OutcomesMTM helping MTM outcomes matter
OutcomesMTM, a medication therapy management delivery system, last week recognized its top chain and independent pharmacies for 2012. Walgreens and Kerr Drug were named top large pharmacy chain and top regional pharmacy chain, respectively.
MTM matters, and people are keeping score. And it’s something you can expect to see more of in the age of accountable care and star-based quality ratings.
According to a recent report released by the American Pharmacists Association, the Centers for Medicare and Medicaid Services in 2012 began a three-year demonstration project for Medicare Advantage Part D plans in which plans will receive quality bonus payments based on their star ratings. And those star ratings soon will be impacted by MTM performance metrics.
CMS guidance for 2013 Part D plans stated: “Sponsors are expected to have a process in place to measure, analyze and report the outcomes of their MTM programs, whether or not goals of therapy have been reached; capture drug therapy recommendations and resolutions made as a result of the MTM recommendations; and to capture beneficiary satisfaction with MTM services, providers, and outcomes.”
But don’t just take our word for it. "Money is a powerful motivator," wrote SoloHealth CEO and Founder Bart Foster as part of a comprehensive explanation of the star-based quality ratings in a recent blog for DSN. "According to the new law, CMS will pay up to 5% of a health plan’s total yearly benchmark payments to those plans receiving four stars or higher. Pending the plan’s size, that could equate to big money," he wrote.
Navarro promotes colon cancer screenings for National Colorectal Cancer Awareness Month
MIAMI — Navarro Discount Pharmacy is promoting colon cancer screenings in the month of March under a partnership with a group focused on the disease, Navarro said Friday.
The regional retail pharmacy has partnered with StopColonCancerNow.com to promote the screenings, which screening guidelines advise adults older than 50 years to receive, or 45 years if they are African-American. According to the American Cancer Society, the five-year survival rate for colon cancer is 90% when detected and treated in the earliest stage.
"Colon cancer is the second deadliest form of cancer in the United States, yet more than 80% of cases could be prevented with timely screenings," StopColonCancerNow.com medical director Simon Behar said. "Through its commitment to wellness and broad reach in south Florida, Navarro is helping us to spread an important message — a colonoscopy can save your life."
The 33-store chain will provide educational materials in pharmacies through the month, which is designated as National Colorectal Cancer Awareness Month, and include information on colon cancer screening in its advertisements and online.
"Keeping our customers healthy is part of what we do, and there is no test more important for those who meet the screening guidelines than a colonoscopy," Navarro EVP and Navarro Health Services president Albert Garcia said. "This partnership is one more way that we are taking care of our customers and helping to make sure they live a healthy life."
ESI report notes fall in spending on traditional drugs
ST. LOUIS — While the country’s spending on specialty drugs increased by 18.4% in 2012, spending on traditional drugs fell for the first time in 20 years, according to a report by Express Scripts.
The pharmacy benefit manager’s 2012 Drug Trend Report found that spending on drugs used to treat such common diseases as high cholesterol and blood pressure, most of them pills, decreased by 1.5%, mainly due to increased use of generics. Total drug trend for the year was 2.7%, consistent with the rate of growth in 2011. Prices for the most highly utilized branded drugs increased by 12.5% in 2012, outpacing the Consumer Price Index’s 1.7% inflation rate, while prices for generic drugs decreased by 24%.
"The first-ever decrease in traditional drug spending is the latest chapter of an ongoing success story for our utilization management programs and for the increased interest in generic medications, home delivery pharmacy and more focused retail pharmacy networks," Express Scripts SVP clinical research and new solutions Glen Stettin said.
The report noted that the patent cliff last year resulted in the introduction of low-cost generic alternatives for many blockbuster drugs and increased utilization in eight of the top 10 traditional therapy classes, while unit costs decreased in seven. But for the second consecutive year, the country spent more on prescription drugs for diabetes than for any other therapy class, with diabetes drug spending increasing by 11%, driven in part by unit cost increases for popular insulins. Drugs for attention disorders also saw an increase in spending, by 14.2%, with an 8.8% increase in utilization, thanks to an increase in adult patients.
Within the pharmacy benefit, specialty drugs accounted for 24.5% of the country’s total drug spending, the highest percentage on record. Four of the 15 most expensive-to-treat diseases in the country in terms of drug spending are treated with specialty medications, including inflammatory conditions, multiple sclerosis, cancer and HIV. The most expensive specialty category overall, rheumatoid arthritis, saw spending increase by an additional 23%, driven by both a 9% increase in utilization and a 14% increase in unit cost. The largest increase in drug spending was for hepatitis C, which saw a 33.7% increase, due almost entirely to the introduction of new drugs in 2011; spending on hepatitis C medications is expected to increase 32.3% this year and 56.3% next year. Costs for cancer drugs increased by 22.3%, while utilization increased by 3.4%. Overall, in 2012, the Food and Drug Administration approved 22 new specialty drugs, many of which host more than $10,000 per month of treatment.
Other findings include an indication that younger physicians and those practicing in Midwestern states are more likely to prescribe generics to Medicare patients, while the largest percentage increase in Medicaid drug spending, 24.3%, was for chemical dependence due to the rise in the number of Americans seeking treatment for drug and alcohol abuse. Utlization of cancer drugs increased by 11.8% for Medicare patients, while Medicare patients increased utilization of medications for hepatitis C by 63.5%; hepatitis C infection rates are more prevalent among patients born between 1945 and 1965. Medicaid also spends more on asthma medication than prescription drugs for any other single condition, and total asthma drug spending increased by 6.2%.