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Practice Transformation

Pharmacy benefit plan sponsors could lower drug spending and out-of-pocket costs by reducing the use of high-cost, low-value drugs, according to a Commonwealth Fund analysis. Researchers also analyzed prescription drug data from 15 large self-insured employers to identify prescription drugs with high prices that have no proven clinical value over similar drugs with lower prices. They found $63 million in potential annual savings. The conclusion: “Plan sponsors could lower drug spending and out-of-pocket costs for enrollees by reducing the use of high-cost, low-value drugs on formularies. Savings could be achieved by improving pharmacy benefit design and management.” (Commonwealth Fund)
Administering pricey specialty drugs in doctors’ offices and patients’ homes instead of hospitals could reduce drug costs by $4 billion a year for insurance plans, according to a study from UnitedHealth Group. “Compared to independent physician offices, hospitals charge more for specialty drugs and their administration, whether treatment takes place in a hospital facility or in a hospital-owned physician practice,” the study said. (FierceHealthcareUHG infographic)

Evidence & Innovation

Neurological side effects from the anti-seizure medication phenytoin are more common in patients with variants of the CYP2C9 gene. This suggests the variants may play a role in patients finding the right medication, according to research published in Pharmacogenetics and Genomics. Variants of the CYP2C9 gene can cause different patients receiving the same dose of phenytoin to have blood levels of the drug that are too high or too low. “CYP2C9 variation was associated with clinically meaningful differences in clinician prescribing practice and patient response, with potential implications for healthcare utilization and treatment efficacy,” they concluded. (Pharmacogenetics and GenomicsKaiser Permanente announcement)
Cigna has launched a service designed to mitigate the high cost of emerging gene therapy treatments. The Embarc Benefit Protection platform brings together expertise on medical management, health services and specialty pharmacy from Express Scripts, eviCore, Accredo and CuraScript SD. Consumers who are covered will have no out-of-pocket payment related to cost of the medication. Organizations that enroll “will be protected from the price shock of high-priced medicines,” according to Cigna. (FierceHealthcareannouncement)

Policy Solutions

The FDA must guard against bias in AI and focus on patient outcomes. That’s the message from the AMA. Specifically, the FDA needs to recognize the risks of software as a medical device (SaMD) that uses machine learning. The agency should incorporate a focus on patient outcomes as a “foundational requirement” of technology development, physicians say. The AMA detailed its concerns in a letter to the FDA.(AMA Digitalletter)
Congress is back and both parties are ready to take on drug pricing and related issues. Who will do what? When? What are the options? The Washington Post offers an overview and analysis. While much is in the air, one thing seems clear: Once January arrives, everyone will be focused on campaigns and not much will get done. (Washington Post)
Free, Live, GTMRx Institute Webinar
Core tenets to implement CMM in primary care:
Getting the medications right
September 26, 2019 | 1- 2 p.m. EDT
Presented by:
The evidence is clear: comprehensive medication management (CMM) is good for patients as well as for the pharmacists, physicians and others involved in their care. Through CMM services, we have a team-based, systematic approach to ensure medications are safe, effective and appropriate for every patient. Now we need to know how to implement it consistently across primary care teams. This webinar will offer a customizable blueprint for delivery of CMM and demonstrate how it improves work-life balance for primary care providers. It will include strategies learned from practices in the field and showcase evidence-based tools practices can use to implement CMM.

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