Breaking down silos with CMM to improve CKM care
Cardiovascular-kidney-metabolic syndrome requires integrated care models, including comprehensive medication management, to address complex, overlapping drug regimens, write the authors of a Cardiology Today paper. Fragmented care across cardiology, nephrology and endocrinology often leads to suboptimal. Incorporating CMM allows pharmacists and clinicians to systematically assess medication appropriateness, effectiveness, safety and adherence across conditions such as diabetes, hypertension and chronic kidney disease. Team-based models that embed CMM into CKM care pathways can improve uptake of guideline-directed therapies, reduce polypharmacy risks and strengthen coordination across specialties. (Cardiology Today)
PGx + CMM personalizes heart medication for veterans
A veteran’s experience with statin intolerance shows how pharmacogenomics can strengthen comprehensive medication management. After multiple medication failures, a PGx test revealed how the veteran’s genetics affected drug metabolism, allowing clinicians and pharmacists to adjust therapy. The case illustrates how VA pharmacists use genetic data within CMM workflows to evaluate medication safety, effectiveness and tolerability over time rather than relying on trial and error. By embedding PGx into CMM, VA care teams can individualize treatment, reduce adverse effects and improve adherence. (VA News)
Practice Transformation
2026: More telehealth and AI reimbursement uncertainty
Companies that provide virtual health services are facing continued uncertainty in 2026: It’s the sixth consecutive year without permanent payment policies for virtual care. Congress extended pandemic-era flexibilities that allow telehealth and hospital-at-home services to be reimbursed at parity with in-person care, but only through January. Reimbursement challenges extend beyond telehealth to artificial intelligence, digital therapeutics and remote patient monitoring, where coverage remains inconsistent despite rapid adoption. Some optimism centers on CMS’ new 10-year ACCESS model, which aims to reimburse tech-enabled care tied to improved outcomes, Modern Healthcare reports. (Modern Healthcare)
High deductibles drive diabetes patients to skimp on meds
Many Americans with diabetes skip essential medications and care because of high-deductible health plans, KFF Health News reports. With median employer plan deductibles around $2,750 and some topping $5,000, patients often delay filling prescriptions or cut doses to stretch limited funds, diabetes advocates warn. They note that routine maintenance drugs are often the first to be skipped. Research links higher cost-sharing to reduced adherence to diabetes medications and monitoring supplies. The trend raises concerns about affordability and access to essential prescription drugs for chronic care. (KFF Health News)
Evidence & Innovation
PBM use of PGx could reshape drug prescribing
Managed PBMs are increasingly incorporating genomics testing into comprehensive medication management to improve prescribing and reduce trial-and-error therapy. PBMs such as True Rx Health Strategies and Capital Rx are embedding pharmacogenomics into medication reviews that assess appropriateness, effectiveness, safety and adherence. True Rx pairs genetic testing with pharmacist-led comprehensive medication management to guide therapy for mental health, pain and cardiovascular conditions. Capital Rx similarly integrates genomic insights into longitudinal medication management. By combining PGx results with medication management, including CMM, PBMs aim to simplify regimens, reduce adverse drug events and improve outcomes. (Managed Healthcare Executive)
Policy Solutions
PBMs and pharmacies face rising False Claims Act enforcement
Pharmacies and PBMs are drawing heightened scrutiny under the False Claims Act as enforcement actions against drug pricing and dispensing practices intensified in 2025. Regulators are increasingly treating PBMs and community pharmacies not as passive intermediaries but as influential gatekeepers whose conduct can trigger government liability, according to the National Law Review. The authors point to accusations that some PBMs have submitted inflated prices to federal programs and manipulated drug pricing benchmarks, and that pharmacies have faced scrutiny for dispensing practices. (National Law Review)
