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.
In the only literacy study of its kind, published just over a decade ago, health practitioners learned that more than a third of U.S. adults would have difficulty understanding basic health instructions. Since then, there has developed a plethora of literature around improving patient comprehension. One of the key ways to improve that communication is by simplifying your word choice. Using analogies to explain complex phenomena helps bridge the gap, too. This study identified some tools to consider when screening for health literacy among your patients. (Boston University has a simple four-question downloadable form to use to assess patient comprehension.) That communications gap is obviously even more challenging when patients have limited proficiency in the provider’s native language. The implications are immense both at the pharmacy counter and in other healthcare settings, like transitions in care, where patients with limited English proficiency experience longer hospital stays and more readmissions. Check out these approaches to better counsel such patients in the pharmacy.
Here are a few other stories that might be of interest:
Continuing education is critical to maintaining your edge in the pharmacy business. This list of pharmacy podcasts from Pharmacy Times inspired us to dig a little deeper for some wider-ranging, business-related podcasts you might enjoy—especially during the holiday next week. (By the way, the Weekly Roundup will not be published the day after Thanksgiving. We hope you enjoy a happy, grateful holiday with your loved ones!) ZigZag is a hodgepodge of stories around entrepreneurship from a new, woman-owned media company called Stable Genius Productions. It’s a little artsy and very genuine. Also, we regularly share stories from Harvard Business Review on these pages; their podcast, Ideacast, provides commentary from an impressive group of leaders in business, politics, science, and journalism. Finally, no list like this would be complete without mentioning The Tim Ferriss Show, covering tactics used by groundbreakers in a range of fields, from finance to sports to business and the arts.