March 12, 2020
11:50 am
Robert Popovian is Vice President of U.S. Government Relations at Pfizer
One of the most underutilized ways to reduce medical costs in the U.S. is health care prevention. Unfortunately, politicians choose instead to implement draconian policies such as price controls or utilization management, which focus solely on cost management without any consideration given to patient outcomes or the value of an intervention to society.
The reason policymakers promote these types of measures is twofold. One, these policies are simple to implement and two, they reach their intended results quickly by reducing budgets, whether it be hospital costs or drug expenditures. On the other hand, promotion of preventative measures are complicated and challenging to implement and are thus ignored, despite the fact that the data show that such measures lead to better patient outcomes, including improvements in quality of life and productivity.
The two examples of preventative interventions that have not only shown to reduce costs but also improve outcomes are improving immunization rates and medication adherence.
Vaccines are one of the most cost-beneficial interventions in health care. In the U.S., we have done a great job ensuring our children are protected from various communicable diseases. Vaccination rates for most serious ailments are in the 90th percentile for children. However, the same cannot be said when it comes to adults, as their vaccination rates are abysmal. For example, less than 50% of adults get a flu shot every year. What’s even more alarming is that approximately 20% of high-risk patients (e.g., patients suffering from lung disease) receive a pneumococcal vaccine. Both measures are well below the Healthy 2020 targets set by the Office of Disease Prevention and Health Promotion (ODPHP).
One approach to encourage adult vaccination is to further expand community-based pharmacist immunization capabilities. The evidence is clear that allowing pharmacists to provide vaccinations is the lowest cost alternative for providing this essential public health service. So it is vital that we expand and harmonize state laws governing pharmacist authority to immunize and to allow pharmacists to administer all Food and Drug Administration (FDA) approved and Advisory Committee for Immunization Practices (ACIP) recommended vaccines.
The second example of a cost-saving preventative intervention is medication adherence. One of the most cost-effective ways to improve patient adherence is through pharmacist-led medication synchronization. Medication synchronization is a service that has been offered for the past several years by pharmacists to patients who take multiple chronic medications.
A pharmacist collaborating with a physician and in consultation with the patient ensures that all of the patient’s medications are refilled on the same day. Pharmacists operationalize the concept by making an appointment with a patient to pick up their prescriptions every month, or at 60 or 90 days — depending on the refill schedule — and to discuss other issues pertinent to their care, such as over-the-counter medicine usage, smoking cessation needs or vaccination requirements. Medication synchronization has not only reduced the number of trips a patient has to take to the pharmacy and lessened the administrative burden for pharmacists and physicians, but most importantly it has led to better patient medication adherence and cost savings overall.
In 2014, for example, the Centers for Medicaid and Medicare Services (CMS) decided that patients enrolled in Medicare Part D plans should have the opportunity to synchronize their medications if they choose to and if it is deemed appropriate by their pharmacist or physician, not only because it improved adherence but also because of the overall health care cost reductions. In their analysis, CMS stated, “while the estimated total 6-year cost of this rule to Part D sponsors is $0.5 million, the savings to Part D sponsors and beneficiaries is $1.8 billion.” More recently, a research article published in Health Affairs suggested that patients with cardiovascular disease whose medications were synchronized were three times more adherent with their medications leading to 9% lower hospitalization and emergency department visits.
Fortunately, most states except for California and a handful of smaller ones have taken the lead from CMS to allow all patients in need to benefit from medication synchronization. It is now up to the pharmacists to offer this service universally to their patients.
No one denies that saving health care costs is a noble cause, and everyone agrees that it is not an easy task. However, policymakers are only focusing on the side of the ledger marked “cost”. Instead, they should be implementing policies that guide us towards the goal of disease prevention to achieve the ultimate endpoint of reducing health care costs while improving patient outcomes.
January 28, 2020
3:42 pm
One area in which we have seen a great deal of bipartisanship in Washington is in the effort to prevent and treat substance use disorder. In 2018, Congress passed groundbreaking legislation by overwhelming margins in both houses that gave states the resources they need to combat what was then commonly known as the opioid crisis.
But as U.S. Representative Diana DeGette (D-CO) pointed out at a recent congressional hearing, the battle is far from over. As she said, this addiction crisis has come in waves – the first being prescription pain medicines, the second heroin, the third synthetic opioids like fentanyl, and now, “it looks like a ‘fourth wave’ of the crisis may have already arrived. The opioid epidemic has fueled a huge increase in methamphetamine use. In 2018, there were more than twice as many deaths involving meth as 2015, and meth is increasingly turning up in overdose deaths and drug busts across the country.”
Given this continued high level of addiction and overdose cases, it is imperative that we give healthcare providers the tools they need to effectively treat substance use disorder patients. So, an essential next step in combating this drug crisis must involve addressing regulatory barriers that are standing between medical professionals and the information they need to provide effective diagnosis and treatment.
A law that is more than 40 years old, known as 42 CFR Part 2, places information sharing in substance use disorder cases on a different plane that that applied to all other patients under HIPAA laws. 42 CFR Part 2 places strict limitations on confidential data sharing among front-line caregivers and, in so doing, makes care coordination extraordinarily difficult. This outdated law worsens the odds of substance use disorder patients surviving and recovering.
There are two bills that have been introduced in Congress to address this problem. The Overdose Prevention and Patient Safety Act in the House and the Protecting Jessica Grubb’s Legacy Act in the Senate would remove these regulatory stumbling blocks and enable caregivers to have the information they need to do their jobs.
The necessity of these measures was underscored by an official with the North Carolina Department of Health and Human Services, who told Congress, “We have invested a lot of resources through peer support and other tools to try to support that coordination, care management, etc. but there is still a huge limitation. Even doctors within the same system can’t easily talk to each other to coordinate care around their patients. North Carolina is fully supportive of modernizing 42 CFR in an attempt to maintain privacy but also move us to integrated care.”
September 19, 2019
4:19 pm
September 16-20 is National Obesity Care Week (NOCW). NOCW is a source for science-based information on obesity. More than 93 million Americans are affected by obesity, with an estimated cost of $480 billion to the healthcare system. The Healthcare Leadership Council (HLC) has joined as a partner of NOCW, advancing our conviction that people who struggle with obesity deserve access to quality care and must be treated with dignity and respect.
Recently, HLC has been focused on how the healthcare system can utilize research on social determinants of health so that essential socioeconomic and environmental factors can be considered and addressed in addition to one’s clinical care. At the beginning of this week, HLC hosted a Hill briefing that had an expert panel present on reducing disparities in health. While this particular briefing looked at the whole patient from a pediatric and senior perspective rather than zeroing in on obesity, there is a strong relationship between obesity and low socioeconomic status that cannot be ignored.
Many HLC members have recognized the need to reach out and invest in the well-being of surrounding communities:
- BlueCross BlueShield of Tennessee has taken many avenues to encourage healthy lifestyles of Tennesseans, such as revitalizing neighborhoods with parks, and repaving the roads with bike lanes.
- The Bristol-Myers Squibb Foundation provided resources to establish one of New Jersey’s largest and most comprehensive children’s hospitals which includes a clinical center of excellence dedicated to the study and treat childhood obesity.
- Fairview Health System launched a new 24-week Healthy Lifestyle Plan that combines evidence-based weight loss strategies with one-on-one lifestyle coaching. This approach can address medical issues that make it hard for someone to lose weight on their own, such as hormone levels, the side effects of prescription drugs, or chronic conditions like sleep apnea.
- Teladoc Health has invested in a personalized virtual care platform for physical and behavioral health, addressing the root of the problem for chronic disease with digital therapeutic interventions and sustainable behavioral change.
It is promising that across the healthcare spectrum there have been a variety of solutions offered to address obesity, but much progress must still be achieved to make a lasting impact on the health of millions of Americans. Many people do not know that obesity is a disease, and education is the just the first step to achieving NOCW’s goal of access to comprehensive obesity care. More voices are needed to enact change. Additional information about ways to take action is available on ObesityCareWeek.org/ACTION.
September 11, 2019
12:03 pm
Several years ago, there was a significant push in Congress to allow wholesale importation of prescription drugs from other countries into the United States. The Healthcare Leadership Council found itself in an opportune position to examine this idea, given that our membership includes not only pharmaceutical manufacturers and healthcare payers, but also the companies that would facilitate the distribution of these imported products.
We found that the promised cost savings from importation were an illusion. When shipping, relabeling, storage, liability coverage and other costs were factored into the mix, the cost differential between medicines in this country and those from countries that employ government price controls was largely erased. It has never been surprising that HHS Secretaries and FDA Commissioners from both Republican and Democratic presidential administrations over the years have attested that the risks connected with drug importation far exceeded any possible rewards.
But now the issue is back in a big way. States – including Vermont, Colorado, and Florida – have passed legislation to set up their own drug importation programs, pending federal government approval, and the current administration has indicated a willingness to work with them in making this happen. Also, Congress is once again considering importation legislation. This is troubling.
The only difference between the drug importation issue today and when we first examined it is that the dangers have exacerbated while the benefits have not. There are certain facts that policymakers should keep in mind when contemplating the prospects of opening our borders to drugs from outside the U.S.
- We already have a drug crisis in this country, much of it fueled by the proliferation of lethal fentanyl that is originating in other countries and finding its way here through our ports and via the international mail service.
- The world is facing an enormous health challenge driven by the increase in counterfeit drugs. The World Health Organization has estimated that one in every 10 pharmaceutical products in low- and middle-income countries is falsified or substandard. Opening our borders increases our exposure to this danger.
- Since we first examined this issue, there has been an explosion in the number of online pharmacies. According to the National Association of Boards of Pharmacy, there are over 35,000 online drug sellers and 96 percent of them are in violation of applicable laws. Many of these operations are based in Canada, the nation often cited as the safe place from which to import drugs.
- And just to dispense with the notion that importing drugs from Canada will drastically lower prices, the numbers simply don’t work. Canada’s population is barely more than one-tenth that of the United States and our neighbors to the north have already been enduring problems with drug shortages. The idea that Canada can provide a sufficient supply of prescription medications to meet American demands is ludicrous.
By all means, we should be having a national conversation on healthcare affordability and accessibility in the United States, seeking solutions that will ensure patients have access to the treatments they need while also maintaining an environment that incentivizes lifesaving medical innovation. A serious discussion requires credible ideas, though, and drug importation doesn’t fit that bill.
April 12, 2019
1:30 pm
In a city as divided along partisan lines as Washington, D.C. is these days, you don’t often come across a legislative idea that wins broad support from both sides of the aisle. The fact that a majority of the U.S. House of Representatives is sponsoring legislation to repeal the medical device excise tax is a strong indicator that it’s time to act to take this counterproductive tax off the books.
This week, a House bill to repeal the medical device tax was introduced by a quartet of lawmakers, Representatives Ron Kind (D-WI), Jackie Walorski (R-IN), Scott Peters (D-CA) and Richard Hudson (R-NC). This legislation has 227 original cosponsors and follows the introduction of a companion bill in the U.S. Senate by Senators Pat Toomey (R-PA) and Amy Klobuchar (D-MN).
Congress has previously acknowledged the inherent flaws in this tax by suspending its implementation. The next logical step is full repeal. A 2.3 percent excise tax on medical device company revenues – not profits – is extraordinarily punitive and disproportionately harmful to innovators still trying to establish themselves in the marketplace. The tax has had a negative effect on investment and job creation and undermines medical innovation at a time in which we need to be incentivizing it.
Chronic disease continues to be the greatest driver of healthcare cost escalation. By continuing to develop more effective treatments and technology, we can enable patients and their healthcare providers to better manage these conditions and reduce the frequency of emergency room visits and acute care episodes. An excise tax on the tools needed to improve quality of life and achieve greater health system sustainability makes no sense. A bipartisan majority of Congress wants to do away with this tax. They should move expeditiously to do so.
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