Can you hear me now? Since Congress authorized OTC hearing products last August, you may have begun to field questions about what’s right for your patients. The AARP, which undoubtedly has the ear of many in this population segment, is touting the ruling as a big win. The news has been positioned as middle-ground for consumers, a balance between the high cost of prescription hearing aids with some of the quality protection afforded by regulation. Clearly an OTC solution is not right for every patient. Audiologists like Jaynee A. Handelsman, Ph.D., director of pediatric audiology at Michigan Medicine at the University of Michigan, have opposed the law, saying "the best approach for consumers to address hearing loss is to seek the services of a licensed and certified audiologist.” But pharmacists can play a positive role
Here’s some hot-off-the-press, not-so-surprising news: independent pharmacy margins on average continue to decline, and pharmacy owners’ profits were also down in 2017, as reported by supply chain pundit Adam Fein. The NCPA—which produces most of the numbers Fein relies on each year in its annual NCPA Digest—takes pains to highlight some of the rosier aspects of the numbers. After all, the number of independents has remained fairly steady over the past 10 years at about 22,000. What’s more, independents reach a clearly underserved market: 81 percent of independent community pharmacies are situated in population areas of 50,000 or less and provide counselling and adherence services where none would otherwise be provided by mail-order or chain pharmacies.
The economic reality of the raw numbers point to a familiar issue: how can pharmacists measure services that provide value but are not necessarily compensated for—or more to the point, what can be done to change that?
‘Tis the season to resolve to do this-or-that to better ourselves, our families, business, and community. You’ve no doubt seen the headlines ad nauseam all weekend. Turns out you don’t have to read them all—we’ve done it for you. Here are some suggestions from around the web to get your ideas percolating.
The American Hospital Association took the U.S. Department of Health and Human Services to task for a proposed $1.6 billion cut in Medicare payments this month in a case that may be decided before the new year. At the center of the litigation is the proposed adjustment of payments that would have gone into the 340B program. The 25-year-old program was signed onto by George Bush. It’s a federal program that lets certain hospitals buy significantly discounted drugs from manufactures. The expectation is that those savings are then pushed into programs that improve access to treatment and create more robust clinical programs for vulnerable patient populations.
There seems to be a lot of public attention on mental health management this time of year. (Perhaps I just notice it as a result of the annual bout against waning daylight which with those of us living in the northern climes must contend.) Regardless, this report caught my eye, and you can find the video of the press conference here. It highlights a range of recommendations for improving care via better coordination of service among agencies, providers, and other stakeholders. Sound familiar?
The biggest news in pharmacy lately has no doubt been the announced merger of CVS with Aetna. The participants say the merger will improve healthcare, which is an interesting spin considering M&A 101 has taught us that mergers are most often about growth, expansion, and profit.
David Mitchell, the founder of Patients for Affordable Drugs, is certainly skeptical that consumers would see much benefit. According to The New York Times, “They’re not doing this to provide better care to people. They’re doing this to make more money.”
That’s the million-dollar question...
The epic “he said, she said” of who’s to blame for drug prices continues with some reporting that it’s taking over significant congressional bandwidth. Part of the complexity of the pricing question headlining congressional inquiry is, of course, what pricing they are actually talking about. A report issued by pharmaceutical industry organization PhRMA—which, unsurprisingly, doubled down on its stance that the middlemen are at fault for skyrocketing drug prices—makes the case that there is “no one price” for prescriptions. What’s more, it says, a multitude of rapidly changing market factors are impacting price, among them: the rise in specialty medications (high dollar, narrow market); the shift from brand to generic; employers moving patients to higher-deductible plans; and the rapid rate of consolidation among the players in the supply chain.
“While consolidation [of PBMs and health plans] may lead to more efficient payment and distribution models, it also raises questions about whether incentives are appropriately aligned across all stakeholders and whether plan sponsors have sufficient expertise and visibility into contractual arrangements to make good purchasing decisions and protect their interests.”
There can be little doubt that the report is not coming from a place of perfect neutrality—after all, the evolving healthcare landscape is a heated turf war, and big pharma continues to point a loaded finger at PBMs. While pharmacists are not described as “a middleman,” there is no doubt that independents get the sensation of being stuck in the middle. Still, it’s an interesting read. Check it out here.
Here are a few other stories that might be of interest:
This week I was reading some recently released statistics on the geographical demographics of physicians post-residency and some of the ways in which individual states are working to retain physicians. (I’d work in Alaska in exchange for student loan forgiveness, but apparently, they don’t need writers so much.) Granted, the physician shortage is not news. While the number of new graduates to primary care has remained fairly steady over the past 10 years, those primary care providers are typically NOT settling outside the cities, leaving a huge care gap—especially in rural areas. When it comes to specialists and mental health providers, the picture is even bleaker.
Inside the pharmacy community, that shortage is seen and understood to be an opportunity. In the mainstream outside the community, that visibility is lacking and other providers are getting the nod: nurses, PAs, pay-as-you-go retail clinics; military personnel; and technology. While the mainstream media is finally starting to get fed important “insider-to-pharmacy” information about DIR fees, pricing, and PBMs, we can’t forget that there is more to the story. Here are just a few salient talking points: