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Practice Transformation

Pharmacists have the training and expertise to help solve the overmedication problem, but reimbursement models work against them, say Don Downing of the Institute for Innovative Pharmacy Practice and Judith Garber of the Lown Institute. “This negative incentive to provide appropriate medication therapy drives up prescription costs and overuse of medication, putting patients at increased risk for harm.” In contrast, when Washington state required commercial insurers to recognize pharmacists as health care providers “overburdened primary care medical clinics all over the state started hiring pharmacists on their medical teams—not to fill prescriptions but to help manage them.” (The Hill commentary)

Evidence & Innovation

The standard 90-day supply of prescription medications poses risks to some patients with mental health issues—especially those at risk for suicide, Brian Barnett, MD, a psychiatrist at Cleveland Clinic, wrote in a commentary for The Wall Street Journal. Insurers and pharmacy-benefit managers have pushed to require physicians to write 90-day (vs. 30-day) prescriptions. “Yet few insurers have streamlined processes for physicians to obtain insurance coverage for smaller medication quantities,” he writes. In 2012 the American Psychiatric Association asked insurers to allow physicians flexibility in determining medication quantities. “Few listened and the scope of the problem has only grown.” (The Wall Street JournalBecker’s Hospital Review)
Utah is paying for some public employees to travel to Mexico to fill their prescriptions, and the savings is immense, NBC reports: The state’s public-employee insurance program can pay for each patient’s flight, give them a $500 per trip bonus and still save tens of thousands of dollars, the Associated Press reports. The program began a year ago, and it has saved about $225,000. (AP, via ABC News)

Policy Solutions

Massachusetts is the latest entity to use value-based Medicaid agreements to pay for expensive medications. If the medication fails, it will get some or all of its money back. MassHealth—the state’s Medicaid organization—has directly negotiated with six drug manufacturers over the price of 12 drugs, which has saved the agency a net of $13 million. Oklahoma, Colorado and Michigan have federal approval for similar agreements. Louisiana and Washington are testing another strategy, employing subscription or fixed payments for hepatitis C drugs. (WBUR)
Pennsylvania is enacting legislation to abolish the heavily criticized “fail first” approach for stage IV cancer drugs, which requires patients to show no improvement with cheaper, insurance-approved drugs before moving on to more innovative—and costly—approaches. Georgia, Illinois and Maryland have enacted similar legislation. (Philadelphia Inquirer)
The FDA and the Federal Trade Commission (FTC) announced a joint initiative to crack down on “false or misleading” marketing claims about biosimilars. The agencies said they would “take appropriate action against false or misleading communications about biologics, including biosimilars, within their respective authorities.” The FDA will also be educating patients and providers about biosimilars “and explain why people should have confidence in the safety and effectiveness of these FDA-approved products just as they would the reference products.” (MedCity NewsFDA/FTC announcement)

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