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Practice Transformation

New genetic therapies promise a one-time dose of cure for progressively debilitating diseases, but they’ve only proven effective for patients in the early stages of the disease. Novartis’s Zolgensma, for example, has only been tested on children six months or younger, so health plans, which must balance million-dollar price tags with member expectations, are carefully considering the patient’s age and severity of disease before covering the treatment. The dilemma pits parents against health plans as analysts and experts sort out the differences between what’s FDA-approved and what is truly effective care. (The Wall Street Journal)
Some chips used by direct-to-consumer genetic companies may not detect variants in a person’s genetic code accurately. When consumers upload the raw data to third-party services to extrapolate risk for diseases, the results are inaccurate 84% of the time for some variants. The author warns consumers and care providers to be wary; results of these tests should be confirmed independently. (The Scientist)

Evidence & Innovation

Austrian researchers found a strong correlation between use of prescription antacids and need for anti-allergy medications. That’s probably because antacids change the stomach’s balance of acids and enzymes, which can cause the immune system to trigger new allergies. “There is evidence that anti-acid drugs don’t just act on the digestive system, but they also act on immune cells, causing a release of pro-allergic substances,” according to the study’s lead author. (CNN Health)
New numbers indicate that only 1.3% of employer-based health plan enrollees account for almost 20% of health spending, averaging $87,870 a year. Some of these high-cost consumers only posted big spending for a single year, but others have high costs year over year because of chronic health conditions like HIV, cystic fibrosis and multiple sclerosis. For the latter, prescription drugs accounted for much of the cost; on average, they spent $34,120 a year on medications, compared to $1,290, the average for all employees. (Benefits Pro; Kaiser Family Foundation)

Policy Solutions

Scammers are targeting seniors to acquire social security numbers, patient histories and DNA samples—then hitting up Medicare for hefty illegal payments. Both the Federal Trade Commission and the Medicare inspector general issued fraud alerts after victims were promised test results that would detect their risk for cancer or medication side effects, but never received the results. Scammers sometimes promised $100 payments in exchange for the data and samples, and some paid off doctors who were complicit in the activity. (Kaiser Health News)
Surescripts, which manages about 80% of the nation’s e-prescribing, recently cut off Amazon PillPack’s access to patient prescribing history via a third party vendor. Last week, Surescripts upped the ante, accusing PillPack of fraudulently accessing the data in the first place and turning over evidence to the FBI. PillPack says patients consent to the data access when they fill a new prescription, and that it’s a safety precaution, saying “the core question is whether Surescripts will allow customers to share their medication history with pharmacies. And if not, why not?” (CNBC)
Coming soon: Focus On calls for members
The GTMRx Institute is now more than 390 members strong! Our Work Groups are forming, education opportunities are growing and we’re raising awareness with key stakeholders. Stay tuned for more information about joining brief, weekly “Focus On” membership calls designed to keep you up to date on our activities.
FREE, live webinar TOMORROW! Register now!
Pharmacogenomics: Lowering costs, improving outcomes through personalized medicine
Tomorrow, August 7, 2019 | 1- 2 p.m. EDT
Pharmacogenomics considers the role of the genome in drug response. It combines pharmacology and genomics, considering how the genetic makeup of an individual affects his/her response to drugs.
Today, more than ever before, we have the ability to target the right drug to improve a patient’s quality of life while also eliminating waste from non-optimized medications. This webinar provides an overview of pharmacogenomics and will showcase an employer case example of the opportunities and savings available to employers and health plans through integration of personalized medicine into benefits plan designs. Read more. Registration is limited to 500 people. Register now.

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