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Practice Transformation

Some 29 million Americans over age 40 are taking an aspirin a day to prevent heart disease, but it’s likely causing more harm than good. Research shows only marginal or no benefit at all for older adults to take aspirin to prevent undiagnosed heart disease. But daily aspirin users have a significantly higher risk of digestive tract bleeding. The American Heart Association and American College of Cardiology published new standards in March on the issue, but researchers say it’s up to doctors to advise their patients to quit taking aspirin. (The New York Times)
A Senate bill would allow for chronic disease prevention services—including medications and care management—to be covered before consumers reach their health plan deductibles is good news for employers. High-deductible health plans, which have become more prevalent in both the independent and employer-based markets, mean a patient with chronic illness thinks twice about accessing preventive care or engaging in some employer-sponsored programs. By removing this financial barrier, employers are likely to see an increase in use of services that, in the long run, manage chronic disease and mitigate the need for higher-cost care. (Benefits Pro)

Evidence & Innovation

Consumers can now deduct $117.74 of the $199 cost of a 23andMe direct-to-consumer DNA test and use health savings and flexible savings accounts to pay for it. The Internal Revenue Service ruled that, for tax purposes, the test is medical care. The company’s test includes a report estimating the consumer’s chance of getting type 2 diabetes, some forms of breast cancer and Parkinson’s Disease, among others. But it differs significantly from a genetic profile ordered from a medical practitioner. With the price cut, observers say it’s likely more people will get the test. (Bloomberg Law)
An entire class of Alzheimer’s disease drugs won’t work on three out of four patients because of a genetic factor, researchers found. The genetic factor isn’t present in animals, explaining why the medications failed when research moved to the human testing phase. The findings are an argument for personalized medicine and genetic testing for Alzheimer’s disease, since one drug might work for one in four patients, but a different drug works for the other three. (HealthIT Analytics)

Policy Solutions

A Medicare and Medicaid proposal that cleared the Senate Finance Committee last week aims to deposit billions in pharmaceutical rebates into Medicare’s budget while incentivizing drug companies to keep prices in check. The bill includes capping the out-of-pocket maximum Medicare beneficiaries pay. There is also a requirement for health plans to provide a “real-time” online tool that provides pricing and formulary data to doctors at the point of care, allowing physicians to view the prices patients pay when they prescribe a medication. (ReutersBecker’s Hospital ReviewU.S. Senate Finance Committee)
Last week, the Food and Drug Administration approved a biosimilar for Humira, an injectable medication to treat rheumatoid arthritis, Crohn disease and other painful conditions. Hadima has been available in the European Union for some time. Although FDA-approved, Hadima won’t be available until June 23, 2023 in the U.S. under the terms of a patent litigation deal with Humira’s manufacturer, AbbVie. The retail price for a month’s dosage of Humira tops $6,000. (Center for BiosimilarsGoodRx)
Coming soon: Focus On calls for members   
The GTMRx Institute is now more than 350 members strong! Our Work Groups are forming, education opportunities are growing and we’re raising awareness with key stakeholders. Stay tuned for more information about joining brief, weekly “Focus On” membership calls designed to keep you up to date on our activities.
Register today for FREE, live webinar
Pharmacogenomics: Lowering costs, improving outcomes through personalized medicine
August 7, 2019 | 1- 2 p.m. EDT
Pharmacogenomics considers the role of the genome in drug response. It combines pharmacology and genomics, considering how the genetic makeup of an individual affects his/her response to drugs.
Today, more than ever before, we have the ability to target the right drug to improve a patient’s quality of life while also eliminating waste from non-optimized medications. This webinar provides an overview of pharmacogenomics and will showcase an employer case example of the opportunities and savings available to employers and health plans through integration of personalized medicine into benefits plan designs. Read more. Registration is limited to 500 people. Register now.

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