The evidence review, Assessing the Impact of Comprehensive Medication Management on Achievement of the Quadruple Aim, authored by GTMRx workgroup experts, explains the differences between CMM and traditional Medicare Part D MTM services and provides the evidence of the CMM process of care and highlights recent research on the value of CMM in achieving better quality of care, reduced health care expenditures, an improved patient experience and greater provider well-being. More than 20 studies were included in the review, ranging from single-center retrospective analyses to multicenter randomized controlled studies. (American Journal of Medicine)
Drugs for inflammatory autoimmune conditions (rheumatoid arthritis, psoriasis, ulcerative colitis and Crohn’s disease) account for a growing chunk of pharmacy spend, according to new data from PBM Prime Therapeutics. Less than 1% of Prime’s commercially insured members suffer from these conditions, yet the related drug treatments were approaching 20% of all drug spend through the medical and pharmacy benefit. Spending on these therapies increased 32.2% per member per month over the course of 15 months. (Fierce Healthcare; announcement)
Anthem Blue Cross and Blue Shield is requiring hospitals to purchase oncology infusion drugs through CVS Specialty, or through Anthem’s own specialty drug network. It’s placing similar restrictions on other infusion/injection drugs in an approach termed “white bagging.” Oncology experts warn of treatment delays. Oncology NP Jennifer Taylor, Crisp Regional Health Services in Cordele, Ga., says the move “seems to be a violation of the standards of care.” Anthem says the program “aims to lower the overall cost of certain specialty medications and reduce out-of-pocket costs for members.” (Georgia Health News)
Cigna recently began offering $500 debit cards to some psoriasis patients who switched from Novartis’ Cosentyx to Eli Lilly’s Taltz (or an older biologic). Cigna-owned Express Scripts had removed Cosenytx from some of its formularies in favor of the lower-cost Taltz. The move comes as biosimilar developers prepare to compete with another psoriasis drug, Humira, reports Fierce Pharma. Bernstein analyst Ronny Gal calls the move a “rehearsal” for Humira. “If Cigna does switch a lot of patients to Taltz, expect other insurers to follow suit.” STAT News reports many patient advocacy groups are “angry” about the incentive. (STAT News; Fierce Pharma)
Vaccinating Americans is the key to stopping the pandemic and returning to some semblance of “normal.” But how do we build vaccine confidence? By engaging the medical neighborhood and expanding to new neighbors that are interested in the health of the community. Building vaccine confidence requires proactive and thoughtful public awareness, education and engagement of a variety of local stakeholders, including community members. That was the focus of a recent Bipartisan Policy Center and GTMRx Institute virtual event. During this event, GTMRx announced the National Task Force: Building Vaccine Confidence in the Medical Neighborhood. (Bipartisan Policy Center webinar)
Medication management reform—specifically high-quality, patient-centered comprehensive medication management (CMM) services—requires technologic innovation, writes GTMRx Executive Director Katherine Capps. Without a proper health IT solution in place, CMM will be little more than a concept.” Making technology-enabled clinical data available at the point of care to the entire team allows providers to execute critical steps in the CMM process.” The data help teams determine which patients have not achieved clinical goals of therapy or who are having medication therapy problems. It also allows them to analyze use patterns for all medications. (Specialty Pharmacy Continuum)
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Dan Rehrauer, Pharm.D., Senior Manager, MTM Program, HealthPartners spoke to the Payment Methodologies Subgroup of the GTMRx Payment and Policy Solutions Workgroup on April 20th about comprehensive medication management (CMM) payment methodologies from a commercial sector standpoint.
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