Retroactive DIR fees: eliminated

No longer can PBMs hit you with retroactive direct and indirect remuneration fees, thanks to a new final rule from CMS. Well, no longer … starting January 1, 2024. That’s when those fees must be reflected in the negotiated price the patient pays at the pharmacy counter.

CMS’s final rule also put an end to a proposed loophole that would have given authority to the Medicare Advantage Part D plans and PBMs to determine how much, if any, of the pharmacy price concessions they would pass through to patients at the point of sale during the coverage gap in the Medicare Part D program.

Quoth APhA CEO Scott Knoer, “Eliminating the retroactive use of DIR fees is a step in the right direction, but it’s only the tip of the iceberg.”

Vitamins for ADHD

Nothing against Ritalin, but before starting a kid on medication for ADHD, there are some other options — and the newest on the list is micronutrients, aka, vitamins.

A study out of Oregon Health & Science University found that giving kids a supplement of “all known vitamins and essential minerals” made them “three times more likely to have better concentration and improved moods.” They were given pretty strong doses — up to the maximum tolerable limit — but the results were encouraging:

After eight weeks, more than half of the micronutrient group showed improvement in their concentration and mood. Children taking the micronutrients also grew 6 millimeters more than those taking a placebo.

Oddly, they didn’t determine which micronutrients had this effect, but that’s for further study.

Dairy is deadly?

On the next episode of “Good for You or Bad for You?” we learn that “Dairy products linked to increased risk of cancer.”

Well, that’s the headline. The detail is that it applies to Chinese people — a population with a high level of lactose intolerance and a low level of dairy consumption. Nevertheless, the study out of Oxford “Like Cambridge But Drearier” University found that yes, more dairy meant more cancer. For example…

People who consumed dairy products regularly had significantly greater risks of developing liver and breast cancer. For each 50g/day intake, the risk increased by 12% and 17% respectively.

Of course, “Further studies are needed to validate these current findings, establish if these associations are causal, and investigate the potential underlying mechanisms involved.”

Reconsidering antibiotics

It might be time to consider not simply cutting back on antibiotics, but saving them as a last resort. That’s not just because of resistance (although it’s a factor). It’s because even a single course can do lasting damage to the gut biome.

These community changes can be profound, with some people’s microbiomes taxonomically resembling those of critically ill ICU patients after taking the drugs. And the microbes that survive the treatment tend to carry resistance genes, potentially enabling pathogens to acquire the means to evade our best pharmacological weapons.

As one microbiologist put it, we need to stop thinking of antibiotics as doing no harm; we need to balance the need with the damage we’re learning they cause. “[T]aking antimicrobials is a gamble every single time you do it, even if it’s fully warranted.”

Feds cut back on J&J vax

The latest Covid vaccine twist: “FDA restricts J&J’s COVID-19 vaccine due to blood clot risk.” The risk is rare, but it’s there*.

Thus the FDA has gone from recommending only some people get the J&J shot, to strongly recommending that only some people get it. (Still eligible: people who are allergic to the mRNA vaccines, and people who don’t want one.)

Hey bud, wake up

Smoking dried cannabis flowers — the buds, not the leaves — can apparently combat fatigue. And that’s true (University of New Mexico psychologists found) even when that fatigue comes from chronic pain, cancer, Parkinson’s Disease, or multiple sclerosis.

This was the first large-scale study to show that, on average, people are likely to experience a 3.5 point improvement of feelings of fatigue on a 0-10 scale after combusting Cannabis flower products, conventionally referred to as “buds”.

The twist: It didn’t matter what kind of cannabis plant it came from — it was independent of THC or CBD levels, “suggest[ing] that other minor cannabinoids and phytochemicals such as terpenes may be more influential.”

Captain Obvious knows 1+1 doesn’t equal 0

Boston University researchers: “Smoking Plus Vaping No Healthier Than Smoking on Its Own”. And yes, that means exactly what you think it does:

[S]moking cigarettes and e-cigarettes didn’t reduce the risk of heart attack, heart failure, stroke or any cardiovascular disease.

Next up: ‘Eating Pop-Tarts with arsenic does not reduce chance of death.’

You are what they eat

If, like most of us, your patients lie awake at night worrying about flesh-eating bacteria, you’ll want to be ready to answer their questions. Fear not. The good folks at Baylor College of Medicine have you covered with “What to know about flesh-eating bacteria.”

Medical engineering

Tattoo you

Why bother with a pesky pulse oximeters when you can get a tattoo that shows your blood-ox level? Well, sort of. Engineers at Tufts have created “a silk-based material placed under the skin that glows brighter or dimmer under a lamp when exposed to different levels of oxygen in the blood.”

At this point the sensor only reads oxygen, but the Tufts team hopes to expand the concept to reading more, including glucose, lactate, and electrolyte levels. (And if you’re curious, the tattoos aren’t permanent — they can last up to a year.)

Skin cancer scanner

Why have a doctor carve away a chunk of your flesh for a biopsy, like some medieval barber/surgeon? Soon enough you might go Star Trek and get a skin cancer test via a little handheld doohickey.

Starting with the same scanning tech as airport security, researchers at New Jersey’s Stevens Institute of Technology improved it, then used artificial intelligence to process the images and determine if a skin blotch was cancerous.

Using their device, [they] could identify cancerous tissue with 97% sensitivity and 98% specificity — a rate competitive with even the best hospital-grade diagnostic tools.