Practice Transformation
MyChart message fees passed on to patient?
Cleveland Clinic began billing for certain Epic MyChart messages in November; now, at least seven other health systems have followed suit. But, as Becker’s Hospital Review reports, what remains uncertain is how long Medicare will cover these charges and whether most commercial insurers will pay at all. Ge Bai, PhD, of Johns Hopkins says the price for commercially insured patients likely depends on the health plan. Some patients could pay as much as $160. “You pay, but you are not the person who negotiates that. Even the most sophisticated and well-informed consumers have their hands tied.” (Becker’s Hospital Review)
Cost Plus, business group, launch drug benefit
Mark Cuban’s Cost Plus Drugs and the Purchaser Business Group on Health have launched a supplemental drug discount benefit for self-insured employers: EmansaRx Plus. This allows Cuban to move beyond the direct-to-consumer market, and it helps the business group expand its internal network of services, Modern Healthcare reports. David Dobrzykowski, associate professor of supply chain management at the University of Arkansas, says the venture could force “PBMs to increase the transparency of their pricing and contract terms with manufacturers and self-funded employer health plans, both of which would bring enormous benefit to consumers.” (Modern Healthcare)
Cigna, Express Scripts to offer adalimumab biosimilar
Express Scripts and Cigna Pharmacy will add biosimilars for AbbVie’s costly rheumatoid arthritis drug Humira (adalimumab) to its commercial formularies beginning in 2023. “By placing biosimilars on our formularies in the same position as Humira, we’re also ensuring that physicians and patients have choice and flexibility as they assess these additional biosimilar therapies,” Katy Wong, chief pharmacy officer, Cigna Pharmacy, said in a prepared statement. The companies have yet to decide which of the seven Humira biosimilars will be available. (Formulary Watch)
Evidence & Innovation
Heart Association: Ask HF patients about supplements
Providers should ask heart failure patients about supplements or other types of complementary and alternative medicines, the American Heart Association said in a new scientific statement published in Circulation. It highlighted the ones that might be beneficial (fish oil and Tai chi), might be harmful (high doses of vitamin D), and have mixed evidence. Doctors know that people with back pain or cancer tend to seek out alternatives, says Duke cardiologist Dr. Rich Krasuski, who’s done research surveying heart patients on alternative medicine. “In heart failure, we don’t often think about that.” (ABC News; Circulation)
Biomarker update: Lyme Disease
Researchers writing in Cell Reports Medicine have identified a set of biomarkers that could make early diagnosis of Lyme disease easier. This, in turn, could be the first step to a more effective, targeted treatment. In their paper, the researchers explain how they pinpointed a specific set of genes that are activated in people with long-term Lyme disease. (Washington Post; Cell Reports Medicine)
Policy Solutions
Proposed rule would reform prior authorization
With a new proposed rule published last week, CMS seeks to overhaul health insurance prior authorizations. The regulation would require Medicare Advantage, Medicaid and health insurance exchange carriers to ease their prior authorization processes and respond to “urgent” requests within 72 hours and standard requests within seven days. This cuts in half the time MA plans currently have to respond to prior authorization requests. Insurers would have to justify denials and publicly report data on their prior authorization decisions. (Modern Healthcare)
In Case You Missed It!
GTMRx nominatee Carolyn Clancy, MD, MACP wins prestigious PCC Conference Barbara Starfield Award
Join us Dec 14 to recognize her!
I am so proud to let you know that our friend and supporter, Carolyn Clancy, MD, MACP, is the 2022 recipient of the Primary Care Collaborative’s Barbara Starfield Primary Care Leadership Award.
In nominating her for the honor, GTMRx noted how Dr. Clancy has transformed evidence into action in support of person-centered care. As did Dr. Barbara Starfield, Dr. Clancy considers person-centeredness to be a tangible concept. As we wrote in our nomination, Dr. Clancy “has devoted her career to advancing person-centered, evidence-based care. In each role, she tirelessly promoted and supported evidence-based, person-centered primary care.”
Dr. Clancy will be recognized during an awards dinner on Dec.14, 2022, part of the PCC conference being held December 14-15th in Washington, D.C.
Hope to see you there,
Katherine H. Capps, Executive Director and Co-founder, GTMRx Institute
NEW 2022 GTMRx Resource | The Outcomes of Implementing and Integrating Comprehensive Medication Management in Team-Based Care: A Review of the Evidence on Quality, Access and Costs
Learn about the peer-reviewed evidence showcasing the value of CMM, through improvements in access to care, provider work life, outcomes and patient satisfaction as well as a reduction in costs. These findings outline the CMM team-based care process that can be implemented in a variety of health care systems to ensure positive patient outcomes.
Developed by the Evidence-Based Resources Subgroup of the Practice and Care Delivery Transformation Workgroup.
NEW 2022 GTMRx Resource | Comprehensive Medication Management via Telehealth Modality in Team-Based Care:A Review of the Evidence on Quality, Access and Costs, December 2022
Learn about the peer-reviewed evidence showcasing the value of CMM delivered as a service via telehealth and its challenges. Telehealth is a promising modality to improve access to care, facilitate patient monitoring and maintain the needed connection with patients that improves their care and health.
Developed by the Evidence-Based Resources Subgroup of the Practice and Care Delivery Transformation Workgroup.
New Report Available! Optimizing Medication Use for Accountable Care Success
A value-based care resource derived from an event sponsored by the GTMRx Institute & the Institute for Advancing Health Value
This report covers:
- Comprehensive medication management (CMM) in ACOs/ enhancing value
- The reported effects of CMM and pharmacy integration
- The key elements of success for effective medication therapy management programs
- Key issues impacting CMM success in ACOs, such as:
- Population health
- Social determinants of health
- Using data to transform care
- Change management/philosophy of practice
- Network expansion and clinical integration
- Accountability and relationship management
Read the report here.
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.
