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The market is buzzing with speculation that Amazon.com Inc. will enter the pharmacy business. Some drugmakers are just fine with changes the tech retail giant might bring to the complex market...Drug companies say getting medicine into patients’ hands is too complicated and costly. Some have pointed to the multiple layers of middlemen -- including insurers, pharmacy benefit managers, distributors and pharmacies -- as one reason for distorted prices and high costs in the U.S...Amazon’s entry could bring more efficiency, Takeda Pharmaceutical Co. Chief Executive Officer Christophe Weber said during an interview in London. That could impact business in the U.S. or in other markets...“I am all in favor of a more effective distribution system,” Weber said, adding that in some countries the markup can be higher than the manufacturer’s own price. “For us it doesn’t matter so much where the point of sale is, as long as we reach the patient.”

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

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...

A large group of U.S. states accused key players in the generic drug industry of a broad price-fixing conspiracy, moving...to widen an earlier lawsuit to add many more drugmakers and medicines in an action that sent some company shares tumbling...The lawsuit, brought by the attorneys general of 45 states and the District of Columbia, accused 18 companies and subsidiaries and named 15 medicines. It also targeted two individual executives: Rajiv Malik, president and executive director of Mylan NV, and Satish Mehta, CEO and managing director of India’s Emcure Pharmaceuticals...The states said the drugmakers and executives divided customers for their drugs among themselves, agreeing that each company would have a certain percentage of the market. The companies sometimes agreed on price increases in advance...“It is our belief that price-fixing is systematic, it is pervasive, and that a culture of collusion exists in the industry,” Connecticut Attorney General George Jepsen, who is leading the case...The...Justice Department is conducting a parallel criminal investigation. On Friday, the department asked the Pennsylvania court presiding over the lawsuit to put the lawsuit’s discovery process on hold, saying it could interfere with the criminal probe

After a successful pilot program with Kroger’s pharmacies, Ohio’s prescription drug monitoring program is the first in the United States to offer advanced analytics for pharmacists and health care providers...The State of Ohio Board of Pharmacy is working with Appriss Health, provider of a comprehensive platform for substance use disorder, to enhance the state’s PDMP, known as Ohio Automated Rx Reporting System...The PDMP now provides NarxCare, an advanced analytics and patient support solution, to Ohio prescribers and pharmacists, in clinical workflow and via OARRS, to assist in clinical decision-making and promote patient safety. The analytics are available for free to Ohio healthcare providers and pharmacists accessing OARRS via electronic health records and pharmacy management systems...NarxCare...aggregates and analyzes prescription information from providers and pharmacies...then presents visual, interactive information — as well as advanced analytic insights, complex risk scores...The system also provides tools and resources that support patients’ needs and connects them to treatment, if necessary.

New guidelines lower the threshold for high blood pressure, adding 30 million Americans to those who have the condition, which now plagues nearly half of U.S. adults...High pressure, which for decades has been a top reading of at least 140 or a bottom one of 90, drops to 130 over 80 in advice announced Monday by a dozen medical groups...The change means an additional 14 percent of U.S. adults have the problem, but only an additional 2 percent will need medication right away; the rest should try healthier lifestyles, which get much stronger emphasis in the new advice. Poor diets, lack of exercise and other bad habits cause 90 percent of high blood pressure...The guidelines were announced Monday at an American Heart Association conference in Anaheim...WHAT THE CHANGES MEAN

• The guidelines set new categories and get rid of "prehypertension":
• Normal: Under 120 over 80
• Elevated: Top number 120-129 and bottom less than 80
• Stage 1: Top of 130-139 or bottom of 80-89
• Stage 2: Top at least 140 or bottom at least 90

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

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

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.

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