Ohio state Medicaid decision worth a gander
WHAT IT MEANS AND WHY IT’S IMPORTANT — If it’s good for the goose, then it’s good for the gander. That’s what was in a recent letter from the Ohio Department of Job and Family Services to the National Association of Community Pharmacists. In place of mandatory mail order and competitive bidding in covering diabetic test strips, Ohio Medicaid is opting to employ a manufacturer rebate model, where manufacturers exchange discounted pricing for a listing on Ohio’s preferred drug list. Sound familiar?
(THE NEWS: Ohio Medicaid program: Beneficiaries can continue getting diabetes testing supplies from local pharmacies. For the full story, click here)
Except in this quasi-PBM model, community pharmacy are the beneficiaries, because it means a potential increase in appropriate reimbursements.
Go ahead. Read that last sentence again. We’ll wait.
According to the letter from Ohio state Medicaid director John McCarthy, this approach will achieve the same approximate 50% savings in the cost of diabetes testing supplies that the Office of Inspector General tied to competitive bidding and mandatory mail. Only this approach not only maintains that Medicaid patient’s access to a community pharmacist, but also sets the stage for increased reimbursements to that community pharmacist. "In fact, we intend to change reimbursement to the pharmacy to be consistent with published pricing," McCarthy noted. "In many cases, this will result in a higher payment to pharmacies. After rebates, Ohio’s new cost for the supplies will be lower than current expenditures."
To summarize, you have a publicly-funded health services provider that in recent years has seen its membership rolls significantly increase (Ohio’s Medicaid spending was up 5.3% FY2007 through FY2010, though that’s compared with a 6.8% national average). And more people are expected to be eligible for Medicaid coverage through the Affordable Care Act. And many are suggesting extra federal funds to help accommodate the economy-related newly Medicaid eligible is not expected to be renewed come FY2014.
Yet, Ohio is figuring out how to help mitigate those rising cost concerns and at the same time support its community pharmacy base. More states need to pick up on this Ohio example.
Take Care Health Systems’ new chief medical officer marks further evolution of U.S. health care
WHAT IT MEANS AND WHY IT’S IMPORTANT — The news that Walgreens has appointed Alan London as chief medical officer of Take Care Health Systems Consumer Solutions Group is important especially since he is a family physician who has more than three decades of experience in patient care delivery, healthcare strategy and business development, and spent 12 years at Cleveland Clinic.
(THE NEWS: Walgreens appoints chief medical officer of Take Care Health Systems Consumer Solutions Group. For the full story, click here)
There were plenty of squeaky wheels with little blogs that questioned the integrity of Dr. Cristine Cassel for her JAMA article, which shed a highly positive light on the convenient care industry, and outlined significant ways in which retail-based clinics are playing an important role in today’s U.S. healthcare system by improving access, cost and coordination of care for patients. But the fact that JAMA published the article, and the fact that guys like London and Andy Sussman, who serves as president of MinuteClinic and SVP and associate chief medical officer of CVS Caremark, are serving in such roles are more evidence that physicians who matter are behind the retail clinic model.
Prior to joining CVS Caremark in 2009, Sussman served as EVP and chief operating officer of UMass Memorial Medical Center, the major teaching affiliate of UMass Medical School, and also served as an associate professor of medicine at the University of Massachusetts Medical School.
You know what happens with squeaky wheels? Eventually you get tired of giving them grease and you just get a new wheel. That’s what the American health care needs. Like the wheel, its design needs to evolve — because everyone knows the round wheel worked better than the square wheel.
FDA approves Perjeta
SOUTH SAN FRANCISCO, Calif. — Genentech has received regulatory approval for a drug designed to treat breast cancer.
Perjeta (pertuzumab) is approved in combination with Herceptin (trastuzumab) and docetaxel chemotherapy for the treatment of people with HER2-positive metastatic breast cancer who have not received prior anti-HER2 therapy or chemotherapy for metastatic disease. With the approval, Genentech has agreed to post-marketing commitments related to the manufacturing process for Perjeta. These include FDA review of data from the next several productions of the medicine.
"[Today’s] approval of Perjeta is an important advance in the treatment of HER2-positive metastatic breast cancer," said Hal Barron, chief medical officer and head of global product development at Genentech. "Perjeta attacks HER2-positive tumors differently than Herceptin. Based on the way the two medicines work together, the combination plus chemotherapy can prolong the time before this aggressive cancer worsens compared to Herceptin and chemotherapy alone. We are very pleased to see our efforts in studying the science of HER2 translate into another personalized medicine."