A subcommittee of the House Energy and Commerce Committee heard testimony earlier this month on the human toll of rising insulin costs as a case study to better understand the impact on patients on prescription pricing overall. According to Rep. Brett Guthrie (R-KY 2nd District), “The prescription drug supply chain is complex, and it lacks transparency. There is limited public information around drug prices due to a lack of transparency around rebates and other price concessions.” The Kaiser Family Foundation recently reported that total Medicare Part D spending on insulin increased by 840% between 2007 and 2017, with no generics available and Eli Lilly, Novo Nordisk, and Sanofi dominating the market. In Minnesota, Attorney General Lori Swanson sued the three. While common wisdom (and massive advertising dollars spent by the Big Pharma lobby) justify high prices as attributable to the cost of R&D, rising insulin costs—which have been averaging 10 percent annually—may go a long way toward putting that argument to bed.
In the midst of an opioid crisis—and where substance abuse is in the headlines nearly every day—treating patients’ pain is a considerable challenge. In the case of cancer patients, for example, opioids remain the go-to, but there are additional approaches available, including drug therapies that change the mind’s perception of pain or those that block the pain signal from traveling to the brain. Researchers are also exploring gene therapies and approaches that juice the feel-good chemicals in the body.
In a close vote, an advisory panel has recommended that practitioners co-prescribe naloxone with opioid prescriptions, and the recommendation is currently under review by the FDA. Health and Human Services has echoed the recommendation, providing guidance to prescribe naloxone for individuals at risk of opioid overdose, “including, but not limited to: individuals who are on relatively high doses of opioids, take other medications which enhance opioid complications or have underlying health conditions.” Proponents have suggested the recommendation could promote a healthy dialogue between providers and patients. However, detractors like Mary Ellen McCann, associate professor of anesthesia at Harvard Medical School, think the measure is too expensive—and potentially ineffective.
After the acquisition of PillPack last year, Amazon has flown fairly low on the radar when it comes to its potential pharmacy business. Last week, however, the firm announced the hire of Nader Kabbani to run its fledgling pharmacy venture. Will the same Amazon executive who led Kindle to disrupt traditional book sales be the right fit for the new role? Possibly—and he’s not alone.
Even as a widespread outbreak of measles worries health officials in the Pacific Northwest, Facebook is under fire for spreading anti-vax messages via group recommendations. The algorithms that power websites where Americans get often inaccurate health-related information from, says Rep. Adam Schiff (D-CA), “are not designed to distinguish quality information from misinformation or misleading information, and the consequences of that are particularly troubling for public health issues.” The Wall Street Journal is reporting that another social platform, Pinterest, has stopped returning search results for “vaccination” in an effort to curb misinformation. Studies have even connected immunization with better heart health, which makes February a great time to talk with patients about vaccines like Tdap. Besides being a public health threat, there’s no doubt that immunizations create opportunities for both revenue—but what can pharmacists do to promote them, especially among the unscientifically inclined? Here’s a place to start: Check out this audio discussion with some of the misinformation surrounding vaccination, and feel free to share the link with your patients via email or across your social media feeds.
Here are a few other stories that might be of interest:
Earlier this month, Jessica Astrup Ehret, a pharmacist from our Sterling Pharmacy in Northfield, MN, testified before the Minnesota Senate on a bill that would provide greater oversight of PBMs. The goal is to increase visibility in the supply chain and eliminate PBM self-dealing. Pharmacists’ legislative involvement is critical to the success of measures like this one, according to Tony Post, director of government affairs for Smart-Fill. “Proprietors in independent pharmacy are fighting tooth and nail to make it in this business,” he said. “They need to get active, now, calling legislators and urging passage of bills like this in their states. They have a chance to make a dent.” Most state pharmacy associations have legislative trackers (like this one in Minnesota), or check out this resource to stay on top of legislation in your state and nationally.
This week, Stat News shared coverage of the “unchecked PBM industry” that is currently under scrutiny in New York by pharmacists concerned about spread pricing in the state’s Medicaid program. A Bloomberg analysis of the practice using Medicaid data reviewed the most common generics and found markups of approximately 32 percent. Of course, the practice is nothing new, but scrutiny seems to be on the rise, and some two dozen states passed attempts to weed out opaque pricing practices during the last legislative session. CVS was recently slapped for the practice when an audit in Ohio found that Ohio PBMs billed managed care payers $223 million more in 2017 than what they paid in pharmacy costs, prompting the state to move to a pass-through model.
From blood to sweat and tears, smart technology is changing the way diabetes is monitored and treated. Last spring, a continuous glucose monitor (CGM) that attached to the abdomen was the first of its kind approved by the FDA. Last summer, the development of a non-invasive smartwatch—which is purported to continuously and non-invasively monitor and track major chronic health risks, such as diabetes, cardiac arrhythmia, congestive heart failure, COPD, sleep apnea, and hypertension—was announced. Testing on a disposable skin patch is underway in Europe and the United States. Next up, perhaps a device that pinches the ear will make it through testing. It’s not always sunshine and rainbows, however. The afore-alluded-to smart lens that was the brainchild of a Google/Novartis team hit hard times and was abandoned late last year (see “tears” above). No one will easily forget the debacle at Theranos.