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Practice Transformation

BCBS Tennessee mail-order plan draws ire
A proposed BlueCross BlueShield of Tennessee policy change could hurt patient access to critical drugs, eight medical societies warn in a letter to the insurer. The change would require physicians to use mail-order pharmacies to order drugs administered in-office, instead of allowing physician offices to bulk-order the drugs and keep them in-house. This, the societies say, could delay patient care, reduce access to much-needed drugs, inflate out-of-pocket costs and increase drug waste. BCBS responded that the policy change would save Tennessee employers around 20 percent on specialty drugs and that the groups’ claims were “stoking fear.” (Becker’s Hospital Review)

Diabetes care teams need pharmacists
Research demonstrates that adding pharmacists to diabetes care teams improves outcomes and can help prevent complications and reduce costs. As more diabetes drugs come to market, it’s time to make that a reality, Drug Topics reports. “The [American Diabetes Association] algorithm for treatment of diabetes is somewhat of a ‘choose your own adventure’ path, and pharmacists are key for helping both patients and providers choose the right medication(s) for the patient’s individual situation,” explains Sarah L. Anderson, PharmD, of the University of Colorado Skaggs School of Pharmacy & Pharmaceutical Sciences. (Drug Topics)

Evidence & Innovation

HCCI: People with employer insurance paying more
Between 2014 and 2018, average health care spending for people with employer-sponsored insurance grew 18.4% to $5,892 per person per year, according to a new Health Care Cost Institute study. Professional services accounted for the largest category of spending in 2018 ($1,985), followed by outpatient facility payments ($1,662), inpatient facility payments ($1,128) and prescription drugs ($1,118). Drugs administered by a physician accounted for 39% of the increase in spending on professional services over the five-year period. (Healthcare Dive; study)

Precision medicine in primary care? Not quite yet
Precision medicine is poised to revolutionize primary care–in particular, predictive genetic testing and pharmacogenomics. But, warns Managed Care, the evidence remains “scant,” and some experts fear routine genetic testing would drive more inappropriate care. Even if the evidence base grows more robust, reimbursement remains a challenge. And then there is physician uptake: Doctors will need to learn how to interpret, use, and communicate genetic testing results to patients. But, says Susanne Haga, associate professor of internal medicine at Duke, “It’s coming… one way or another.” (Managed Care)

Policy Solutions

Interoperability is coming. Here’s what to expect
Proposed government rules supporting a “consumer-directed, seamless flow of medical information” will likely go into effect very soon, predicts Lori Evans Bernstein, who was a senior advisor to the first National Coordinator for Health IT. She shared three insights on what to expect: EHR companies will see their business models disrupted, technology companies that build trust will “earn their moment in the sun,” and new privacy laws will be needed ”for our new, consumer-centric health system.” (Fierce Healthcare)

All the Democratic presidential candidates agree that the federal government should take a more aggressive approach to lowering drug prices, but the agreement pretty much ends there. Stat News features interviews with several of the candidates on this very topic. Find out their stances on drug prices and their plans for lowering them. (STAT News)

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