Practice Transformation
HealthPartners’ decision to close 30 retail pharmacies illustrates a significant change in the pharmacy profession: a move to the clinic. “So, I think going forward we will change to more of a clinical pharmacy focus,” Sarah Derr, executive director of the Minnesota Pharmacists Association, tells Minnesota Public Radio. “We’re really looking at ‘what can the pharmacist provide to the patient?’ and not focusing on the little technical steps of filling a prescription.” Future jobs will involve using pharmacogenetics to prescribe the right medication for a patient, she says. It will also involve working alongside physicians in the clinic. (Minnesota Public Radio)
PillPack’s branding changed from “PillPack, an Amazon company” to “PillPack by Amazon Pharmacy.” According to CNBC, this may indicate that the retail giant plans to expand its pharmacy ventures. The change represents the first public reference to Amazon Pharmacy. It could signal plans to enter other areas of the sector by serving patients with acute medical needs, or by adding a pharmacy to its retail stores–perhaps even Whole Foods. (CNBC)
Evidence & Innovation
UPMC Health Plan and Biogen entered into a value-based arrangement for two specialty multiple sclerosis treatments: Tecfidera (dimethyl fumarate) and Avonex (interferon beta-1a). Reimbursement will be linked to MS patient-reported progression of disability. Previous value-based contracts connected payments to things such as emergency department visits, hospitalizations and relapse rates. However, a UPMC study showed that patients, providers, pharmaceutical representatives and others ranked physical disability as one of the most meaningful outcomes of MS. (Becker’s Hospital Review; announcement)
Genetic tests are expensive, difficult for non-genetics-trained clinicians to correctly order and interpret—and growing in popularity The situation is exacerbated by a lack of specific billing codes to support claims adjudication and use of more complex tests such as multi-gene panels and whole exome or whole genome sequencing. Enter the laboratory benefit manager (LBM). A recent Health Affairs Blog post considers the growing use of third-party LBMs to manage laboratory test utilization—specifically, genetic testing. (Health Affairs Blog)
Policy Solutions
Medicare Part B premiums will rise nearly 7% next year to $144.60 per month. Deductibles also will increase to $198 next year, up $13. CMS attributed the increases to increased spending on medications—specifically, specialty drugs administered in physician offices. “These higher costs have a ripple effect, resulting in higher premiums and deductibles,” according to a statement from the agency. (MDedge; CMS)
CAR-T therapy for advanced blood cancers has shown promising results, including complete remissions in some patients—but its costs aren’t sustainable for hospitals, according to a commentary published in the Journal of Clinical Oncology. The list prices of CAR-T therapies range from $373,000 to $475,000, and hospitals incur other costs when providing the treatment. For example, patients are often briefly hospitalized after administration. Under the current Medicare repayment model, hospitals could lose up to $300,000 for each CAR-T treatment administered, according to the authors. (Becker’s Hospital Review; Journal of Clinical Oncology)
