Practice Transformation
Texas NAMI head: End nonmedical switching
Health insurers and PBMs are making the current mental health crisis through “nonmedical switching”—moving stable patients from their current medication to one that may not work as well for them, writes Greg Hansch, LMSW, of the National Alliance on Mental Illness of Texas. “As a result, a patient with a mental health disorder who was stable on his or her current medication may be forced to switch to a different medication regardless of the side effects.” The insurers increase profits, but “the patient may relapse, requiring additional care and greater health care expenses in the long run.” (Dallas Morning News)
UnitedHealth to end cost sharing on insulin, naloxone, others
UnitedHealth Group will eliminate cost-sharing for several prescription drugs—perhaps as early as next year, the company announced last month. It plans to eliminate copays for insulin for diabetes; epinephrine for severe allergic reactions; albuterol for acute asthma attacks; glucagon for hypoglycemia; and naloxone for opioid overdoses. Waiving cost-sharing for drugs doesn’t lead to higher spending or premium increases, Paul Fronstin of the Employee Benefit Research Institute tells Modern Healthcare. Because people with chronic conditions are likely to reach their out-of-pocket maximums each year, covering the insulin costs will not raise expenses for health plans. (Modern Healthcare)
Evidence & Innovation
Analysis raises questions about fast-tracked drugs
For fast-tracked drugs, the FDA requires confirmatory trials to show either that the drugs were rightly fast-tracked and should stay on the market or that the original decisions were wrong and the drugs should be withdrawn. However, an NPR analysis of FDA and NIH data collected over 30 years finds that 42% of confirmatory trials required by the FDA had not been started a year or more after authorization was granted. A pricing analysis from GoodRx also showed drugs that obtained accelerated approval saw 26% more price hikes over a decade than other FDA-approved drugs. (NPR)
Over 40% of parents say “no” to vaccine for youngest kids
About a month after FDA granted emergency use authorization for the Moderna and Pfizer COVID-19 vaccines for children 6 months to 4 years of age, 43% parents said they would not be getting those children vaccinated, up from previous months in the Kaiser Family Foundation (KFF) COVID-19 Vaccine Monitor Poll. This response was more common among Republicans or Republican-leaning parents (64%) and unvaccinated parents (64%). Perhaps more significant, 70% of parents of young vaccine candidates said they have never spoken to a pediatrician about the COVID vaccine. (Medpage Today)
Report finds big variation is claims costs for same condition
A report on high-cost claims and injectable drug trends found that of the top 18 costliest conditions, the difference between average cost and highest-cost claims was more than $1 million. It also found a 354% increase in the number of COVID-19 claims from 2020 to 2021. The report from Sun Life also found a rise in total spend from $30.4 million to $114 million, but an 18% decrease in average cost for treatment. Other findings: Claims for three conditions—malnutrition, transplant and hemophilia—had at least 70% of total costs from drugs, and 21% of employers had at least one plan member with more than $1 million in claims from 2017 to 2020. (BenefitsPRO; Sun Life report)
Policy Solutions
GTMRx provides insights to HHS to strengthen primary care
HHS recently invited stakeholders to share their ideas on improving health care access, equity, outcomes and community engagement as part of an HHS initiative to advance primary care in the US. GTMRx provided a detailed response. The big picture view is as follows: “We believe that clinical pharmacists providing CMM services as part of interprofessional teams in collaboration with primary care clinicians can significantly contribute to advances in quality, equity, and access through individualized and population-based approaches to care that reduce unwarranted variation in cost. The opportunity for improvement is tremendous.” It also offered specific recommendations. They include paying for primary care teams to care for people and a call to “support training programs to ensure there is a sufficient workforce of qualified interprofessional team members—including clinical pharmacists—credentialed and privileged to provide CMM services to meet patient and population needs.” (GTMRx comments; HHS Factsheet)
In Case You Missed It!
GTMRx Workgroup Update
On July 21, James Gelfand, JD, Co-President, ERIC (ERISA Industry Committee) joined the GTMRx Employer Advisory Group meeting to discuss GTMRx’s consultative/strategic partnership with The ERISA Industry Committee (ERIC) to promote PBM transparency and fiduciary responsibility reform.?
New Episode of Voices of Change Out Now | Alliance for Medication Management: Work in Washington State
An innovative care coordination system is emerging in eastern Washington State. Empire Health Foundation is providing funding to develop and implement a care coordination system that brings pharmacists and care coordinators together to simultaneously address medication related problems and the associated social determinants of health that are impacting the patient’s ability to achieve the intended benefits from their medications. The program is designed to support and supplement the primary care provider’s care plan and identify potential medication related problems, social barriers and behaviors that reduce medication effectiveness.
The program is called Medication Care Coordination or MCC and has been developed as a collaboration between Empire Health Foundation, Aging and Long-Term Care of Eastern Washington (ALTCEW), Rural Resources Community Action (RRCA) and Medication Review, Inc (MRI).
The Washington State University School of Pharmacy is providing academic resources in support of the program and has generated several articles on the findings from early pilots. The Alliance for Integrated Medication Management (AIMM) is providing strategic program design, management development and implementation support to program partners.
Host Katherine (Katie) Capps talks to Jeri Rathbun, Empire Health Foundation; Dr. Bob Crittenden, Health Policy Advisor; and Dr. Candace Anderson, Pharmacists, Medication Review, Inc. Take a listen.
GTMRx Webinar: Building, Managing and Sustaining Your CMM Practice June 22
Where is CMM available? What quality measures are being used to evaluate the value of CMM? What do CMM staffing models look like? How mature are CMM practices and what are the various needs based on stages of maturity?
Hear from, M. Shawn McFarland, PharmD, FCCP, BCACP, Veterans Health Administration, on early findings from the GTMRx National Registry of CMM Practices.
Learn from organizations at various lengths of maturity shedding light on the benefits of a more widely adoption of CMM and the challenges of getting there:
- Early stage CMM practice (1-2 years) — Sara Maki, PharmD, BCACP, NorthMemorial Health
- Mid-level stage CMM practice (10+) — Richard Bone, MD, Advocate Medical Group
- Fully mature CMM practice (20+) — Amanda Brummel, PharmD, BCACP, University of Minnesota
Join us to be part of meaningful change
Irma, like many others, struggles as a result of our current trial-and-error approach to medication. That is why we advocate for a new, comprehensive approach to medication use and prescribing. As a non-profit 501(c)(3) and 501(c)(4) organization, the GTMRx Institute and Foundation relies on funding from our supporting members. We ask that you consider becoming a Supporting Signing Member so we can continue to provide relevant, timely resources to get the medications right!
If you’re interested in supporting the Institute or Foundation at a higher level, please contact us. Your dollars will bring about meaningful change for people like Irma.
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.
