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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.

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

One way that community pharmacies can improve how well they care for their patients and their bottom line is to provide enhanced services. These include services that can help keep patients out of the emergency room or hospital and, for which, in some instances, the pharmacist can be reimbursed by a third-party payer or by the patient...These services can be revenue streams that can help local pharmacies compete with big-box stores and mail-order...There are nine ways that community pharmacies can profitably implement enhanced services...If you don’t do this, other healthcare providers will...Other pharmacies, nursing services, and telephone-based providers are already on board with these things...The nine services are:

1. Enhanced delivery
2. Immunizations
3. Medication therapy management (MTM)
4. Medication synchronization
5. Adherence or convenience packaging
6. Medicare plan selection
7. Point-of-care testing
8. Nutrition
9. eCare capability

President Trump signed bipartisan legislation...that would free pharmacists to tell consumers when they could actually save money by paying the full cash price for prescription drugs rather than using health insurance with large co-payments, deductibles and other out-of-pocket costs...The legislation on gag clauses has been praised by lawmakers in both parties...The legislation...also includes a provision to combat agreements between drug makers that stifle competition by delaying the marketing of lower-cost copycat versions of expensive biotechnology medicines. Such biologic medicines account for a rapidly growing share of drug spending...Under the new law, manufacturers of the original product and the copy, known as a biosimilar, will have to report such agreements to the Federal Trade Commission, which can challenge them as violations of antitrust laws. The agreements are known as pay-for-delay deals because the branded drug company pays a potential competitor to delay entering the market...

Pharma might have thought it could fend off the Trump administration's bid to get drug prices into consumer advertising, but it was wrong...Even a last-ditch set of concessions—announced by PhRMA Monday morning—couldn't forestall HHS Secretary Alex Azar's own proposal Monday afternoon. The pharma plan was "a small step," Azar said, before saying he'd require DTC television ads to include the list price on all $35-and-up drugs covered by Medicare or Medicaid, which is essentially every drug in the pharmaceutical universe...And Azar didn't just counter. He took direct aim at the just-announced PhRMA idea.

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.

A recent memo from Centers for Medicare and Medicaid Services clarifies why many Americans aren’t getting the medications they need. The wrong person is choosing your prescription drug, and it isn’t your doctor...starting in 2020, Medicare Part D health plans can implement “indication-based drug therapy.”...Doctors do not treat indications; we treat patients, one at a time, each with his or her own name, unique medical history, and individual reactions to specific medications, whether good or bad...In other words, the person choosing your medications has no medical training, no license to practice medicine, and does not even know your name...Prescribing the wrong Rx for you occurs throughout health care. It is not limited to Medicare...Most health plans require doctors in their panels to use the “fail first” approach, also known as step therapy. When starting treatment, the treating physician can only prescribe the most “cost-effective, medically sound” medication. “Cost-effective” means cheapest drug for the health plan. “Medically sound” means lowest risk of side effects, which often means least likely to be medically effective. After the first drug fails to help the patient, the doctor is then allowed to take the next step with a second drug also chosen by the health plan. Eventually, when all the cheap alternatives fail, the doctor may be allowed to special order the right drug. The bottom line? An insurance actuary, not your doctor, chooses your Rx..

Walgreens Boots Alliance CEO Stefano Pessina says Walgreens is a "true health-care company."... Amazon has already stolen sales of everyday items and is in the process of acquiring online pharmacy Pillpack...Walgreens wants to be seen as more than a retailer...Its competitor, CVS Health, has been touting itself as a health-care company dedicated to transforming the patient experience and lowering costs in the process. To help its case, CVS is acquiring insurer Aetna...It's not that being a retailer is a bad thing. But investors want drugstores reinvent their businesses as Amazon already steals sales of everyday items like toilet paper and will soon enter the prescription drug delivery business with its acquisition of online pharmacy, Pillpack...

The Justice Department’s approval of the $69 billion merger between CVS Health and Aetna...caps a wave of consolidation among giant health care players that could leave American consumers with less control over their medical care and prescription drugs...The approval marks the close of an era, during which powerful pharmacy benefit managers brokered drug prices among pharmaceutical companies, insurers and employers...The two companies say that they will be better able to coordinate care for consumers as the mergers help tighten cost controls...critics worry that consumers could end up with far fewer options and higher expenses...Just last month, the Justice Department also approved the takeover of Express Scripts, a major CVS rival, by the big insurer Cigna...This type of consolidation in a market already dominated by a few, powerful players presents the very real possibility of reduced competition that harms consumer choice and quality...Facing the prospect of competition from outsiders like Amazon, whose tentative forays into the pharmacy business have already shaken up the industry, established players have also been looking for ways to stay relevant to their customers and enlarge their share of the health care market...The companies “are feeling pressure to do something different or it will be done to them,”...

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