Study: PGx+CMM reduces utilization, saves employers money
A study in The Pharmacogenomics Journal found that pharmacogenomics-enriched comprehensive medication management (PGx+CMM) can reduce healthcare utilization and offer cost savings for self-insured employers. The 26-month study, using a propensity-matched pre-post design, revealed a 39% reduction in inpatient and emergency department visits and a 21% increase in outpatient visits among program participants compared to a control group. These findings suggest that PGx+CMM may improve employee healthcare outcomes and offer economic benefits, making it a viable option for self-insured employers, according to the authors (The Pharmacogenomics Journal )
Will CVS split up? Who gets custody of PBM?
CVS Health, facing investor pressure to improve performance, will lay off approximately 2,900 employees, primarily in corporate roles, as part of a $2 billion cost-cutting initiative. But the company is reportedly exploring more drastic options, including a potential separation of its retail and insurance divisions. This could result in the creation of two publicly traded companies—but nothing has been finalized. One key question that needs to be resolved in the event of a split: Will the pharmacy benefits manager unit be housed within the retail division or under the insurance business? (Reuters; KFF Health News)
Practice Transformation
Congress leaves much healthcare work undone
Congress has departed DC until after the election, leaving several critical healthcare issues unresolved. Key priorities include reauthorizing and funding community health centers, extending telehealth authorities, and addressing $8 billion in Medicaid Disproportionate Share Hospital payment cuts. Other urgent matters are mitigating a 2.9% reduction in Medicare physician reimbursements and renewing telehealth authorities. Some resolutions will depend on the election’s outcome. According to Modern Healthcare, some issues have bipartisan support and may be resolved before the end of 2024, including measures to rein in pharmacy benefit managers. (Modern Healthcare)
FTC takes action against three PBMs
PBMs have exploited this system to their advantage, at the expense of the patients, according to the Federal Trade Commission. It announced last month that it had lodged an administrative complaint against the three largest pharmacy benefit managers, accusing them of inflating insulin prices and steering patients toward higher-cost insulin products to increase their profits. The legal action targets CVS Health’s Caremark, Cigna’s Express Scripts and UnitedHealth’s Optum Rx and subsidiaries they’ve created to handle drug negotiations, agency officials said. The three collectively control 80% percent of prescriptions in the United States. (The New York Times)
Evidence & Innovation
Tech issues contribute to medication errors
Technology-related errors (TREs) were a significant problem in a pediatric hospital’s computerized physician order entry (CPOE) system: 32.5% of prescribing errors were linked to technology, according to research published in the Journal of the American Medical Informatics Association. The study revealed that TREs accounted for a substantial portion of errors over the four-year post-CPOE implementation period. TRE rates declined initially but stabilized at 1.11 errors per 100 orders. Common TREs included incorrect selections from drop-down menus and system configuration issues. High-risk medications like insulin and oxycodone were frequently involved. Only 32.7% of TREs had available clinical decision support to mitigate the errors. (Journal of the American Medical Informatics Association; Becker’s Hospital Review)
Policy Solutions
Preventive care claims denials hit at-risk people hardest
Denials of insurance claims for preventive care were more common among at-risk populations, including low-income patients, those with a high school degree or less, and those in racial and ethnic minority groups, according to research in JAMA Network Open. The cohort study of over 1.5 million patients found that these denials, which should be cost-sharing exempt under the ACA, perpetuate inequitable access to high-value healthcare. “This study adds to the policy discussions around promoting equitable access to primary health care, including preventive services.” (JAMA Network Open; MedPage Today interview with author)
