Author: Peter

Teens seeking to buy emergency contraception at pharmacies continue to face significant roadblocks…Researchers checking on the accessibility of the “morning after pill” at pharmacies in four Southwestern states found that just 28 percent made it simple and straightforward for teens to purchase the emergency contraception, according to the results published in the Journal of Adolescent Health…Despite the FDA ruling . . . that emergency contraceptives should be sold over-the-counter without age or identification restrictions, this is not being fully implemented into the pharmacy setting as anticipated…

CVS is piloting a program in Boston that includes free delivery on most prescriptions and online purchases, access to a pharmacist helpline, a 20 percent discount on all CVS-branded products and a monthly $10 coupon. Called CarePass, a membership costs $48 annually or $5 monthly, less than half the price of a Prime membership...CarePass is a bold attempt to fight Amazon — and may even put the retailer ahead. CarePass bundles prescription drug delivery with everyday items — something Amazon doesn't yet do.

Amgen is cutting the list price of its cholesterol drug Repatha by 60% to $5,850 in an unprecedented move to make the drug available to senior citizens...“We’ve got to make sure those who need [Repatha] can get it,” says Robert Bradway, Amgen’s chairman and chief executive. “The losers are the patients who have gone to the pharmacy counter and have not been able to get the medicine they need, and that’s what we need to address as a company, as an industry, and as a society.”...Cardiologists have complained that it has been tremendously difficult to get insurance plans to pay for the drugs, which lower...low-density lipoprotein...This decision will open up access to the most effective LDL-lowering therapy to a much larger group of patients and that has major positive public health implications.”

Food and Drug Administration Commissioner Scott Gottlieb stressed the need for reform on the reimbursement side of medicine, calling it an "ossified paradigm" that could weigh on cutting-edge therapies like CAR-T cancer therapy..."There are places where I am extremely worried that if we don't adapt the approach to reimbursement soon, we may foreclose therapeutic opportunities,"...The FDA head referenced how radiopharmaceuticals were treated in reimbursement, "underpaying hospitals and forcing them to lose money." Gottlieb warned the same thing is happening now with CAR-T.

Laura Joszt, Managing Editor at The American Journal of Managed Care. Welcome to This Week in Managed Care from the Managed Markets News Network

Campaign contributions from pharmaceutical companies named in lawsuits filed by the state and several local governments have largely dried up this year...The pharmaceutical industry — long one of the biggest political players in the country, donating tens of millions of dollars to candidates and politicians at all levels of government — has contributed less to state-level candidates this election cycle despite contributing nearly $1 million to various candidates and PACs over the past decade...Seven of the 14 pharmaceutical companies implicated in a Clark County opioid lawsuit that had donated more than $934,000 to state level candidates or party committees have been easing off, and only two named companies — Johnson & Johnson and Purdue Pharma — continued to donate any money after those lawsuits were filed...

The Centers for Medicare and Medicaid Services issued a proposed rule...that would allow Medicare Advantage plans greater flexibility to offer telehealth benefits...The proposed rule would also update the Star Ratings methodology, streamline benefits for Dual Eligible Special Needs Plans and give auditors more latitude to recover improper payments. In doing so, the agency would codify multiple sections of the Bipartisan Budget Act of 2018 passed earlier this year...Perhaps the biggest change, which would take effect in 2020, would allow plans to offer "government-funded" telehealth benefits to all members whether they live in rural or urban areas. Beneficiaries could also receive telehealth services in their home rather than a medical facility...Industry groups have been clamoring for the government to rethink the limitations around telehealth reimbursement that limited services to rural patients...CMS suggested the telehealth provision may steer more Medicare enrollees toward MA, since traditional Medicare’s telehealth benefits are somewhat limited by location and clinical need...

Nicole Grassano, PTNN, Pharmacy Week in Review, this weekly video program provides our readers with an in-depth review of the latest news, product approvals, FDA rulings and more.

Nevada may have lost more than $2.1 million because of overbilling, fraud and overall lack of oversight of the same community homes that were found earlier this year to be providing squalid living conditions to the state’s most vulnerable residents...the state’s Division of Public and Behavioral Health likely lost up to $1.5 million in possible overpayments because of overbilling from providers of so-called community-based living arrangement homes for people with mental illnesses — and lost another $600,000 because of a discrepancy in rates paid for similar services...The financial audit...identified various questionable and potentially fraudulent billing practices by those operating the homes, including billing more hours than those recorded on time sheets, reporting serving more than one client at the same time, charging for duplicative services and paying different rates for similar services from various providers...

President...Trump...announced a new payment model that would more closely align the cost of Medicare Part B drugs with the prices paid for the same drugs in other countries...As they unveiled the "International Pricing Index" model, federal health officials projected the proposal could save Medicare more than $17 billion over the course of a five-year pilot. The Centers for Medicare & Medicaid Services currently pays the average sales price plus 6% for Part B drugs, and in the new proposal would instead pay a target price based on international prices and look to alternatives for the add-on fee...Medicare currently pays about 180% more than other countries for drugs in Part B, which includes pharmaceuticals that are administered in a clinical setting, HHS Secretary Alex Azar said. Through the IPI model, HHS is looking to bring that figure down to 126%.