing of painkillers much like a credit score influences the terms of a loan. The use of systems to analyze opioid-prescribing data has sparked questions over whether they have undergone enough independent testing. This prescription-drug data has led patients to be dismissed from clinician practices, which could leave patients at risk of being untreated or undertreated for pain,…
News Brief | August 08, 2023 | Investigation: PBMs divert patient assistance funds
Investigation: PBMs divert patient assistance funds A local Ohio TV station conducted an in-depth investigation into how PBMs stand between patients and funds from pharmaceutical companies to help pay for medication. They report on how pharmacy benefit managers and their partners have diverted billions in drugmakers’ assistance intended for individual patients. Instead, they use the cash to set up their own health insurance programs for major employers – typically giving themselves a 25% share of the savings, public documents show.…
News Brief | July 11, 2023 | Bipartisan efforts seek to rein in PBMs
Bipartisan efforts seek to rein in PBMs Congress continues to focus on PBMs, crafting several legislative packages that include reforms to make the role of pharmacy benefit managers in drug pricing more transparent and overhaul how PBMs are compensated, and curb potentially anticompetitive behavior. Among the specifics: requiring PBMs to report their negotiations, pricing information, and benefit designs; banning spread pricing (where PBMs reimburse pharmacies less than what they charge payers; Other proposals would ensure PBMs pass on rebates to…
News Brief | June 13, 2023 | PBM bill advances
PBM bill advances Pharmacy benefit managers would be required to report more information on their deals with pharmaceutical companies under legislation unanimously approved by a House committee last month. PBMs would need to create reports for employer clients each year that detail prescription drug spending, acquisition costs, out-of-pocket expenses, formulary placement and rebates. In addition, the Government Accountability Office would produce a report on group health plan pharmacy networks, including those that health insurers own. (Modern Healthcare) SCOTUS revives whistleblower suits Last…
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…
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…
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…
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…
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…
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…
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…
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…
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…
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…
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…
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…
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…
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…
