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Practice Transformation

The Drug Channels Institute estimates that the gross-to-net bubble–the dollar gap between sales at brand-name drugs’ list prices and their sales at net prices after rebates and other reductions–reached $175 billion in 2019. The bubble reflects–and drives–many of patients’ problems and misunderstandings of U.S. drug prices, explains Adam J. Fein, PhD, CEO of the Institute. Recent executive orders related to drug pricing revived the issue, but few grasp the “complex economic interplay of patient out-of-pocket spending, cost-shifting, premiums and payer incentives.” He includes a list of frequently asked questions to help readers better understand pricing and its implications. (Drug Challenges)
Roughly 90% of primary care practices continue to face COVID-19-related challenges, according to a survey of almost 600 primary care clinicians conducted last month by the Larry A. Green Center and the Primary Care Collaborative. Overall, only 13% of PCPs surveyed said they are adapting to a “new normal.” The survey is conducted weekly, and the most recent findings are posted here. (Fierce Healthcare; survey results)

Evidence & Innovation

Last week, the University of California Board of Regents approved the establishment of a School of Pharmacy and Pharmaceutical Sciences. In this podcast, Jan Hirsch, PhD, founding dean and GTMRx Distinguished Fellow, discusses the teaching and research focus of the new school and how it will help solve health care’s $528.4 billion medication optimization problem. The new school will include UCI’s existing pharmaceutical sciences department and its new clinical pharmacy department. Its Doctor of Pharmacy program will begin enrollment in fall 2021. (UCI podcast; Becker’s Hospital Review)

Policy Solutions

The U.S. government will pay for COVID-19 vaccines and their distribution, and it is working with commercial insurers to offer them at no cost, according to Health and Human Services official Paul Mango. Because initial vaccine supplies will likely be limited, the government will prioritize health care workers, the elderly, nursing home residents and people at high-risk for illness, according to National Institutes of Health Director Dr. Francis Collins. (Wall Street Journal)
CMS has announced two payment initiatives for COVID-19 drug treatment and counseling. The first tracks the effectiveness of COVID-19 drug therapies; new procedure codes will allow Medicare and other insurers to identify the use of remdesivir and convalescent plasma. The other pays for counseling to slow the spread of the virus. CMS will use existing E&M codes to reimburse providers who are eligible to bill CMS for counseling services regardless of where the test is administered. (Healthcare Finance News)
The House recently voted to approve the bipartisan Foster-Kelly Amendment, which removes language that bars federal funding for the adoption of a unique patient identifier. It’s part of the of the six-bill FY2021 “minibus” package. The Senate must still approve the amendment. If the ban is ultimately lifted, Health and Human Services could work with the health care community to develop a nationwide patient-matching strategy—something health care stakeholders across sectors have been calling for for decades. (Healthcare Finance News)

In Case You Missed It!

The Health IT to Support Optimized Medication Use Workgroup welcomes Mark Gunnels, principal solutions architect at Tabula Rasa HealthCare. Gunnels brings 10 years of valuable experience in programming, and we are delighted to have him join our team.
GTMRx Subgroup Kickoff
On Tuesday, August 11th, the Payment Methodologies Subgroup and the Telehealth Delivery of CMM Subgroup of the Payment and Policy Solutions Workgroup had their kick off calls. The Payment Methodologies Subgroup is currently focusing on building a value framework and the Telehealth Delivery of CMM Subgroup is focusing on identifying the barriers and enablers of providing CMM via telehealth.
GTMRx Blueprint for Change Available Now!
New report calls for medication management reform with guidance for how medications are managed. 
On July 22, 2020, “The GTMRx Blueprint for Change,” a robust report based on eight months of multi-stakeholder input, was released. The report outlines steps for reform, including an evidence-based process of care – Comprehensive Medication Management (CMM) – that personalizes the approach and leads to better care, reduced costs and improved patient satisfaction and provider work life.
The GTMRx Blueprint for Change includes recommendations to engage everyone involved in patient care—from physicians to clinical pharmacists, health plan sponsors, providers, consumer groups and policymakers. The GTMRx Four Pillars of Medication Management Reform include revamping:
    • How we practice
    • How we pay
    • How we use diagnostics
    • How we integrate technology
  You can download the report here.
Hear more about using a risk stratification process for patient identification to select individuals that benefit most from comprehensive medication management services intended to produce value-based outcomes: economic, humanistic and clinical. There will also be discussion about why it is vital for regulators, care providers and payers to work together to establish standards and best practices to ensure access to clinical information, to include diagnostics, at the point of care. This webinar will also showcase a case example of risk stratification in action with the Teachers Retirement System in Kentucky.
Molly Ekstrand, BPharm, BCACP, AE-C, Consultant with North Star Medication Optimization, LLC, along with Jane Gilbert, CPA, Director of Retiree Health Care, Teachers Retirement System of the State of Kentucky, will offer an overview of how health care IT infrastructure can efficiently enable health systems, payers and purchasers of health care to identify groups of patients who will most likely benefit from comprehensive medication management services.
Find more information here.
Hosted by the GTMRx Institute’s executive director and co-founder, Katherine H. Capps, Voices of Change features leaders who have knowledge, experience and ideas to solve this urgent need to get the medications right. The most recent episode features Amanda Brummel, PharmD, BCACP, vice president, Clinical Ambulatory Pharmacy Services Fairview Pharmacy Services. Past guests include Orsula V. Knowlton, PharmD, MBA, president and chief marketing & new business development officer of Tabula Rasa HealthCare, Inc., Anand Parekh, MD, chief medical advisor, Bipartisan Policy Center and GTMRx President Paul Grundy, MD, chief transformation officer, Innovaccer.
Listen here.
Donate to the GTMRx Foundation through AmazonSmile!
AmazonSmile is an easy way for 0.5% of your qualified purchases go to the GTMRx Foundation at no cost to you. And signing up is simple—go to smile.amazon.com and select “Get the Medications Right Foundation” as your charity of choice. If you prefer to directly donate instead, you can do so here.
Adding the foundation on AmazonSmile will help us continue to provide no cost educational webinars, issue briefs, weekly news briefs and promote the need for transformation of our current system of medication use through social media campaigns.
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