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David D'Altorio, PharmD, senior vice president of health services at MedImpact Healthcare Systems, discusses methods to improve communication among drug manufacturers and health care providers.

Valeant Pharmaceuticals' much-ballyhooed agreement with Walgreens includes an unusual inventory provision that helps explain why the pharmacy chain might have been eager to strike a deal...Valeant is buying back its drugs from Walgreens and selling them on consignment to the pharmacy, a provision that triggers an upfront financial hit. Walgreens won't physically return the drugs, just the title to them...It's just one out-of-the-ordinary feature of an out-of-the-ordinary pharmacy deal. Valeant announced last week that it had teamed up with Walgreens to distribute its drugs, discounting key skin and eye brands by 10% and another slate of meds by an average of 50%. Walgreens is taking the Valeant drugs on consignment and collects fees for filling prescriptions…The Walgreens partnership replaces Valeant's relationship with Philidor, a specialty pharmacy that was closely tied to the drugmaker until questions arose about its operations...The drugmaker is expecting a sales hit from the pharmacy shift, partly because of the mechanics of the Walgreens deal and partly because of lower demand for its drugs in the wake of the Philidor allegations.

In time for the quit smoking New Year resolutions that are anticipated at the end of this month, the International Pharmaceutical Federation has outlined the wide variety of different ways in which pharmacists can reduce the use of tobacco through a new publication. The briefing document, "Establishing tobacco-free communities: A practical guide for pharmacists", gives a number of examples from around the world, showcasing pharmacists’ value in performing health promotion, triage and referral as well as other interventions.

Employers are taking significant action to reduce their exposure to rising costs associated with specialty medicines...Although pharmacy represents approximately 20% of employer-sponsored medical benefits costs, it is increasing at a rate that accounts for roughly half of medical cost inflation and should be a top priority for employers...The price, utilization and delivery of specialty prescription drugs, many of which require special handling or delivery, are a top pain point for employers...employers are beginning to consider new aggressive approaches... employers have added new coverage and utilization restrictions for specialty pharmacy, such as requiring prior authorization or limiting quantities based on clinical evidence... employers plan to exclude compounds from their benefit coverage...the compounding process results in higher cost and their use may not be FDA-approved in compound form, health insurers increasingly will not cover them...

Pharmacists in Minnesota are fighting for the rights to take breaks and refuse to work more than 12 hours in a row...Since September 2015, the Minnesota Board of Pharmacy has received...comments for and against a work conditions rule that would prohibit pharmacies from denying breaks and requiring pharmacy staff to work more than 12 consecutive hours.

•  ...those opposing the work condition rule tended to be from trade and professional associations, health systems, pharmacy owners, and pharmacy managers.
•  ...National Association of Chain Drug Stores and the Minnesota Retailers Association submitted comments that suggested limitations on hours and uninterrupted breaks could “go against the professional judgment of a pharmacist for certain situations.”
• ...CVS Health “strongly believes that a pharmacist should continue to manage their own work schedule and not rely on a board rule to dictate work conditions,” a company spokesperson commented.
• ...opposition to the rule said they feared consequences related to their schedule.
• ...Nearly all those in favor of the rule were pharmacists.

All MTM (medication therapy management) services may be billed for, but the question remains: which insurance companies will reimburse them? Many studies have validated the value of the pharmacist in providing MTM services solely as a cost-avoidance model for any specific medical group. Ideally, MTM services would be billed and reimbursed while cost-avoidance would be documented through an increasingly positive outcome of care for these specific patients...MTM services may be focused on specific situations such as a targeted medication review or discharge education, or they may be provided as complete comprehensive medication reviews...The following are general descriptions of the different forms of MTM services:

• Comprehensive Medication Review
• Target Medication Review
• Bedside MTM
• As Time Permits
• Inpatient MTM Program
• Outpatient MTM Program
• Complete MTM Program
• Billing for MTM Services
• MTM Implementation
• Conclusion

National Association of Specialty Pharmacy Executive Director James E. Smeeding, RPh, MBA, discusses the trend of larger entities absorbing independent specialty pharmacies.

• Why did you decide to pursue a managed care residency?
• What is the structure of your residency?
• What are your day-to-day tasks?
• How did you decide that your residency program was the right fit for you?
• What career opportunities does a pharmacy resident have after completing a managed care program?
• What advice do you have for students looking to pursue a residency in managed care?

SPECIALTY PHARMACEUTICALS featured prominently in the FDA’s new drug approval and expanded indications list once again in 2015. Below is the first of a 2-part summary of specialty pharmacy–related FDA approvals and expanded indications that took place this year...Part 2, which will be featured in the next issue of Specialty Pharmacy Times, will include oncology drugs and late-breaking FDA actions...

Bleeding Disorders

• Ixinity (coagulation factor IX (recombinant), Emergent BioSolutions Inc)
• Nuwiq (coagulation factor VIII (recombinant), Octapharma)
• Coagadex (coagulation factor X (human), Bio Products Laboratory Ltd)
• Adynovate (antihemophilic factor [recombinant] pegylated, Baxalta Inc)

Inflammatory Conditions

• Cosentyx (secukinumab, Novartis Pharmaceutical Corp.)
• Humira (adalimumab, AbbVie)

Cystic Fibrosis

• Kalydeco (ivacaftor, Vertex Pharmaceuticals)
• Orkambi (lumacaftor/ivacaftor, Vertex Pharmaceuticals )

HIV

• Evotaz (atazanvir/cobicistat, Bristol-Myers Squibb Co)
• Prezcobix (darunavir/cobicistat, Janssen Therapeutics)
• Genvoya (cobicistat/elvitegravir/emtricitabine/tenofovir alafenamide, Gilead Sciences, Inc)

Hepatitis C

• Technivie (ombitasvir/paritaprevir/ritonavir, AbbVie Inc)
• Daklinza (daclatasvir, Bristol-Myers Squibb)
• Harvoni (ledipasvir/sofosbuvir, Gilead Sciences, Inc.)

• Glatopa (glatiramer acetate injection, Sandoz, Inc.)
• Betaconnect (Bayer HealthCare’s electronic auto injector - Betaseron (interferon beta-1b)

Specialty Ophthalmics

• Lucentis (ranibizumab, Genentech)
• Eylea (aflibercept, Regeneron Pharm)

Hypercholesterolemia

• Praluent (alirocumab, Sanofi-Aventis)
• Repatha (evolocumab, Amgen Inc)

Miscellaneous Specialty Approvals

• Natpara (parathyroid hormone, NPS Pharmaceuticals, Inc)
• Cresemba (isavuconazonium sulfate, Astellas Pharma US, Inc)
• Cholbam (cholic acid, Asklepion Pharmaceuticals LLC)
• Jadenu (deferasirox, Novartis Pharmaceuticals)
• Anthrasil (anthrax immune globulin intravenous [Human], Cangene Corp)
• Rapamune (sirolimus, Wyeth Pharmaceuticals)
• Promacta (eltrombopag, GlaxoSmithKline and Novartis Pharmaceuticals)
• Envarsus XR (tacrolimus extended-release tablets, Veloxis Pharmaceuticals A/S)
• Dysport (abobotulinumtoxinA, Medicis and Ipsen)
• Keveyis (dichlorphenamide, Taro Pharmaceutical Industries Ltd)
• Procysbi (cysteamine bitartrate, Raptor Pharmaceutical)
• Xuriden (uridine triacetate, Wellstat Therapeutics Corporation)

Natasha Nicol, PharmD, FASHP, director of Global Patient Safety Affairs at Cardinal Health, provides prevention strategies to reduce medication errors.