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Practice Transformation

RAND: Biosimilars could save $38.4B
Biosimilar drugs could drive down prices for expensive medicines, saving an $38.4 billion, according to a new RAND Corporation study published in the American Journal of Managed Care. The number could be higher with higher biosimilar use. Most of the expected savings would come from downward pressure on the brand-name biologics they compete with, rather than lower biosimilar prices. The estimated savings are lower than two other recent assessments. The new analysis uses more recent data, more comprehensively breaks down savings by source and biologic, and is clearer on the baseline case used to estimate savings, according to RAND. (American Journal of Managed CareRAND announcement)
COVID burnout even worse than EHR burnout
Clinician burnout continues to rise. Before COVID-19 began, the percentage of clinicians reporting some degree of burnout was consistently about 25%. Post-pandemic, that number has climbed to approximately one-third, according to a new KLAS Research Arch Collaborative report. EHR frustration still contributes to burnout, but pandemic-related factors such as workload and chaotic work environment have surpassed it. During 2021, all contributing factors to clinician burnout increased in frequency, and the rate of increase accelerated, according to the report. (EHR Intelligence)

Evidence & Innovation

Medicare: Lack of access to meds for opioid use disorder?
Less than 16% of the one million Medicare beneficiaries diagnosed with opioid use disorder in 2020 received medication to treat the condition, a new Office of Inspector General report found. Beneficiaries in Florida, Texas, Nevada and Kansas were less likely to receive such medication than beneficiaries nationwide. Asian/Pacific Islander, Hispanic and Black beneficiaries were less likely to receive medication than white beneficiaries. Not everyone needs medication for opioid use disorder, but this low percentage may indicate difficulty in accessing it, the OIG noted. (Fierce HealthcareOIG report)
The impact of one drug on Medicare costs
HHS Secretary Xavier Becerra last week ordered Medicare to reconsider a premium hike after Biogen halved the price of Aduhelm, its controversial Alzheimer’s drug. The standard premiums jumped 15% for 2022. STAT News points out that it’s unusual for Medicare to change premiums after a plan year has begun: Normally, if Medicare has extra premium funds, they are factored into the next year’s premium calculations. Another factor to consider: CMS also proposed covering Aduhelm only for people enrolled in qualifying clinical trials. (STAT News)

Policy Solutions

Inconsistent messaging hurts COVID effort
“Throughout the pandemic, we have seen how inconsistent messaging around COVID has fueled doubt around science, giving place to consistently messaged misinformation that has found its way into communities all across America,” Kavita K. Patel MD, MSHS, and Joseph V. Sakran, MD, MPH, MPA write in Scientific American. They call for a “rapid response system” that quickly evaluates new data and ensures “the most consistent, evidence-based messaging is released to the health care workforce and the general public.” Frontline health workers must be involved in such discussions: “They are closest to the struggle and often know what the best solutions are.” (Scientific American)
Centene makes another PBM-related settlement
Centene has made another multimillion-dollar settlement deal with a state to resolve claims it overcharged for prescriptions in the state’s Medicaid program. New Hampshire is at least the fifth state with which Centene has reached a deal, Healthcare Dive reports. Centene has agreed to more than $236 million in no-fault settlements in Arkansas, Illinois, Ohio, Mississippi and New Hampshire. More settlements may be coming. The issues relate to Centene’s PBM subsidiary Envolve Pharmacy Solutions. (Healthcare Dive)
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In Case You Missed It!

GTMRx sponsoring Health Care Value Week

January 24 – 28, 2022
Health Care Value Week will feature opportunities for interested stakeholders to participate in meaningful dialogue with health care executives and policymakers in the Administration and Congress through virtual events and social media.
GTMRx will host a panel on Value-based Strategies: A Better Way to Manage Medications with speakers Katherine H. Capps, GTMRx executive director, Steven Chen, PharmD, MHS, GTMRx distinguished fellow, associate dean for clinical affairs at USC School of Pharmacy, and Michael Hochman, MD, MPH, CEO of Healthcare in Action,
SCAN Group. This session will take place on January 24, 2021 from 3:00pm -3:30pm EST as part of Monday’s Special Edition of the Virtual Value-Based Payment Summit event.
More information and registration for Health Care Value Week can be found here.
You can register for the Virtual Value-Based Payments Summit: Update on CMS/CMMI Payment Reform Initiatives here.
GTMRx Institute Blog | A sparkling solution: 
CMM is the innovation we need. Stop stalling. 
In a season of hope, I’m feeling a just little frustrated about the current health care system’s resistance to change. Specifically, of course, I’m talking about giving patients access to comprehensive medication management through team-based, person-centered care. The potential of CMM is undisputed, yet we still lack buy-in from the very stakeholders who could bring it to scale.
Two questions from a recent survey of health care leaders that we conducted illustrate the promise and predicament of CMM…
SEE THE EVIDENCE | The Outcomes of Implementing and Integrating Comprehensive Medication Management in Team-Based Care: A Review of the Evidence on Quality, Access and Costs
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, updated in December 2021, outline the CMM team-based care process that can be implemented in a variety of health care systems to ensure positive patient outcomes.
SEE THE GUIDANCE | The Integration of Telehealth Delivery within a Comprehensive Medication Management Practice
Considering the advantages of telehealth and the future direction of health care, it is no longer a question of if telehealth needs to be implemented into practice; rather, it is a question of how to integrate tele­health and CMM services. Core to a plan is a patient care team that works together to achieve a goal of enhancing patient-centered care and medication optimization. Outlined are essential steps to integrating telehealth services and CMM practice: define what telehealth means for your practice, secure stakeholders, develop a team, equipment and software needs; assess costs and financial stability, educate staff, patients and caregivers, develop a workflow, measure health care outcomes and meet with your team regularly.
SEE THE GUIDANCE | Value Framework for Providing CMM in Telehealth
The escalation of telehealth has shed light on the opportunities that exist to increase patient access to care through virtual visits that extend beyond the traditional in-office visit. Included as an opportunity for telehealth is comprehensive medication management (CMM). This value framework, intended for health care team members, payers for health care services and health care policy makers, proposes a guide for providing CMM services via telehealth. Although obstacles to telehealth delivery of CMM exist, the bene­fits to providers, patients and payers outweigh the barriers. For sustainability of telehealth and CMM provided via telehealth, effort from multiple stakeholders is needed to address the challenges that exist.
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 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.
The GTMRx Institute is supported by our Founding Funders, Executive Members and Strategic Partners.
  See past issues of our weekly news brief here

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