Practice Transformation
A path forward? PBMs as a fiduciary
PBMs could provide employers with the transparency they need into employee drug prices and help them save money. How? By agreeing to serve as a fiduciary, writes David A. McKay who spent 20 years representing self-funded plans in audits and litigation against PBMs. “By agreeing to serve as a fiduciary, a PBM can commit to putting the employer’s best interests ahead of the PBM’s profits when negotiating with pharmacies and drug manufacturers and setting prescription drug prices. The reluctance to make such a commitment by many PBMs could be part of the reason behind escalating drug costs.” (BenefitsPro)
Meanwhile: No FTC study of PBMs
Because of a deadlocked (2-2) vote, the FTC will not study PBM’s impact on independent and specialty pharmacy operations. After hours of testimony by community pharmacists and patients, “all of whom painted the same shocking picture about PBM abuse… it is inexplicable that two members of the commission could vote against the study,” Douglas Hoey, CEO of the National Community Pharmacists Association, said in a statement. Commissioner Christine Wilson, who opposed the study, stated: “I am wary of having the FTC used as a pawn to boost the profitability of certain sectors or insulate them from competition.” (Fierce Healthcare)
Employers want to fix health care
In an opinion piece for MedPage Today, Elizabeth Mitchell, CEO of Purchaser Business Group, and author/consultant/futurist Ian Morrison, PhD, discuss how large employers are trying to fix health care. “Large employers are no longer willing to … continue to extend blank checks to hospitals, doctors, health plans, and consultants with no regard for quality and proof of outcomes.” Rather, they are “thinking about how to create a new, high-functioning vehicle by pushing fundamental changes in the way clinical services are conceived, priced, and delivered” in five areas, including setting standards, resisting provider and payor consolidation and holding intermediaries to account. (MedPage Today)
Evidence & Innovation
2020 saw fastest year-to-year jump in health costs since 2002
Spending on health care rose 9.7% in 2020 to $4.1 trillion in 2020. Compare that to the 4.3% increase in 2019; it’s the fastest year-over-year jump since 2002. Almost all of that came from federal spending as the government mobilized to contain the spread of the virus. Federal spending in categories like assistance to health care providers, public health programs and Medicaid payments jumped 36% in 2020. At the same time, the US GDP declined 2.2%, and the share of the economy devoted to health care spending spiked, reaching 19.7%. Out-of-pocket spending dropped by 3.7% in 2020. (Health Affairs; Politico)
Burnout worse; team-based care can help
Nearly half (47%) of physicians reported feeling burned out in 2021 vs. 42% in 2020, according to Medscape’s Physician Burnout and Depression report. Emergency medicine topped the list with 60%, followed by critical care (56%) and OB-GYN (53%). Tying for fourth with 51%: family medicine and infectious diseases. Want to help? Leaders from the Institute for Healthcare Improvement and the Henry Ford Health System shared five recommendations in the Harvard Business Review. Among them: team-based care. “Well-executed, team-based care honors clinicians’ level of training and reduces the time and effort clinicians spend on the administrative tasks that they so often find physically and emotionally depleting.” (Medscape Report; HBR)
Policy Solutions
Study: Copay coupons increase spending on couponed drugs
Drug copay coupons may save patients money, but they significantly increase amounts paid by insurers and employers, according to a study by the National Bureau of Economic Research. (The study has yet to be peer-reviewed.) Looking at MS drugs, the research team estimated coupons raise negotiated prices by 8% percent and result in about $1 billion in increased U.S. health care spending annually. Overall, their findings suggest copayment coupons increase spending on couponed drugs without bioequivalent generics by up to 30%.(NBER-PDF; Becker’s Hospital Review)
In Case You Missed It!
The Right Drug Dose Now Act Introduced Feb. 28, 2022
Yesterday, the GTMRx Institute issued a letter of support for the Right Drug Dose Now Act. (See the press release from Congressman Swalwell here.)
GTMRx’s Precision Medicine Enablement via Advanced Diagnostics Workgroup invited congressional staff from the Personalized Medicine Caucus to present on draft PGx legislation underway on two occasions. The Personalized Medicine Caucus, co-chaired by Representatives Tom Emmer (R-MN) and Eric Swalwell (D-CA), engages members in a constructive dialogue about legislative and regulatory policies that can help realize the full potential of personalized medicine. The recommendations that came out of these discussions were put into our Letter to the Personalized Medicine Caucus Co-Chairs—Representatives Tom Emmer (R-MN) and Eric Swalwell (D-CA)—on the Right Drug Dose Now Act.
Some of the GTMRx recommendations to the Caucus included:
- Incorporating comprehensive medication management definition and language.
- Combining PGx testing with the CMM process of care.
- Expanding implementation of EHR guidelines, education awareness campaigns, and reporting.
- Clarifying the definition of adverse drug events.
New Podcast Episode: Jessica Lea, PharmD
Host Katherine H. Capps talks to Tria Health CEO, Jessica Lea. As a trained pharmacist, she brings 20 years of knowledge and expertise in managed care and pharmacy benefits and is an advocate for the pharmacists’ role in improving outcomes. Her background in academia and numerous pharmacy achievements continue to fuel her passion of providing patient-centered care that results in optimal health outcomes.
In the episode, she offers guidance to employers as health plan sponsors to develop a “Buy Right Strategy”—an educational outreach program to educate employers about a new process of care to ensure medication are safe, effective and appropriate for their employees.
A Comprehensive Overview of the Institute, It’s Vision, Mission and Leadership
The Get the Medications Right Institute is working to decrease misuse, overuse and underuse of medications and avoid waste by advancing comprehensive medication management to ensure appropriate and personalized use of medications and gene therapies. Learn more in this brochure.
Interested in supporting our work?
Please contact Jeff Hanson (e: [email protected])
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.
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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.
