Practice Transformation
CVS hiding the generics?
A recently unsealed whistleblower suit claims that CVS Health subsidiaries coordinated to prevent members from accessing generic drugs, according to Stat News. The whistleblower, Alexandra Miller, says that when she reported the behavior to a superior, she was told that the company had decided the benefits of the alleged scheme outweighed the likelihood of being caught. Specifically, she claims that the SilverScripts Part D subsidiary, the Caremark PBM and the retail pharmacies worked together to prevent access to generics; which allowed it to pocket higher rebates. CVS plans to “vigorously” defend itself. (Stat News; Fierce Healthcare)
Prior authorization battles in the spotlight
In the wake of an OIG report and as Congress moves ahead on legislation addressing prior authorizations in Medicare Advantage programs, advocates on both sides are becoming more vocal—and combative. “It’s really the number one frustration with the healthcare system,” says AMA president-elect Jack Resneck, MD. AHIP President Matthew Eyles counters with this: The AMA “seek[s] to undermine the valuable quality-improving, cost-saving, and waste-reducing tools of the program for their own financial benefit.” (MedPage Today)
Lee: Even Superman needs collaborators
“A strong working relationship between pharmacists and physicians is necessary to optimize personalized care. This team-based holistic approach, or collaborative care model, prioritizes patient safety, improves outcomes and helps reduce costs,” says Joyce Yu-Chia Lee, UC-Irvine health sciences clinical professor. UCI News interviewed Lee, who launched the CMM clinic at the UCI Health Family Health Center in Anaheim. “My 5-year-old son has the DC superheroes book, and the last page ends with the
statement, ‘Superman is strong, but together with the other DC superheroes, he is stronger.’ I associate the collaborative care model with this statement a lot.” (UCI News)
Evidence & Innovation
Medicare could have saved 3.6M on generics with Cuban
Researchers estimate that in 2020 alone, Medicare could have saved $3.6 billion less on generic acid reflux, cancer and other drugs if purchased through Mark Cuban’s Cost Plus Drug Company rather than through the network of private insurance plans and retail pharmacies that operate the program; according to the paper published in the Annals of Internal Medicine. “It’s clear Medicare is overpaying for some generic drugs, and that they could save billions,” lead author Dr. Hussain Lalani tells the Wall Street Journal. “There are some serious inefficiencies in the pharmaceutical supply chain.” (Wall Street Journal; Annals of Internal Medicine)
Policy Solutions
Will nanotech save us from antimicrobial resistance?
Nanotechnology has the potential to effectively detect antimicrobial resistance, AZoNano reports. It would, according to the publication, be a “revolutionary” development in the battle to stay ahead of superbugs. Nanosensors, which use nano-materials such as gold nanoparticles, may be quicker, cheaper and more sensitive than existing molecular methods for diagnosing antimicrobial-resistant infections in patients. (AZoNano)
90% of employers addressing mental health
Roughly 90% of employers surveyed in Wellable Labs’ 2022 Employee Wellness Industry Trends Report expressed increase investment in mental health programs. They have good reason, Modern Healthcare reports: It improves the bottom line. Employees with unresolved depression see a 35% reduction in productivity, according to the American Psychiatric Association. Depression among the workforce costs the U.S. economy roughly $210.5 billion a year — in reduced productivity, absenteeism and medical costs. (Modern Healthcare/Crain’s Detroit Business)
In Case You Missed It!
GTMRx SPONSOR/SPEAKER: VIRTUAL NATIONAL PRIMARY CARE TRANSFORMATION SUMMIT JULY 26-29. FREE REGISTRATION FOR CLINICAL PHARMACISTS AND PHYSICIANS ($1095 VALUE!)
GTMRx is a proud sponsor of the Virtual National Primary Care Transformation Summit, which will take place July 26-29, 2022. The event will feature in-depth conversations and discussions with leaders from CMS/CMMI, VillageMD, Aetna/CVS, Humana, United/Optum, Boeing, Google, Walgreens and others involved in primary care transformation. As a sponsor of the event, we have arranged free registration for a number of clinicians to include NPs, PAs, clinical pharmacists, and primary care physicians (regularly an up-to $1,095 value).
If you qualify, you may register using our special link here: https://registration.eventsair.com/2022pctsummit/pct-comp-gtmrx/Site/Register.
Don’t Miss! After registering, be sure to catch our virtual panel discussion on Friday, July 29, 2022 from 11:15am – 11:00am ET. GTMRx Mini Summit 28: Integrating Pharmacists into Advanced Primary Care: A Better Way to Manage Medications
Faculty:
- Katherine H. Capps, Co-Founder, Executive Director, GTMRx
- Julie Ceno-England, MD, Chief Medical Officer, OneOme
- Steven W. Chen, PharmD, FASHP, FCSHP, FNAP, Associate Professor, Associate Dean for Clinical Affairs and Heeres Chair in Community Pharmacy, USC School of Pharmacy
- Michael Hochman, MD, MPH, Chief Executive Officer, Scan’s Homeless Medical Group; Inaugural Director, USC Gehr Center for Health Systems Science & Innovation
- Mitchell A. Kaminski, MD, MBA, Program Director, Population Health, Jefferson College of Population Health
New Episode of Voices of Change Out Now | Alliance for Medication Management: Work in Washington State
An innovative care coordination system is emerging in eastern Washington State. Empire Health Foundation is providing funding to develop and implement a care coordination system that brings pharmacists and care coordinators together to simultaneously address medication related problems and the associated social determinants of health that are impacting the patient’s ability to achieve the intended benefits from their medications. The program is designed to support and supplement the primary care provider’s care plan and identify potential medication related problems, social barriers and behaviors that reduce medication effectiveness.
The program is called Medication Care Coordination or MCC and has been developed as a collaboration between Empire Health Foundation, Aging and Long-Term Care of Eastern Washington (ALTCEW), Rural Resources Community Action (RRCA) and Medication Review, Inc (MRI).
The Washington State University School of Pharmacy is providing academic resources in support of the program and has generated several articles on the findings from early pilots. The Alliance for Integrated Medication Management (AIMM) is providing strategic program design, management development and implementation support to program partners.
Host Katherine (Katie) Capps talks to Jeri Rathbun, Empire Health Foundation; Dr. Bob Crittenden, Health Policy Advisor; and Dr. Candace Anderson, Pharmacists, Medication Review, Inc. Take a listen.
GTMRx Workgroup Update
On June 23, the GTMRx Physician Advisory Group had their fourth meeting featuring a briefing with GTMRx’s ERIC strategic partner James Gelfand, JD, co-president, ERIC (ERISA Industry Committee). GTMRx has formed a consultative/strategic partnership to drive advocacy to support GTMRx initiatives and goals focused on enhancing GTMRx opportunities on the demand side (employers as health plan sponsors/ consumer groups).
During the meeting, the group also heard from GTMRx executive physician advisor Michael Barr, MD, MBA, MACP, FRCP, president, MEDIS, about the themes seen across the results from the GTMRx physician survey and how the results support an action-oriented agenda.
GTMRx Webinar: Building, Managing and Sustaining Your CMM Practice June 22
Where is CMM available? What quality measures are being used to evaluate the value of CMM? What do CMM staffing models look like? How mature are CMM practices and what are the various needs based on stages of maturity?
Hear from, M. Shawn McFarland, PharmD, FCCP, BCACP, Veterans Health Administration, on early findings from the GTMRx National Registry of CMM Practices.
Learn from organizations at various lengths of maturity shedding light on the benefits of a more widely adoption of CMM and the challenges of getting there:
- Early stage CMM practice (1-2 years) — Sara Maki, PharmD, BCACP, NorthMemorial Health
- Mid-level stage CMM practice (10+) — Richard Bone, MD, Advocate Medical Group
- Fully mature CMM practice (20+) — Amanda Brummel, PharmD, BCACP, University of Minnesota
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.
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.
