Pharmacy-PBM model may aid patients’ health in the long-run
WHAT IT MEANS AND WHY IT’S IMPORTANT The fact that CVS Caremark presented research highlighting the benefits that pharmacy benefit management tools can have on improving medication adherence is important on several different levels.
(THE NEWS: CVS Caremark research highlights methods for improving medication adherence. For the full story, click here)
CVS Caremark has had some challenges on the PBM side of its business, and while it appears to be doing a better job selling to big payers these days, it still has been the subject of scrutiny by some who have questioned the vertically integrated pharmacy-PBM model. Studies, such as those presented at the 22nd Annual Meeting of the Academy of Managed Care Pharmacy, are meant to demonstrate the value of that structure at a critical time.
As reported by Drug Store News, one of the more recent snags is a bill that would prohibit federal PBM contracts with companies that operate both a PBM and retail pharmacies. It not only has sparked debate but, if passed, could be a blow to the vertically integrated pharmacy-PBM model.
Some critics are calling for PBM reform within the Federal Employees Health Benefits Program, claiming that PBMs have unclear pricing methods, retain most discounts or rebates prescription drug manufacturers give them, and receive little oversight from the Office of Personnel Management. The bill, which was introduced in January, now has been sent to the Committee on Oversight and Government Reform for consideration.
But many, including the OPM, have spoken out in opposition to the bill, stating that it would impose "significant administrative costs" that could be passed on to federal employees.
By continuing to highlight the benefits of the vertically integrated pharmacy-PBM model, and by introducing research to support its claims, CVS Caremark is banking that its message will continue to resonate.
Meanwhile, an article in the prestigious New England Journal of Medicine by two healthcare policy opinion leaders is fueling the message that pharmacy’s role in helping patients take medications correctly is key to improving lives and reducing long-term healthcare costs.
The article, titled "Thinking Outside the Pillbox — Medication Adherence as a Priority for Health Care Reform," supports NACDS’ campaign to raise awareness of pharmacy’s role in boosting medication adherence, reducing healthcare costs and improving lives.
"Pharmacy plays a critical role in helping patients take the right medications and take them correctly," stated NACDS president and CEO Steve Anderson. "As the face of neighborhood health care, pharmacists are uniquely qualified to help patients understand the importance of following their medication regimens properly. Working together, pharmacists and patients can improve health care for individuals and for the system overall through reduced costs."
The reality is that there’s a great deal at stake — not only patients’ health but a staggering $300 billion annual drain on the U.S. healthcare system due to poor medication adherence, which frequently is at the root of preventable hospitalizations and patient illness.
PBGH reports cost-effective diabetes management in Pittsburgh
PITTSBURGH Patients diagnosed with Type 2 diabetes in Pittsburgh were more likely than similar patients nationwide to receive A1c, blood glucose, serum cholesterol, ophthalmologic or urine glucose tests than those in other areas, but best-performing regions use the same management services at a higher rate, according to a report released Wednesday by the Pittsburgh Business Group on Health.
The report, based on data from 2007 and 2009, also found that the disease was managed in a more cost-effective manner in the Pittsburgh region, compared with other regions around the country. The report is meant to help employers assess whether their diabetes management strategies are working to change employees’ behavior, improve health and contain their healthcare costs.
“In only our second year of analyzing and comparing this data, we’re already seeing a positive trend in the management of diabetes in the Pittsburgh region,” PBGH executive director M. Christine Whipple said in a statement. “We’re looking forward to analyzing the 2009 data, which will give us three consecutive years of trends and enable us to say definitively what direction diabetes management is taking in the Pittsburgh region.”
Shoppers Drug Mart responds to Ontario’s revised generic pricing rules
ONTARIO Canadian retail pharmacy chain Shoppers Drug Mart has responded to the Ontario government’s decision to further drug reform measures in the province by reducing generic drug reimbursements for Ontario Drug Benefit Program beneficiaries.
The Ontario Liberal Government announced Wednesday that generic prescription drug prices for patients that benefit from the province’s drug benefit program will be reduced from the current level of 50% of the equivalent brand name price to 25% of the equivalent brand name price. The announcement also indicated that planned reductions in generic prescription drug pricing would also be extended to the private sector over a multi-year period. Shoppers Drug Mart said that such changes will impact its sales and profitability and the government “will further interfere in the commercial relationships between generic manufacturers and pharmacies” and that the government will play an increased role in the regulation of private sector drug benefit programs –– programs, Shoppers said, the government does not fund or pay for.
“These announced reductions in drug pricing and pharmacy reimbursement, on the heels of significant cuts just four years ago, will only serve to further commoditize healthcare and the practice of community pharmacy at a time when Ontarians need it most,” said Jurgen Schreiber, Shoppers Drug Mart president and CEO. “These announced changes reinforce our view that in the long-term, the successful players in retail pharmacy will be those with size, scale and an ability to leverage operating efficiencies. Shoppers Drug Mart, with the largest integrated pharmacy network in the country and the leading market share, will be challenged in the short-term to adjust to the changes announced [Wednesday], but remains well-positioned for the long-term.”
Discussions regarding changes to the Ontario Drug Benefit Program have been underway for more than nine months, Shoppers said.