News Brief | February 28, 2023 | Data privacy: FTC fines GoodRx $1.5M; CMMI responds to Executive Order on Lowering Drug Costs

Practice Transformation

February full of deals
Last week, UnitedHealth Group closed its $5.4 billion acquisition of the home health and hospice provider LHC Group. LHC will be folded into Optum supporting UnitedHealth’s plan to make Optum the entry point for patients. Modern Healthcare reports. Also last week, Amazon completed its $3.9 billion acquisition of primary care chain One Medical; the deal gives Amazon a network of more than 220 medical offices in 27 markets across the US, according to Healthcare Dive. (Modern Healthcare; Healthcare Dive)

HHS/CMMI Response to Executive Order: New models to cut drug costs
The CMS Innovation Center rolled out three new payment models intended to lower drug costs. One involves a list of generic drugs for which the out-of-pocket Part D costs will be capped at $2 a month per drug; the second will help expand access to cutting-edge cell and gene therapies for people with Medicaid. The third would create new payment methods for drugs put on the market via accelerated approval. The Innovation Center did not provide a timeline. (Fierce Healthcare; Innovation Center Fact Sheet)

Evidence & Innovation

Lessons from ACOs: Integrating medical, social care
A recent Health Affairs Forefront article discusses lessons learned from a group of ACO managers working to address social determinants of health. Among the lessons: Health system investments are needed to build effective partnerships with community-based organizations (CBO). That includes developing an inventory of community resources, building relationships with local CBOs, and establishing a reliable process for referring patients to CBOs.” However, many CBOs lack the funding to meet the demands from health care organizations. The authors argue that the CMS Innovation Center has an “immediate opportunity to develop an updated model based on the community-based care transition program.” (Health Affairs Forefront)

Policy Solutions

Data privacy: FTC fines GoodRX 1.5M, launches tech office

Early this month, the US Federal Trade Commission , for the first time, exercised its power to penalize companies that don’t notify consumers about health data breaches. It fined GoodRx $1.5 million for sharing private health information from its users with data brokers and advertising platforms such as Facebook and Google. About two weeks later, the FTC launched an Office of Technology to strengthen its ability to “fully grasp” rapidly changing technologies in the digital marketplace and support its policy and law enforcement efforts. (STAT; CNET; Crowell; HHS)
PBM legislation advances in Commerce Committee
The Senate Commerce Committee held a hearing this month on legislation to make it illegal for PBMs to engage in spread pricing –charging health plans and payers more for a prescription drug than what they reimburse to the pharmacy and keeping the difference as profit. According to the law firm Frier Levitt, this  often results in reimbursement below the pharmacy’s acquisition costs. They report the bill would also prohibit PBMs from “arbitrarily, unfairly, or deceptively clawing back payments made to pharmacies, or increasing fees or lowering reimbursements to offset reimbursement changes in federally funded health plans.”(Frier Levitt; video of hearing)
Speak up: CMS to solicit comments on drug negotiation process
As CMS prepares to negotiate with pharmaceutical manufacturers on prices for certain high-cost prescription drugs, it’s providing opportunities for public comment. It will begin soliciting input on issues related to drug-pricing negotiations from patients, advocates, pharmaceutical manufacturers, health plans, and clinicians. Most of these comment periods will open in Spring and Summer 2023. CMS spells out the details in a memo on the Medicare Drug Price Negotiation Program. (Commonwealth Fund; CMS memo)

In Case You Missed It!

Katherine H. Capps, Co-Founder and GTMRx Board Member will present ” A Better Way to Manage Medications: CMM + Pharmacogenomic Testing ” at PMLS Updates in Precision Medicine and Pharmacogenomics – March 2-3, 2023

We are delighted to be a part of the upcoming PMLS Updates in Precision Medicine and Pharmacogenomics event in Orlando, March 2-3, 2023. Join over 40 thought leaders for two days of discussions and networking. Only a few weeks left to take advantage of the 20% discount. Use code SPEAKER20 when registering.

Register here!

See the agenda here!

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.
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.

Become a Supporting Member Today

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.
  See past issues of our news brief here. 

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Support the GTMRx Foundation to get the medications right™. A donation from you can help to reduce the 275,000 lives lost and $528 billion wasted each year due to suboptimal medication use. Donations support practice and policy transformations and allows us to provide free resources for our members. We believe everyone deserves access to comprehensive medication management to ensure safe, appropriate and effective medication use. Help us make that happen. Need to be convinced? Watch Brenda's story.