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.
With a reach of 32 million lives, Accountable Care Organizations are good testing grounds for new concepts and programs to improve the quality and delivery of healthcare. More and more, those organizations are relying on pharmacists to help them deliver results. Physicians are recognizing the expanded role—in wellness visits, transitions of care, servicing rural areas, ambulatory care, anticoagulant management, and diabetes care, to name a few. Collaborative care models get arguably more critica las patient disease states get more complex. Even the business press has identified the upside of team-based care.
However, change comes slowly to this profession—and it’s hard.
The lack of supply chain resilience in pharma is nothing new, and pharmacists and hospitals have been negotiating the problem for years. The task force set up in July that is focused on solving the problem has tossed out a range of solutions, including a national stockpile of critical medications. A retroactive study released last month of 1.3 billion prescription claims and a cohort of 1,114 generic drugs found that low-priced generic drugs were at a higher risk for drug shortages. Manufacturers have been quick to blame lack of regulatory clarity on the FDA. The FDA has said that it is playing with half a deck: It can’t force manufacturers to disclose the reasons for shortages. Chintan Dave, PharmD, PhD, Brigham and Women’s Hospital, Boston, MA, the study’s author, said: “In the short term, the FDA should recognize that very low generic drug prices might be a factor in subsequent shortages and continue to consider the risk of shortages when taking steps to promote the safety and quality of the generic drug marketplace.” Check out this discussion of the problem and some of its causes.
“Rural folks are older, poorer, and sicker,” Brock Slabach, MPH, FACHE, senior vice-president for the National Rural Health Association (NRHA) told attendees last weekend at the 2018 American Society of Health-System Pharmacists (ASHP) Midyear Clinical Meeting. With widespread hospital closures and the rate of rural poverty higher than that of metropolitan areas, healthcare delivery faces a broad range of challenges. Family practice residency programs like this one in Pennsylvania are taking a shot at the problem. For pharmacies, opportunities presented by the shortage include medication therapy management (MTM) and counseling for chronic diseases. Here are some ideas being implemented across the pond. Check out these best practices for engaging with physicians through transitions of care states. In some states, remote dispensing is also legal. Thinking about leveraging telehealth in your pharmacy? Here are some “golden rules” for starting a program in your pharmacy and some considerations for policy development along the way.