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Nearly one in five hospitals mark up medicine prices 700 percent or more, according to a new analysis from The Moran Company, prepared for The Pharmaceutical Research and Manufacturers of America...This means that if a hospital purchased a medicine for $150, a 700 percent markup could result in patients being billed $1,050, according to the study. And the analysis also found that 320 hospitals – eight percent of those included in the study – marked up some medicine prices more than 1,000 percent...The analysis used Centers for Medicare and Medicaid Services data that included total costs and charges for all medicines from 3,792 hospitals. On average, those hospitals marked up the price of medicines nearly 500 percent, consistent with an analysis of 20 medicines previously conducted by Moran...Markups on medicine prices often lead to higher reimbursement by health plans. More than half of commercial payers reimburse hospital outpatient departments as a percent of billed charges. Hospitals have incentives to increase markups as higher charges are associated with greater profitability...

King's Daughters Medical Center...found it challenging to provide an accurate, verifiable home medication record for its providers to trust as they made important decisions about existing medications both during an inpatient visit and after discharge...King's Daughters now uses external medication history from pharmacy fill data as well as insurance claims data, provided by vendor DrFirst, to complement verification and push the information to the providers...While it is not intended as a replacement for the patient/family interview, its integration into the electronic health record greatly augments the conversation and can prompt a patient to include easily forgotten information...This reduces the risk of prescription loss and makes the process more efficient for the patient while ensuring the health record is updated in advance of future visits...King's Daughters is required to report its performance on both medication reconciliation (with a threshold goal of 50 percent) and e-prescription (10 percent) to the Centers for Medicare and Medicaid Services...most recent reporting period, Q4 2017, our stats were 77 percent and 52 percent, respectively...integrating medication management tech into the EHR also helped King’s Daughters more effectively retrieve historical data and deliver that information to providers to facilitate new prescriptions in a trustworthy manner that both reduces errors and the abuse of controlled substances...

Pharmacists call shortage of small-volume parenteral solutions "severe"...The shortage...is affecting virtually all U.S. hospitals, according to results of a survey by the American Society of Health-System Pharmacists... that limited inventory of the critical product has required health care providers to adopt new procedures and use alternative therapies to treat patients...Survey respondents are taking a variety of steps to mitigate the shortages, including using alternative methods of administration such as intravenous push, intramuscular injections, or oral dosage forms; using nonformulary premixed solutions and/or frozen products; and implementing protocols that restrict the use of product...The shortage of SVPs is the latest in a series of shortages of critical medications, including sodium bicarbonate and epinephrine. Drug shortages pose a significant threat to the safety and quality of patient care in hospitals and other health care settings and may result in delayed treatment and increased risk of adverse reactions and medication errors...“We strongly believe that the current drug shortage situation is unacceptable and unsustainable,” said ASHP CEO Paul W. Abramowitz, PharmD...“It threatens harm to patients, wastes valuable health care resources, causes great uncertainty, and disrupts the health care system.”

Proponents argue that limits reduce the risk of addiction, but are they keeping pharmacists from caring for their patients?... As the opioid crisis worsens, pharmacies, pharmaceutical manufacturers, and legislators are scrambling to help solve the problem. Recently, those efforts have focused on limiting opioid supplies. But in the effort to prevent unnecessary medications, are pain patients getting left behind?...Express Scripts and CVS Caremark recently announced a seven-day supply limit, and PhRMA...supported a seven-day limit...one-size fits all approach and will supplant providers’ clinical decision-making and the needs of patients who have legitimate need for these medications...payer limits restrict patients with legitimate pain management needs from accessing opioids. Those limitations...will force patients not at risk of abuse or misuse to work with their prescriber and pharmacist—which will cost the health-care system and “significantly” impact patients with limited resources, physical restrictions, or transportation issues...

The 340B Drug Pricing Program took center stage at the Senate's HELP panel for the third time in several months...this time turning the focus to audits of hospitals and drug manufacturers conducted by the Health Resources and Services Administration...HRSA Director Krista Pedley said that, in the past five years, 12 of 600 program manufacturers faced audits compared to 981 of 12,700 of hospitals...No findings of wrongdoing were discovered in any of the 12 audits of manufacturers, she noted, whereas 60% of the audits of covered entities resulted in repayment to manufacturers...

Accountable care demands that data crunching these days be agile to enable quick pivots in strategy...With rising drug costs, value-based care, changes in reimbursement rules and more demanding consumers, there's no shortage of things that can change in a year. That means hospital IT departments need to employ quicker, more agile analytics that enable them to pivot in response to fast-changing conditions...And that’s why Dana Darger...director of pharmacy at Rapid City (South Dakota) Regional Hospital...said healthcare organizations need to think more like stores when it comes to issues of dollars and cents..."Hospitals have never behaved with what I'll call a retail mindset,” Darger said. “Retail stores can tell you what they make on everything."...As healthcare moves inexorably toward value-based reimbursement, entities are going to need to analyze data more quickly and make those retail-type business decisions..."If you look traditionally at the way pharmacy works, pharmacists tend to look at the world as expense-driven," said Darger. "They base things on what drugs cost, rather than what the margin is..."A lot of times, people are trying to get the data to say what they want it to say. You have to figure out how to let the data tell the story so you can make changes based on it."

The American Hospitals Association and other organizations have made good on their promise to sue the federal government in an effort to halt a major cut planned for the 340B Drug Pricing Program...The hospitals are arguing the reimbursement change exceeds the authority of the HHS secretary and is "arbitrary and capricious." They ask the court to force HHS to delay implementation or strike the cut entirely...HHS released a final rule earlier this month that changes the amount 340B hospitals will be paid for most drugs to 22.5% less than the average sales price starting at the beginning of next year. Currently those hospitals are paid the average price plus 6%...The cut of about 30% would hurt nonprofit hospitals' margins, according to a recent report from Moody's. The CMS has argued the change would reduce out-of-pocket costs and improve patient-provider relationships. The agency has calculated the 340B cut would save about $900 million next year...AHA has been strongly critical of the cut, saying it threatens patient care, particularly for vulnerable populations that are most likely to use safety net hospitals benefiting from the drug payment program...A recent report found 340B hospitals had a larger decrease in charity care spending than other hospitals, but AHA said the study was misleading and incomplete.

With the recent deaths of Spade and Bourdain, health care professionals are also concerned about suicide contagion, a phenomenon in which high-profile suicides influence patients to attempt or committ suicide themselves...pharmacists can play a key role in preventing suicide...pharmacists are ideally situated to assist those in need because of their frequent interactions with patients and access to medical records...However, pharmacists are often unprepared to properly respond to signs of suicide risk, as very few pharmacy schools incorporate suicide prevention courses into their curricula...here are 5 ways pharmacists can help patients who are contemplating suicide...

1. Identify at-risk patients.
2. Monitor medication use and mental health.
3. Collaborate with the health care team.
4. Refer to suicide prevention resources.
5. Be encouraging and empathetic.

Physicians say they face long wait times for insurers to process prior authorizations and the delays can negatively impact patient outcomes...The American Medical Association surveyed 1,000 physicians, and 64% said they wait at least one business day for insurers to decide on prior authorization. Nearly one-third (30%) said they wait at least three business days for decisions...The vast majority of physicians surveyed said that lag time can have serious consequences for patients; 92% said the prior authorization process can lead to delays in access to care, and 78% said that waiting for a decision from insurers "sometimes, often or always" causes patients to abandon certain treatments entirely...The AMA survey illustrates a critical need to help patients have access to safe, timely and affordable care, while reducing administrative burdens that take away from patient care...Six major industry groups—including America's Health Insurance Plans and the AMA—joined forces to improve the prior authorization process. The groups agreed to five steps:

1. Reduce the number of healthcare professionals subject to prior authorization requirements based on their performance, adherence to evidence-based medical practices or participation in a value-based agreement with the health insurance provider.
2. Review the services and medications that require prior authorization on a regular basis and eliminate requirements for therapies that no longer warrant them.
3. Improve communication between health insurance providers, healthcare professionals and patients to minimize delays in care and ensure clear prior authorization requirements, rationale and changes.
4. Protect the continuity of care for patients on an ongoing active treatment or a stable treatment regimen when there are changes in coverage, insurance providers or prior authorization requirements.
5. Accelerate industry adoption of national electronic standards for prior authorization and improve transparency of formulary information and coverage restrictions at the point-of-care.

Damaged Baxter plants on the island make large portion of saline products, already in short supply...hospitals are feeling even more compromised from the shortage ever since production at Baxter facilities in Puerto Rico was hampered...by hurricane Maria...“Clearly this has a huge impact on hospitals as well as home infusion pharmacies and infusion centers since many medications given by the I.V. route are mixed into these bags and given by infusion,” said Matthew Grissinger, RPh, from the Institute for Safe Medication Practices...The most severe shortages are being felt with small-volume parenteral solutions, such as the 50 and 100 milliliter minibags of sodium chloride 0.9%, dextrose 5%, and I.V. nutritional products made by Baxter...the American Society of Health-System Pharmacists had been hearing from both large and small hospitals alike that they only had a 1- to 2-week supply of small-volume parenteral solutions left. ASHP has been working around the clock to identify solutions and strategies for facilities...FDA has also been actively involved, and is monitoring a list of about 30 critical drug products that are either manufactured solely or primarily in Puerto Rico. Of those 30 drugs, 14 are sole-source products, meaning there are no alternatives available...To mitigate the shortage of I.V. solution products, FDA is doing something that it rarely does: import products from overseas plants. In this case, FDA is allowing temporary importation of an alternative supply of sodium chloride 0.9% injection bags, dextrose 5% injection bags, and metronidazole injection into the U.S. from Baxter facilities in Ireland, Australia, Mexico, and Canada...