Practice Transformation
Hospitals mark up prices on medicines by an average of 250%—and some as much as 533%, according to Bernstein analyst Ronny Gal. For example, Neulesta, a drug given to chemotherapy patients, was marked up 364% percent on average. Hospitals also charge different prices for the same drug: The average variation is about 36%. To use the Neulesta example again, some hospitals charge $5,000 per treatment, while others charge $20,000. Such markups incentivize hospitals to use expensive branded products instead of biosimilars. (Stat News; Becker’s Hospital Review)
Nearly half (47%) of adults surveyed last month say they either have received the COVID-19 vaccine or want it as soon as possible, compared to 34% of those polled in December, according to a Kaiser Family Foundation poll. It found that when someone close has been vaccinated, people are more likely to want the shots. Consistent with previous polling, 13% say they will “definitely not get” the vaccine. The vaccine remains politicized: Enthusiasm increased for both Democrats and independents, but it hasn’t shifted among Republicans, who remain the most resistant. (KFF survey; Kaiser Health News)
More price hikes by drugmakers have been recorded in the first two weeks of January this year (813) than for all of January 2020 (737). That total also is approaching the record for a full January during the past decade (895) set in 2018. Moreover, all the change in those two week were increases. That’s never come close to happening before, USA Today reports. The high for the month of January over the previous 10 years is 72%, recorded last year. (USA Today)
Evidence & Innovation
Legacy, meet disruptor. Anthem has launched a digital health incubator offering financial assistance, mentoring and partnership opportunities. For example, it hosts challenges for innovators to compete for prizes while developing solutions targeting key health issues. Another approach allows entrepreneurs-in-residence to work with a navigator who offers coaching, strategic insights and access to other experts. “Getting to work with a payer upfront is instrumental to making sure not only do they get access to patients in the market but have the experience to build the right product,” explains Kate Merton, who leads Anthem Digital Incubator. (FierceHealthcare)
Current models undervalue clinical pharmacy services, according to research published in Value in Health. Looking at medication management therapy for hypertension, researchers showed that current reimbursement rates may underestimate the benefit realized by US payers. Their conclusion goes beyond merely MTM. “New reimbursement models are needed to allow pharmacists to offer cost-effective clinical services,” they argue. “By improving the understanding of the value of pharmacists in terms of healthcare efficiency, decision makers are better informed to consider new reimbursement models that will subsequently lead to the uptick in the provision of services provided by pharmacists.” (Value in Health)
Policy Solutions
Many hospitals are ignoring a new rule designed to give consumers information about prices. “Hospitals are playing a hide-and-seek game,” Ge Bai, an expert on health care pricing at Johns Hopkins Bloomberg School of Public Health, tells the Washington Post. “Even with this regulation, most of them are not being fully transparent.” One reason: The $300/day fine isn’t much of an incentive. The rule went into effect Jan. 1. (The Washington Post*; Kaiser Health News)
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In Case You Missed It!
The AMA and ASHP (GTMRx founding funder) are committed to exploring the potential of pharmacogenomics-based selection, dosing and monitoring of medications to improve health outcomes. To further clinicians’ understanding of this emerging area of medicine, the AMA and ASHP are developing an informative series of virtually convened and facilitated webinars to evaluate the evidence base, identify and promote current best practices and guidance on the clinical application of pharmacogenomics and understand the health equity implications of adoption.
The webinars are free and will run February 9, February 17, February 24, March 2, March 11 and March 18. Register here.
The Get the Medications Right Institute (GTMRx) workgroups have developed a set of Tools from Our Experts to advocate for medication management reform. These tools are designed to be useful resources for all stakeholders, and we believe these will be vital to optimize medication use through CMM in practice. We encourage you to share them, post them and use them to advocate for medication management reform. Find these guidance documents here.
Those interested in designing and creating a CMM program can utilize this document to enable health information technology in practice. Discover four foundational components (clinical decision support tools; population health and risk stratification; patient engagement and care coordination; including economic, clinical and humanistic outcomes) that advance the adoption of CMM in practice and utilization of health IT. These components are broken down into the journey and evolution toward a mature IT-enabled support system. This guidance document, developed by the Health IT to Support Optimized Medication Use Workgroup, offers a reasoned pathway for those interested in using health IT for the delivery of CMM throughout the continuum of care. Read it here.
Employers want a better health care system. They want to decrease waste and ensure that their employees have access to effective, efficient, high-value care.They are focusing on managing chronic conditions and medication costs, and rightly so. Nearly 75% of primary care visits involve medication prescribing. It’s how we treat and manage most conditions. But we still haven’t managed to get the medications right.
Read more here.
Listen here.
Hosted by the GTMRx Institute’s executive director and co-founder, Katherine H. Capps, Voices of Change features leaders who have knowledge, experience and ideas to solve this urgent need to get the medications right. Did you miss the most recent episode? Liz Helms discuss the patient’s perspective in getting the medications right, saying, “[Patients] need to ask the questions. We need to understand why we’re taking that, and if we’re taking multiple medicines, then we need to understand if they all work together. And if they don’t all work together, then there should be conversations [on] what should we do to change that?”
Episodes feature:
- Liz Helms, president and CEO of the California Chronic Care Coalition
- Liz Fowler, JD, Ph.D., executive vice president for programs, The Commonwealth Fund
- Amy Gutierrez, Pharm.D.,senior vice president and chief pharmacy officer, Kaiser Permanente
- Amanda Brummel, PharmD, BCACP, vice president, Clinical Ambulatory Pharmacy Services, Fairview Pharmacy Services
- Orsula V. Knowlton, PharmD, MBA, president and chief marketing & new business development officer, Tabula Rasa HealthCare
- Anand Parekh, MD, chief medical advisor, Bipartisan Policy Center
- Paul Grundy, MD, president, GTMRx; chief transformation officer, Innovaccer
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.
