Chronic disease is both the cash cow and the nemesis of the healthcare team—depending on whose bleachers you’re sitting in to watch the game. The CDC reports that diseases such as diabetes and hypertension consume more than 85 percent of healthcare spending in the US. In the pharmacy community, we talk at length about how chronic care management can impact our bottom line and improve patient outcomes. It’s clear that collaboration is at least part of the answer.
Thursday’s announcement that Amazon was purchasing small New Hampshire-based mail-order pharmacy PillPack hit insurer, chain, and PBM stocks hard. The deal was an accelerated bid to acquire licensure nationwide (almost). PillPack was founded to address patient confusion over taking multiple medications by shipping dosed prescription packages. Interestingly, in 2016 the company fought and won a tussle with Express Scripts, who alleged that the company misrepresented their services and had dropped them. The acquisition, expected to close in late 2018, is another clear sign that Amazon is taking its foray into health care seriously. The disruption continues apace and certainly bears watching. To date, commentators seem focused on the supply chain and scalability aspects of their entry into the market, and few are talking about its impact on patient care. Independents are also watching and waiting but one thing is sure: they’re used to the competition.
In a world of health plan-owned PBMs that leave the anti-trust crowd gnashing their teeth, it’s hard to be surprised when patent squabbles mire the path of generics to market. Last month’s wrist-slap by the FDA may signal a shift in attitude, but it remains to be seen whether outing branded pharmaceutical manufacturers will stop their practice of delaying generic launches—or, as proponents of the practice refer to it, “managing the patent lifecycle.” Last week, the FDA approved a generic version of Suboxone, a combination of buprenorphine and naloxone that has been used extensively to treat heroin addiction and is touted for reducing cravings for and withdrawal symptoms from opioids.
The newly authorized generic was supposed to be sold by Mylan N.V. and Mumbai-based Dr. Reddy’s Laboratories SA. However, on June 19, mere days after getting the go-ahead from the FDA, Indivior, the manufacturer of Suboxone, convinced a US court that the generic infringed on its patent, and the New Jersey court issued an emergency temporary restraining order against its sale. The latest fracas is not the first for the UK-based company.
The media—and the public—has dialed up its attention to depression over the past few weeks in the wake of a number of high-profile suicides. According to the CDC, overall suicide rates have climbed sharply between 1999 and 2016, including more than 45,000 suicides reported in 2016 alone.
Prescription medications related to high blood pressure, acid reflux, and other conditions aren’t helping. According to Columbia psychiatry professor Mark Olfson, author of this recently released study, the more of these medications a patient is on, the higher the risk for depression as a side effect. So, pharmacists may find themselves in a dual role in the battle against mental illness among their patients:
It’s no secret that data is driving innovation in healthcare. From secondary uses of electronic health records to an explosion of direct-to-consumer genetic testing (despite its potential inaccuracies), data is creating a large pool of genetic information from which researchers can draw. For example, the radiology department at Johns Hopkins is culling a vast database of old CT scans to fuel current pancreatic cancer research. A 2017 study of internet trends notes a significant uptick in consumer use of digital apps to monitor or manage health.
Deciding who is David and who is Goliath in this fight is not an easy call. On Wednesday, the administration ended the lengthy congressional debate and signed so-called “right-to-try” legislation, giving terminally ill patients access to medications that have not been approved by the FDA. Senator Ron Johnson (R-WI), author of the bill, said in a letter to FDA Commissioner Scott Gottlieb that the legislation was “fundamentally about empowering patients to make decisions in cooperation with their doctors and the developers of potentially life-saving therapies” and “not to grant the FDA more power.”
In 2017, a Missouri nurse called in a prescription to a pharmacy technician following the discharge of a patient from the hospital. The tech erred in transcribing the prescription, the pharmacist didn’t catch the error, and the pharmacy system didn’t flag it. A month later, the patient was dead and the pharmacy plead guilty to negligence.
According to the FDA, medication errors harm 1.3 million individuals each year and kill at least one person a day. Healthcare costs from medication errors in the U.S. are estimated to be $21 billion per year. The repercussions of a mistake are enormous, which makes transparency about human error a challenge
The National Institute of Health has announced that its All of Us research program is open to all-comers, 18 years of age or older, nationwide. The program aims to advance precision medicine by expanding the collection of lifestyle, clinical, genomic, and electronic health records. The hoped-for applications of precision medicine research are broad: