Some pharmacies are just more equal than others

PBMs keep saying they pay all pharmacies equally — that they don’t show a preference for the chains they happen to own. No sirree. So I guess there’s no need for a KFF Health News article, focused on Georgia, titled, “PBM Math: Big Chains Are Paid $23.55 To Fill a Blood Pressure Rx. Small Drugstores? $1.51.”

For example, the chains received an average of nearly $54 for the antidepressant bupropion, while Bell’s Family Pharmacy in Tate, Georgia, got $5.54, the analysis said. For a drug used to treat blood pressure, amlodipine, chain pharmacies received an average of $23.55, while Bell’s got $1.51.

Bell’s Family Pharmacy closed earlier this year.

Stroke? Don’t wait on anticoagulants

Old recommendation: When someone with an irregular heartbeat has a stroke, wait 5 days before starting them on anticoagulants to reduce the risk of a brain bleed.

New study’s conclusion: Starting those anticoagulants earlier (within 4 days) not only reduces the risk of a second stroke even more, the patients “have no increased risk of a brain bleed than those who take them later.”

States ponder GLP-1 benefits

Only 13 state Medicaid programs cover GLP-1 drugs for weight loss, but that might be changing as more states are either considering coverage or outright planning it.

What’s interesting is that the states that don’t cover them cite cost as the reason — the drugs are expensive, after all. But at least half the states that do cover them also cite costs — reducing obesity, they figure, will pay benefits by reducing other health issues. (But see “Where are the GLP-1 savings?” below.)

There’s plenty more in the mix, though: Overall Medicaid costs. The (possible) need for legislative approval. Obesity requirements. Federal aid. So it’s all up in the air.

Where are the GLP-1 savings?

The idea is that by combating obesity, GLP-1 drugs will reduce the cost of healthcare for both individuals and insurers. Losing weight helps across the board, and there’s also evidence that the drugs can directly affect other conditions.

But an analysis by PBM Prime Therapeutics of 3,000 people taking either semaglutide or liraglutide for obesity found that, after 2 years, their cost of care went up 46%. (To be fair, the cost of care of people not on GLP-1s went up 14%.)

And that wasn’t just because of those meds — overall medical costs went up.

Over the two-year period, the analysis found “no reduction in obesity-related medical events,” such as heart attacks, strokes and diagnoses of type 2 diabetes, or use of prescription drugs for hypertension and high cholesterol, compared to the control group.

This adds a bit of complexity to the calculus, doesn’t it?

Vaccine-rec updates

Second Covid shot for 65+

The CDC is recommending that people who are 65 or older, or who are immunocompromised, get a second shot of this year’s Covid vaccine. And for those who are severely immunocompromised? Three or more shots are okay in consultation with their health care provider.

More people should get pneumonia vax

The CDC is recommending that all adults 50 and over (not just 65 and older) get the pneumococcal conjugate vaccine. That comes after a 14-1 recommendation from its Advisory Committee on Immunization Practices. Interesting note: ACIP made the recommendation based on age rather than risk because panel members thought that would increase vaccine uptake.

Speaking of pneumonia…

A lot of kids seem to be getting walking pneumonia — infection from Mycoplasma pneumoniae. The surge in cases (all right, maybe “surge” is a bit strong) started in the spring, the CDC reported, and “has been increasing over the past six months, peaking in late August.”

What’s notable, the agency said, is that a lot of 2- to 4-year-olds are getting M. pneumoniae infections, which is unusual.

Cases have been dropping a bit nationwide since August, but there are still localized hot spots, mostly in the middle of the country.

Captain Obvious will remember it for you wholesale

“Reminders Reduce Age-Related Memory Decline”