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. (ABC 6 On Your Side)
Using discount drug outlets could save Medicare over $600 million
Medicare Part D beneficiaries and the U.S. government have the potential to save tens of millions of dollars if enrollees buy self-administered oncology drugs using low-cost outlets like Mark Cuban Cost Plus Drug Company, according to a study published in the Journal of Clinical Oncology. Using low-cost outlets for seven self-administered oncology drugs could save Medicare Part D estimate $661.8 million. “This really emphasizes the fact that Medicare is overpaying for medications, and it’s coming out of all of our pockets,” says study author Ruchika Talwar. (Specialty Pharmacy Continuum; Journal of Clinical Oncology)
Practice Transformation
Tobacco Settlement Redux
Mendocino County, Cal. has the highest rate of overdose deaths in the state. Yet, its board of supervisors decided to use more than $63,000 of opioid settlement funds to help fill a budget shortfall. They aren’t the only ones. Mathew Myers says his experience as former president of the Campaign for Tobacco-Free Kids, suggests the first few years of spending set the tone for the future. “If states don’t start spending money for the designated purpose effectively and build it into the DNA of the budget process, the risks down the road only grow,” (KFF Health News)
Evidence & Innovation
Committee advances PBM pill
The Senate Finance Committee voted to advance legislation regulation PBMs 25-1. Among other provisions, the legislation would delink PBM compensation from the price of the drug, which would remove an incentive for PBMs to favor higher priced drugs. The legislation would also ban spread pricing, which is when a PBM charges Medicaid more for prescription drugs than they pay. The chair and the ranking member both noted that additional proposals on PBMs that didn’t make it into the bill could be added over the August recess. (The Hill)
CMS gives ACO update
In a blog published in Health Affairs Forefront , CMS officials describe the progress of their accountable care strategy, and outlines areas CMS is exploring in 2023 to build on these efforts to accelerate the growth of and access to ACOs “The vision articulated in 2022 will continue to guide regular policy updates, scale important learnings to improve beneficiary care, and create new model tests that can strengthen access to high-quality, integrated, and coordinated care for beneficiaries”(Health Affairs)
Policy Solutions
Dealing with perscription messages leads to burnout
Prescription authorization message volumes are linked with higher odds of clinician burnout, according to research published in JAMIA, highlighting the need for support from pharmacists and others. “The finding that prescription authorization message volumes were associated with higher odds of burnout suggests that more support should be provided to physicians, the authors wrote. The study also found that perceived EHR work stress was significantly associated with clinician burnout across all specialties Psychiatry had the highest unadjusted proportion of physicians reporting burnout (60%), followed by COVID-intense specialties and primary care, both at 55%. (JAMIA)
