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Practice Transformation

Dr. David Shulkin, former secretary of the Department of Veterans Affairs, counts the successful program to cure hepatitis C in the veteran population as one of the VA’s big successes. The program used a team approach with clinical pharmacists in the lead to identify, proactively reach out to and treat more than 100,000 veterans with a new medication therapy. (MediumVA announcement)
Providers use the Beers Criteria to check whether a medication is likely to cause an adverse reaction in a patient 65 years or older. When clinicians don’t consider the Beers List warnings—or when they ignore clinical decision tools that flag certain drugs for older patients—adverse events can occur. That costs money and harms patients. In this commentary, a clinical pharmacist discusses the need for vigilant Beers List use, and calls for better design of systems to minimize prescribing the wrong medication. “Emergency department–based clinical pharmacists can contribute to the critically important task of screening and preventing ADRs, and should be more widely utilized.” (JAMA Network)

Evidence & Innovation

Researchers in New Jersey are collecting a biobank of information comparing brain and blood samples of people in treatment for opioid use disorder and people who are taking opioids without addiction. The National Institute on Drug Abuse estimates that half of the risk of addiction is hereditary; this research aims to identify new genes that could be involved. In a few years, the research may help clinicians know which patients are more apt to become addicted ­before they write the prescription. (WHYY)
Those $200 steroid inhalers commonly prescribed to treat mild asthma don’t work for about half of those who use them. New research shows patients with a low level of eosinophils (a type of white blood cell) reacted the same with the inhaler as with a placebo. Because the test to differentiate “low Eos” from “high Eos” levels in patients isn’t common yet, they recommend doctors try a different therapy if patients don’t respond well to these inhalers—rather than just prescribing a bigger dose of a medication that doesn’t work. (UCSF research)

Policy Solutions

The world’s most expensive drug, Zolgensma, was approved by the Food and Drug Administration in May to treat a rare spinal disease. The gene therapy won’t feel the crunch of any legislation currently pending to lower medication prices, though, because proposals are primarily aimed at high-priced generics. Manufacturer Novartis AG has offered a five-year plan to cover the cost and is negotiating directly with insurance plans to link the price to its effectiveness. Health plans like Harvard Pilgrim have already said they’ll pay the price, as the benefits are worth it. (Roll Call)
The Health Resources Services Administration officially recommends the tests newborns receive at birth to detect serious illness that may occur in early childhood. But now, gene sequencing can predict the risk of hundreds more health conditions that may—or may not—surface over a lifetime. Should infants routinely be gene sequenced? How much information is too much? Based on HRSA standards, a new study informs future policy decisions about gene sequencing in infancy. It identifies and categorizes several hundred health risks that could be helpful for parents to know, prioritizing them for likelihood, timing of onset and whether there’s a useful treatment available. (Medical Life Sciences News;Journal of Pediatrics abstract)

June 19, 2019, 1-2 p.m. EDT | Comprehensive medication management is a team sport, with the potential to improve patient care and access while optimizing the skills of all clinicians on the team. The Veterans Health Administration has systematically integrated clinical pharmacy specialists into the care team to accomplish CMM for a range of chronic conditions. Join us for this free webinar featuringAnthony P. Morreale, Pharm.D., MBA, BCPS, FASHP, associate chief consultant for clinical pharmacy and policy for the Department of Veterans Affairs Pharmacy Benefits Management, and Julie Groppi, Pharm.D., FASHP, who will explore the practice model and outcomes of CMM integration, as well as the tools that support the team. (Register now)
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