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Cate Douglass, PTNN. This weekly video program provides our readers with an in-depth review of the latest news, product approvals, FDA rulings and more.

Patients in Missouri will no longer have to repeat ineffective medications... Step therapy is a cost-savings measure used by some insurers that requires patients to take different medications from what their health care provider prescribed before agreeing to cover the cost of the original medication... Missouri Governor Jay Nixon recently signed into law the "Step Therapy for Prescription Drugs" bill (HB 2029), which prohibits insurers from requiring patients to take medications they’ve already tried when they switch their coverage or change jobs, or if the medication is reclassified...Importantly, the law doesn’t ban the practice of step therapy altogether. It also doesn’t preclude insurers from having patients try a generic version of a medication. Rather, it prohibits insurers from going through step therapy more than once for a given medication...

Mike Glaicar, Business Development: Pharmacy Times...(PTNN) This weekly video program provides our readers with an in-depth review of the latest news, product approvals, FDA rulings and more.

Justin Gallagher, associate publisher of The American Journal of Managed Care. Welcome to This Week in Managed Care from the Managed Markets News Network

People naturally assume that the medicines prescribed by doctors are tightly regulated and have been approved by the Food and Drug Administration, but that’s not true. Loopholes in the regulations that set the standards for a practice called "drug compounding" have enabled dangerous products to injure and kill untold numbers of unsuspecting patients...FDA exempted compounding pharmacies from many of the manufacturing, labeling and other requirements other drugs are subject to...FDA does not require pharmacies to report adverse events associated with compounded drugs...the FDA has the authority to take action when compounding pharmacies violate the law and can act quickly if there is an "imminent hazard to public health," regulators have failed in several critical areas, including inspecting pharmacy records, enforcing quality standards and being able to identify the facility that made a particular drug...In order to create an acceptable risk-benefit paradigm for drug compounding, FDA needs to increase its scrutiny over compounding pharmacies. When a pharmacy is allowed to morph into a large-scale drug manufacturer without adequate oversight, it’s a matter of life and death.

Between 2015 and 2025, according a new article in Health Affairs, growth in U.S. health spending is projected to increase about 5.8% on average — a number that surpasses growth in the gross domestic product by 1.3 percentage points. And in 2016...the...national health spending per capita will surpass $10,000 for the first time...Despite the cost per capita, aggregate national spending growth, Medicaid spending growth is expected to slow this year, to 5.3% from an average of 10.8% in 2014-2015, with an expected from in prescription spending growth to 4.9% from the 17.7% growth seen in 2015. Private payers will also see steady low spending growth of 4.9%, down from 5.1% in 2015. Medicare, on the other hand, is expected to see its spending growth rise this year to 5.2%, an increase from the 4.6% growth it saw last year...The report expects prescription drugs to have a smaller impact on health spending in the next 10 years than they did in 2014 and 2015, which it attributes to an expected drop in the number of approved new drugs, and the anticipated increase in availability of biosimilars.

...the reason a pharmacy prepares a specific concentration of an i.v. or oral liquid medication has little to do with clinical or patient safety considerations...the pharmacy staff follows standard recipes because "they've always done it that way," said Pasko, director of ASHP's Center on Medication Safety and Quality and principal investigator for ASHP's Standardize 4 Safety campaign...Pasko hopes the campaign will change that mindset and result in consistency, at the national level, in how i.v. and oral liquid admixtures are formulated for patient use..."We're really trying to emphasize to everyone that this is a patient safety effort,"..."We're putting patients at risk every day when we dispense a different concentration than what someone else does."...Standardize 4 Safety has put together an interprofessional panel of experts to propose voluntary, evidence-based standardized concentrations for 32 i.v. medications associated with a high risk of patient harm due to dosage errors...ASHP has urged pharmacists to get involved with the Standardize 4 Safety community through its online communication platform on ASHP Connect...

Government spending on compounded drugs that are handmade by retail pharmacists has skyrocketed, drawing the attention of federal investigators who are raising fraud and overbilling concerns...Spending on these medications in Medicare’s Part D program, for example, rose 56 percent last year, with some of the costliest products, including topical pain creams, priced at hundreds or thousands of dollars per tube. The federal workers’ compensation program has also seen a recent spike in spending...The spending jump, along with a sharp increase in the number of patients getting the compounded drugs "may indicate an emerging fraud trend,"...

This Week in Managed Care...Cate Douglass with The American Journal of Managed Care.

I’ll respectfully disagree: Healthcare "Ubers" are already proliferating and will ultimately reshape 21st-century medicine. The more aspects of healthcare we can shift from relationship to transaction, the better life will be for patients and doctors alike..."Uber for X, Y or Z" means "making something easy and convenient." But Uber is also about safety, reliability, and civility...Uber’s true essence is this: It accumulates a vast amount of information on the micro-details of cities; overlays that information with real-time data on prospective drivers, riders, and road conditions; reduces staggeringly complex decision trees to algorithms; and instantly presents drivers with a manageable number of highly intuitive options. It thus obliterates the learning curves and fixed costs that such information previously demanded...Uber establishes, digitizes, and stores relationships to make transactions possible...To shift some (not all) of healthcare from relationship to transaction, we’ll have to imitate what Uber did: Accumulate vast databases of population health care information. Develop better and more comprehensive telemetry for real-time tracking. Apply artificial intelligence to discern patterns no intuitive physician can see and to narrow down treatment options. And package this information for instant comprehension by patients and providers...some aspects of healthcare will be impervious to Uber-like innovation...As we convert more and more of medicine to transactions—and we will—patients will find it easier to tend to their health, and doctors will find themselves freer to focus on those areas where relationships are truly irreplaceable...