A crack in the door of Medicare negotiation

The Trump Administration has a proposal for lowering drug prices: Let Medicare create formularies for certain classes of drugs (as opposed to covering every drug).

This is potentially a Very Big Deal. Why? Right now, Medicare cannot by law negotiate drug prices. But even if it could, it has little bargaining power because Part D plans have to cover so many drugs.

To give it that bargaining power, it needs to be able to say “No.” And that’s what this proposal would allow (to some extent) by letting Part D sponsors remove some drugs from the formulary in six “protected” classes of meds*.

From CMS:

The proposal would make three exceptions that would allow Part D sponsors to: 1) implement broader use of prior authorization and step therapy for protected class drugs, including to determine use for protected class indications; 2) exclude a protected class drug from a formulary if the drug represents only a new formulation of an existing single-source drug or biological product, regardless of whether the older formulation remains on the market; and 3) exclude a protected class drug from a formulary if the price of the drug increased beyond a certain threshold over a specified look-back period.

(Emphasis ours.)

Obviously it’s not simple, but again, this is only a proposal at the moment. Yet it represents an interesting foot — or at least toe — in the Medicare-negotiation door.

* Antidepressants; antipsychotics; anticonvulsants; immunosuppressants for treatment of transplant rejection; antiretrovirals; and antineoplastics.

Something’s rotten, but it ain’t in Denmark

When the latest surveys find that a third of Americans skip buying their prescriptions because of cost;

…while new data show out-of-pocket healthcare spending continues to rise, and “low-income families experienced the highest growth in healthcare spending burden“;

…and 30 percent of Americans now says they “Have difficulty paying for basic necessities, like food, heat, and housing” because of healthcare spending;

…and a study has to suggest that we help older Americans get enough to eat so they can afford diabetes treatment;

… we’re doing something wrong.

Give yourself a gift

A gift of immunization certification from APhA! It’s your last chance this year: Sunday, December 2, from 8:00 a.m. – 5:00 p.m at the GPhA Education Headquarters in Sandy Springs.

GPhA members get a huge discount — it’s only $349 for the course, which gets you not only the APhA certification, but (if you complete both the self-study and classroom work) a whopping 20 hours of CPE credit.

Check out GPhA.org/2018immunization for the details and sign up today!

Aye, there’s the rub

The National Institutes of Health is sponsoring a clinical trial of a contraceptive gel for men. The combination segesterone acetate (aka Nestorone) and testosterone would be rubbed on the back and shoulders and is expected to “[reduce] sperm production to low or nonexistent levels.”

The robot will second-guess you now

Amazon is going to start selling software that will comb through patients’ medical records and recommend treatments based on what it finds.

Drinks are on you

“Pharmacist Salaries Keep Rising.” Side note: The biggest growth is in hospitals.

Thanks for nothin’

Teva had promised a lower-cost alternative to the Epi-Pen. Instead, it priced its epinephrine injector exactly the same.

Longer than you, if you keep asking me

Next time you’re tempted to ask an older patient, “So, how long you think you’ve got left?” … maybe reconsider. It turns out — per the Annals of Family Medicine Research — that older people prefer not to talk about life expectancy.