Representatives Doug Collins (R-GA) and Vicente Gonzalez (D-TX) introduced H.R. 5958, the Phair Pricing Act of 2018, to lower the cost of prescription medications for patients in the Medicare Part D program. The bill will require all pharmacy DIR fees, including quality payments made to a pharmacy, to be incorporated at the point of sale and ensures pharmacists have meaning control over the quality measures. Both this bill and H.R. 1038, the Improving Transparency and Accuracy in Medicare Part D Spending Act, are paths to achieve one solution: Eliminate retroactive pharmacy DIR fees that contribute to high patient drug spend and make it nearly impossible to run a small business.
Under a little-known Medicare rule, people can pay a lower cash price for prescriptions instead of using their insurance. But first, they must ask the pharmacists about that option. Medicare’s website and annual handbook do not mention the simple question that can lead to savings for millions of beneficiaries. There are different prices that may be available to consumers. Many beneficiaries may not know that if they pay a lower cash price for a covered drug at a pharmacy that participates in their insurance plan and then submit the proper documentation, insurers must count it toward their out-of-pocket expenses.
According to a May 29 Wall Street Journal article, CVS Health appears to be billing the state of Ohio’s Medicaid program more that it is paying pharmacies, driving up taxpayer costs. CVS’s actual drug payments aren’t transparent to the state or MCOs. Attempting to drive independents out of business, CVS has slashed payment rates below pharmacies’s wholesale drug costs. Pharmacists contend CVS is pocketing the increased “spread pricing” — that’s the difference between what the PBM pays pharmacies and charges the state.
Only one-third of patients with poorly controlled blood sugar on oral drugs require adjusted treatment, reports a study by researchers at the Cleveland Clinic. The researchers suggests that only about one-third of patients with poorly controlled blood sugar on oral drugs were switched to higher doses, different drug or insulin within six months. As such, researchers said, “Patients should empower themselves by checking their blood sugars daily, knowing what their target blood sugar levels should be, and having regular appointment with their physician.”
The FDA says EpiPen is in short supply because of manufacturing problems Mylan NV, which sells EpiPens manufactured by Pfizer, said some pharmacies are in short supply, but the product is available at other pharmacies.
A growing number of states are requiring health care providers to prescribe naloxone alongside prescription opioid painkillers to try to reduce overdose deaths. Walmart Inc. said it would restrict initial acute opioid prescriptions to no more than a seven-day supply as it aims to curb opioid abuse.
The number of opioid prescriptions filled at retail pharmacies dropped 10 percent in 2017, the steepest drop in the amount of painkillers dispensed to patients in 25 years, according to a report from IQVIA Institute for Human Data Science. The volume of prescription opioids has receded only to the levels of 2006 and 2007.
Research for opioid alternatives is intensifying with a growing number of painkillers with little or no risk of substance use disorder entering clinical trials. The FDA approved Zilretta (triamcinolone acetonide) a pain relief treatment in October. According to the National Institutes of Health, upwards of 25 million Americans suffer from daily pain.
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