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Practice Transformation

Historically, medical and pharmacy benefits have been siloed. When employers and other organizations design benefit plans, they typically use one company for medical benefits and a different one for pharmacy benefits. As separate entities, they don’t share data or information—creating a disconnect. “As a result, plan sponsors are challenged to ensure that members receive coordinated care and understand the true cost of care,” says Jerry Buller, DPh, MMHC, chief pharmacy officer at Trellis Rx, a specialty pharmacy that partners with health systems to enhance patient experiences. “These issues are particularly relevant for patients with chronic and complex conditions, who often require high-cost specialty medications. A plan sponsor and medical team may miss important opportunities to comprehensively manage a patient’s care.” Moving into 2020 and beyond, Buller believes plan sponsors will begin demanding solutions that address these siloes—as more integrated delivery networks are now offering comprehensive health plans as a solution to these challenges. (Managed Healthcare Executive)
Some public health experts worry about precision medicine, Modern Healthcare reports. It’s exciting but, warns Ronald Bayer, professor of socio-medical sciences at Columbia University’s Mailman School of Public Health, it diverts attention from more foundational health concerns, such as poverty. Dr. Muin Khoury, director of the CDC’s office of genomics and precision public health, says he believes precision medicine advancements will lead to improvements in population health. Precision medicine today encompasses traditional health data and social factors, he says. (Modern Healthcare)
“Nine years ago, my family attended a medical conference in Philadelphia for the genetically unblessed. My husband, Eddie, and I found kinship with the other parents there, born of shared purpose: We refused to accept the diagnosis that our child was going blind.” In this Wall Street Journal piece, Kristin Papiro, RN, describes how genomic science kept her sons—who had a rare condition called Leber congenital amaurosis–from going blind. “The genomic researchers producing this incredible science deserve more, not less, investment. Thanks to them, my boys can see the light,” she concludes. (WSJ)

Evidence & Innovation

Futurist and tech guru Bernard Marr recently identified the technology trends that will transform health care and medicine in 2020. Machine learning and AI topped the list. Genomics also made the cut. Artificial intelligence and machine learning help advance genomic medicine, making the “analysis of genes and gene mutations that cause medical conditions much quicker.” Robotics, 5G and digital twins were some of the other trends on Marr’s list. (Forbes)
Hospitals are spending a larger share of their drug budgets for new cancer and migraine treatments, according to Lumere, a research and analytics firm. Researchers found a 199% percent rise in spending on expensive immunotherapies used to treat small cell lung cancer during the first three quarters of 2019 compared to the same period in 2018. Immunotherapies accounted for 1.2% of total drug spending during that period. They also found a 90% growth in spending for migraine prevention drugs. Most of the spending was on Amgen’s Aimovig. (STAT)

Policy Solutions

Congress is debating new legislation that could lower drug pricing and restructure Medicare Part D—capping out-of-pocket costs at $2,000. The bill, the “Elijah Cummings Lower Drug Costs Now Act” or H.R.3, is expected to pass in the Democratic controlled House. But Congress is not the only body looking to regulate drug pricing—both HHS and the White House have made the issue a top priority for their upcoming policy initiatives. (Health Affairs)

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