Practice Transformation
Research published in the Journal of General Internal Medicine finds that 20% of people with diabetes and high-deductible health plans regularly skip their medications. Compared to people without HDHPs, people with high deductibles are 28% more likely to not take their medicines on time due to cost. “Patients with diabetes should recognize that a high-deductible plan will put them at risk for missing or delaying their medications, and doctors need to recognize that their patients with these plans may not be able to adhere to treatment plans,” senior author Dr. Danny McCormick said in a prepared statement. (Journal of General Internal Medicine; announcement)
Evidence & Innovation
Researchers have identified three claims-based markers of medication that could be used to help identify patients for CMM: when a patient filled a medication with high complexity that could affect adherence; a medication defined as costly that could affect access; and a medication defined as risky. “These markers were associated with higher costs, acute care utilization, and gaps in medication use compared with the overall population and within certain subgroups. Providing CMM to these patients may improve health system performance in relevant quality measures,” they conclude. (Journal of Managed Care & Specialty Pharmacy)
Utilization management, including prior authorization, bogs down the system and can delay care. It’s also costly: Researchers estimate that at least $93.3 billion a year is spent on navigating that administrative complexity. Patients and physicians end up paying most of that, but it also costs insurers and drug manufacturers, according to research published last week in Health Affairs. “All stakeholders in the US pharmaceutical system would benefit from a de-escalation of utilization management, combining lower drug prices with lower barriers to patient access,” the authors conclude. (Health Affairs; Modern Healthcare*)
In a Medicaid population, the average annual opioid doses prescribed to Black patients were 36% lower than white patients treated at the same hospitals, according to research published in the New England Journal of Medicine. “We do not know whether or how these differences affect patient outcomes, because both opioid underuse and overuse can cause harm. We do know that skin color should not influence the receipt of pain treatment.” (New England Journal of Medicine)
Policy Solutions
The FDA will deprioritize some existing work and accelerate its review of Pfizer’s application for formal approval of its COVID-19 vaccine, STAT News reports. This could improve vaccine uptake because many organizations have hesitated to require vaccines fearing courts will find it illegal to mandate one distributed under emergency use authorization. However, ethicists Arthur Caplan and Dorit Reiss argue that the FDA can amend the vaccines’ EUA documents to make it clear that mandates are permitted. (STAT News; STAT commentary)
Drug manufacturers stamp out different pills on the same machines, and while they’re supposed to clean between production rounds, trace contamination is “rampant,” Bloomberg reports. However, the number of cross-contaminated drugs that have been prescribed to Americans remains unclear because drugmakers largely handle the matter themselves, supervisors are often lax on guidelines and employees are fallible, current and former FDA inspectors told Bloomberg. It almost got an Olympic archer disqualified: Pills he takes for a thyroid condition contained traces of a banned drug. (Bloomberg)
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In Case You Missed It!
Cureatr, a comprehensive medication management (CMM) solutions company dedicated to repairing the United States’ $528 Billion and 275,000 deaths a year suboptimal medication management problem, has joined the GTMRx Institute as a silver Strategic Partner.
Mary Roth McClurg, Pharm.D., MHS, is professor and executive vice dean-chief academic officer at the UNC Eshelman School of Pharmacy. She has focused her research efforts on advancing comprehensive medication management and the role of the clinical pharmacist as an integral member of the primary care team, with the goal of optimizing medication use and improving care in patients with multiple chronic diseases.
Medicine is how we treat most conditions: Roughly 75%-80% of physician office and hospital outpatient clinic visits involve medication therapy. And more often than we would like, it is how disasters occur. More than 275,000 die each year because of medication misuse, overuse or underuse. The financial cost tops $528 billion annually, and employers are on the hook for a large portion of that.
Employers have the incentive, the leverage and the responsibility to change this. The evidence, best practices and tools are there to solve the systemic issues that lead to suboptimal medication use. Employers can lead the charge, through their contract authority and work with their suppliers, but they first must understand just how irresponsible doing nothing is. Download the issue brief for more.
We are sharing new survey results that assess the medication management habits and needs of over 1,000 people. Nearly one quarter of people cited that their medications are not routinely reviewed and evaluated by their medical team—shocking, given that one-third are taking four or more medications and/or supplements per day. The GTMRx Institute staff, workgroup and taskforce leaders and participants have created a set of tools to help inform and educate the consumers of health care services—and providers who have direct contact with the consumers—about why it’s important to get the medications right. We invite you to read more, share these tools and join us to ensure appropriate use of medications.
Leadership from GTMRx’s PGx Payment and Policy Taskforce and Payment and Policy Solutions Workgroup have created 5 policy recommendations on PGx + CMM that policymakers should consider to ensure that patient medications are managed safely and effectively based on the unique characteristic of an individual patients’ genetic profile, including:
- Add the assessment of patient medications and drug-gene interactions to Medicare (Welcome to Medicare visit) and Medicaid benefits,
- Require CMS to reimburse preemptive multi-gene panel testing as one single test with one standard compensation code,
- Require CMS to reimburse members of the care team trained to evaluate/manage all medications based on patient’s genotype, multi-drug interactions, Rx metabolism, etc.,
- Direct the National Quality Forum (NQF) to review and make recommendations on drug-gene interaction efficacy and safety checks prior/post admin of drugs within CMM,
- Recommend the U.S. Preventive Services Task Force evaluate evidence of PGx testing and CMM, for drugs with known drug-gene interactions, as a preventive health care practice that addresses patient outcomes/medical expenditures and that should be covered by ACA plans.
In addition to development of Vaccine Confidence Leagues (VCLs) and community-building activities, the task force’s recommendations include:
- Accelerated approval of vaccines
- Public education
- Payment reform
- Improved vaccine access for primary care practices
- More effective immunization information systems (IIS)
- No cost-sharing for certain patients
- Enhanced diversity, inclusion, and equity
Find the report Frequently Asked Questions here.
Read the report here.
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