Practice Transformation
President Biden last week announced a summer-long initiative to reach the vaccine-resistant. Outreach will become increasingly granular, and it will include going door-to-door and visiting places of worship. Primary care will play a large role: “My team is going to place renewed emphasis on getting the vaccines to more and more family doctors and health care providers so more Americans can get this shot at their doctor’s office from the folks that they know and they trust the most,” he said. The announcement represents an escalation of current vaccine push, The Washington Post reports. (The Washington Post)
The anticipated shortage of physicians and nurses may pale in comparison to that of the rest of the health care workforce, including medical assistants, pharmacy techs and administrative staff, STAT News reports. The post-pandemic spike in demand for medical services will exacerbate the problem. Roughly 50,000 jobs have been added to the health care sector since January, but it will take 500,000 jobs to get back to pre-pandemic levels. (STAT News)
Evidence & Innovation
A GoodRx analysis of chargemaster prices at 16 geographically diverse hospitals in the US showed that average prices for 12 commonly used generic drugs were up to 6,000% higher than the average prices in pharmacies. For example, aspirin has an average retail price of $0.15. For hospitals in the analysis, the average was $6 per tablet, and as high as $19 per tablet. Patients with no health insurance, those with high deductibles and those who receive treatment in out-of-network hospitals are ones who must pay the higher prices. (Becker’s Hospital Review)
Walmart will start selling its own private brand of analog insulin. It will cost $72.88 per vial and $85.88 per FlexPen, which the company said reflects prices that are between 58% to 75% lower than other insulin products on the market. This is the latest addition to Walmart’s private brand of diabetes products, ReliOn. It already sells a low-price version of insulin for about $25, but that is an older formulation that some doctors and advocates say is not as effective as newer versions of insulin— analog insulin. (CNBC; CBS News)
The US life expectancy continues to fall behind that of other countries, and one reason is COVID-19, according to research published in BMJ. “The US has experienced a massive decline in life expectancy in 2020 on a scale that hasn’t be seen since World War II,” says study author Dr. Steven Woolf of Virginia Commonwealth University. The life expectancy gap between the U.S. and comparable countries already increased from 1.88 years in 2010 to 3.05 years in 2018. Researchers found the gap substantially increased to 4.69 years between 2018 and 2020. (USA Today)
Policy Solutions
Skyrocketing prescription drug costs—and a 2020 SCOTUS decision—have led state legislatures to introduce bills targeting PBMs. More than 100 separate bills have been introduced in 42 states this year, according to the National Academy for State Health Policy, which crafts model legislation on the topic. A 2020 U.S. Supreme Court upholding Arkansas’ right to enforce rules on PBMs opened the floodgates, and at least 12 of the states have adopted new oversight laws. But it’s not yet clear how much—if any—money consumers will save. (Fortune)
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In Case You Missed It!
Leadership from GTMRx’s PGx Payment and Policy Taskforce and Payment and Policy Solutions Workgroup have created 5 policy recommendations on PGx + CMM that policymakers should consider to ensure that patient medications are managed safely and effectively based on the unique characteristic of an individual patients’ genetic profile, including:
- Add the assessment of patient medications and drug-gene interactions to Medicare (Welcome to Medicare visit) and Medicaid benefits,
- Require CMS to reimburse preemptive multi-gene panel testing as one single test with one standard compensation code,
- Require CMS to reimburse members of the care team trained to evaluate/manage all medications based on patient’s genotype, multi-drug interactions, Rx metabolism, etc.,
- Direct the National Quality Forum (NQF) to review and make recommendations on drug-gene interaction efficacy and safety checks prior/post admin of drugs within CMM,
- Recommend the U.S. Preventive Services Task Force evaluate evidence of PGx testing and CMM, for drugs with known drug-gene interactions, as a preventive health care practice that addresses patient outcomes/medical expenditures and that should be covered by ACA plans.
In addition to development of Vaccine Confidence Leagues (VCLs) and community-building activities, the task force’s recommendations include:
- Accelerated approval of vaccines
- Public education
- Payment reform
- Improved vaccine access for primary care practices
- More effective immunization information systems (IIS)
- No cost-sharing for certain patients
- Enhanced diversity, inclusion, and equity
Find the report Frequently Asked Questions here.
Read the report here.
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