Association between health system specialty pharmacy use and health care costs among national sample of Medicare Advantage beneficiaries.

BACKGROUND: Health care expenditures are growing rapidly. There is a growing body of literature showing that health system specialty pharmacy is associated with improvement in clinical outcomes; however, there is a lack of data on its effect on health care costs and utilization. OBJECTIVE: To perform exploratory research assessing the association between health system specialty pharmacy use and health care costs and utilization. METHODS: A retrospective cohort study was conducted examining medical and pharmacy claims from 2018 and 2019 of Medicare Advantage beneficiaries. Optum Advisory Service's proprietary deidentified Normative Health Information database was used, which includes claims, membership, and provider data for 12.6 million Medicare Advantage members. Members who filled a prescription at a health system specialty pharmacy and had a specialty provider participating in the health system specialty pharmacy care model in clinic were assigned to the intervention group. Members who did not use a health system specialty pharmacy but had the same provider (provider benchmark group) or different provider (network benchmark group) were considered as comparisons. The network benchmark group was further refined to match variation in health care cost due to geography. The primary outcome measure was total health care costs (across the medical and pharmacy benefit) on a per-patient per-month basis. Secondary outcomes were selected utilization drivers and cost subcomponents. Cost and utilization metrics were calculated on a risk-adjusted basis using Centers for Medicare & Medicaid Services Hierarchical Condition Categories (CMS-HCC) risk score methodology. Differences were assessed for categorical variables with chi-square tests, and 2-tailed t-tests were used for continuous variables. RESULTS: Of the analytic sample of 9,780 members used in this study, 208 (2.1%) used health system specialty pharmacy services. During the 2018 baseline period, total health care costs and utilization were similar after CMS-HCC risk score adjustment ($9,520 among health system specialty pharmacy users; $8,691 among the provider benchmark group; $9,510 among the network benchmark group) but lower in 2019 ($7,060, $7,683, and $8,152, respectively). The differences in 2019 were primarily driven by savings in pharmacy and free-standing physician-related costs. CONCLUSIONS: Use of a health system specialty pharmacy is associated with a lower health care cost. Further study is required to analyze how drug and disease-specific interactions influence total health care costs and utilization for health system specialty pharmacy populations. DISCLOSURES: This study was funded by Shields Health Solutions and completed with Optum Advisory Services, which provided all analysis and was the sole source of data. University of Massachusetts Medical School investigators were independent context experts, who volunteered their time for this study. Hellems is employed by Optum Advisory Services; Fasching and Smith are employed by Shields Health Solutions; and Soni and McManus are employed by the University of Massachusetts Medical School. Soni received support from the National Institute of General Medical Science (T32GM107000), National Center for Advancing Translational Sciences (TL1-TR001454), and the Eunice Kennedy Shriver National Institute of Child Health and Human Development (1F30HD091975-03). McManus's time was supported by R01HL126911, R01HL137734, R01HL137794, R01HL135219, R01HL136660, U54HL143541 from the National Heart, Lung and Blood Institute. McManus has received research support from Bristol Myers Squibb, Care Evolution, Samsung, Apple Computer, Pfizer, Biotronik, Boehringer Ingelheim, Philips Research Institute, Flexcon, Fitbit; has consulted for Bristol Myers Squibb, Pfizer, Philips, Samsung Electronics, Rose Consulting, Boston Biomedical Associates, and FlexCon; and is also a member of the Operations Committee and Steering Committee for the GUARD-AF Study (NCT04126486), sponsored by Bristol Meyers Squibb and Pfizer. The other authors have nothing additional to disclose. The content is solely the responsibility of the authors and does not necessarily represent the official views of the NIH. The funders played no role in the design and conduct of the study; collection, management, analysis, and interpretation of the data; preparation, review, or approval of the manuscript; and decision to submit the manuscript for publication.

Health spending expenditures for commercial plans are predominantly concentrated among a small population of high-intensity consumers across settings of care.

BACKGROUND: Rising health care spending has sparked new efforts to constrain health care expenditures. OBJECTIVE: To explore how health care spending is distributed across consumers and how utilization patterns compare across health care resource expenditures (eg, hospital, outpatient care). METHODS: Using the IQVIA PharMetrics Plus database, we conducted a retrospective claims analysis for the 2018 plan year to examine commercial health care spending and utilization across 5 settings of care: ambulatory services, inpatient services, office visits, pharmacy services, and additional services. RESULTS: Consistent with findings from previous analyses of total health spending, total health care spending for a large commercially insured population was largely concentrated within a small population of high-intensity consumers. These patterns persist when looking at individual segments of spending, including spending on prescription drugs and inpatient and ambulatory services. Inpatient spending was the most concentrated, with 97% of spending occurring within the top tenth percentile of patients. CONCLUSIONS: Our findings suggest that health care spending for commercial plans is predominantly concentrated within a small population of high-intensity consumers across all settings of care. Curbing rising health care spending will require systemwide evaluation of the value of spending within and across settings of care for a subset of high-resource-use patients. This is particularly important for health care settings with the highest concentration of spending, including inpatient care. DISCLOSURES: This study was funded by the National Pharmaceutical Council (NPC). Ciarametaro, Buelt, and Dubois are employed by the NPC. Kleinrock and Campbell are employed by IQVIA, which was contracted by the NPC for data analysis.

Alternative mechanisms for delivery of medication in South Africa: A scoping review.

BACKGROUND: The number of people in South Africa with chronic conditions is a challenge to the health system. In response to the coronavirus infection, health services in Cape Town introduced home delivery of medication by community health workers. In planning for the future, they requested a scoping review of alternative mechanisms for delivery of medication to patients in primary health care in South Africa. METHODS: Databases were systematically searched using a comprehensive search strategy to identify studies from the last 10 years. A methodological guideline for conducting scoping reviews was followed. A standardised template was used to extract data and compare study characteristics and findings. Data was analysed both quantitatively and qualitatively. RESULTS: A total of 4253 publications were identified and 26 included. Most publications were from the last 5 years (n = 21), research (n = 24), Western Cape (n = 15) and focused on adherence clubs (n = 17), alternative pick-up-points (n = 14), home delivery (n = 5) and HIV (n = 17). The majority of alternative mechanisms were supported by a centralised dispensing and packaging system. New technology such as smart lockers and automated pharmacy dispensing units have been piloted. Patients benefited from these alternatives and had improved adherence. Available evidence suggests alternative mechanisms were cheaper and more beneficial than attending the facility to collect medication. CONCLUSION: A mix of options tailored to the local context and patient choice that can be adequately managed by the system would be ideal. More economic evaluations are required of the alternatives, particularly before going to scale and for newer technology.

Participating doctors' perspectives on the regulation of voluntary assisted dying in Victoria: a qualitative study.

OBJECTIVES: To investigate the perspectives of doctors involved with voluntary assisted dying in Victoria regarding the Voluntary Assisted Dying Act 2017 (Vic) and its operation. DESIGN, SETTING, PARTICIPANTS: Qualitative study; semi-structured interviews with 32 doctors who had participated in the voluntary assisted dying system during its first year of operation (commenced 19 June 2019). Doctors were interviewed during April-July 2020. RESULTS: Three major themes related to problems during the first year of operation of the Act were identified: the statutory prohibition of health professionals initiating discussions with their patients about voluntary assisted dying; the Department of Health and Human Services guidance requirement that all doctor-patient, doctor-pharmacist, and pharmacist-patient interactions be face-to-face; and aspects of implementation, including problems with the voluntary assisted dying online portal, obtaining documentary evidence to establish eligibility, and inadequate resourcing of the Statewide Pharmacy Service. CONCLUSIONS: Doctors reported only limited concerns about the Victorian voluntary assisted dying legislation, but have had some problems with its operation, including implications for the accessibility of voluntary assisted dying to eligible patients. While legislative change may resolve some of these concerns, most can be ameliorated by improving the processes and systems.

[Sickle cell disease in the Democratic Republic of the Congo: what are the barriers to treatment using hydroxyurea?] / Drépanocytose en République Démocratique du Congo: quels sont les obstacles à un traitement par hydroxyurée?

INTRODUCTION: hydroxyurea is the unique medication that has been proven to prevent complications in patients with sickle cell disease and is approved by the Food and Drug Administration. This medication requires a prescription to be dispensed, it must be available and at an affordable price. The purpose of this study was to determine the availability and market price of hydroxyurea in the Democratic Republic of the Congo and to make a comparison between these two aspects in a small city, such as Mbujimayi, and in a big city, such as Lubumbashi. METHODS: we conducted a cross-sectional study in the context of a face-to-face survey involving 188 Congolese pharmacies from 1st April to 1st September 2017. RESULTS: hydroxyurea was available at 41/188 (22%) participating pharmacies, but more frequently at those of a big city than at those of a small city (34/96 versus 7/92). Most patients got a prescription (36/41; 88%). The average price of hydroxyurea was $15 (from $10 to $35 a blister packs of 25 capsules), which was higher than the purchasing power of the majority of sickle cell patients. Hydroxyurea is still an imported product from Europe, the United States or Asia. CONCLUSIONS: hydroxyurea is one of the main treatments to slow down disease progression in sickle cell patients. Nevertheless, in the Democratic Republic of the Congo, its availability could be improved, in particular in small cities, and its price is still too high.

The cost of Medicare-funded medical and pharmaceutical services for mental disorders in children and adolescents in Australia.

OBJECTIVE: To examine the health care costs associated with mental disorders and subthreshold mental disorders within a nationally representative sample of children and adolescents in Australia. METHOD: Data were derived from the Young Minds Matter Survey (N = 6,310). Mental disorders were classified using the Diagnostic Interview Schedule for Children Version IV. Participant data were linked to administrative data on health care costs. Adjusted generalized linear regression models and two-part models were used to estimate mean differences in costs between those with a mental disorder or subthreshold disorder and those without. RESULTS: Costs associated with health care attendances and medications were higher for children and adolescents with mental disorders and subthreshold mental disorders compared to those without a mental disorder. The additional population health care costs due to mental disorders amounted to AUD$234 million annually in children and adolescents, of which approximately 16% was attributed to out-of-pocket costs. Findings showed that those with subthreshold mental disorders or comorbid mental disorders have substantial additional costs of Medicare-funded medical and pharmaceutical services. CONCLUSION AND IMPLICATION: Mental disorders in children and adolescents are associated with significant health care costs. Further research is needed to ensure that this population is receiving effective and efficient care.

Análisis modal de fallos y efectos y análisis de minimización de costes de tres programas de entrega de medicamentos / Healthcare failure mode and effects analysis and cost minimization analysis of three pharmaceutical services

Objetivo: El objetivo principal fue evaluar y comparar tres programasde entrega de medicamentos requeridos por los pacientes atendidosen las consultas externas de farmacia hospitalaria: mediante centros desalud, empresa de mensajería externa y oficinas de farmacia. El objetivosecundario fue analizar el coste económico desde la perspectiva delsistema público de salud.Método: Se utilizó el análisis modal de fallos y efectos para el objetivoprincipal. El análisis económico se realizó mediante un estudio de minimización de costes.Resultados: Los resultados en índice de probabilidad de riesgo fueron184 puntos para la entrega mediante centros de salud, 170 mediantemensajería y 126 mediante oficina de farmacia. El estudio económicomostró que actualmente el programa con menor coste económico fue ladispensación mediante oficina de farmacia respecto a mensajería y centros de salud (7.986,52 € versus 18.434,52 € y 11.417,08 €).Conclusiones: La entrega mediante oficina de farmacia tiene el menoríndice de probabilidad de riesgo debido en gran parte al papel delfarmacéutico en la custodia y conservación del medicamento. (AU)

Objective: The main purpose of this study was to analyze and comparethree different medication delivery methods used by the outpatient careunit of a hospital pharmacy, namely health center collection, communitypharmacy collection and home delivery. The secondary purpose was tocompare the economic cost of those methods for the Spanish health service.Method: A failure mode and effects analysis was carried out to attain theprimary objective. For the secondary objective, an in-depth analysis wasperformed of the economic costs associated with each program using acost-minimization analysis.Results: The failure mode and effects analysis resulted in scores of184, 170 and 126 points for the health center collection, home deliveryand community pharmacy collection programs, respectively. The economic evaluation, for its part, rendered estimated costs of €18,434.52,€11,417.08 and €7,986.52 for home delivery, health center collectionand community pharmacy collection services, respectively.Conclusions: The results of the study indicated that collection at the community pharmacy was the program associated to the lowest risk, most likely dueto the crucial role of the pharmacist regarding the custody and preservation of medicines. (AU)

Healthcare failure mode and effects analysis and cost­minimization analysis of three pharmaceutical services.

OBJECTIVE: The main purpose of this study was to analyze and compare three different medication delivery methods used by the outpatient care unit of a hospital pharmacy, namely health center collection, community pharmacy collection and home delivery. The secondary purpose was to compare the economic cost of those methods for the Spanish health service. METHOD: A failure mode and effects analysis was carried out to attain the primary objective. For the secondary objective, an in-depth analysis  was performed of the economic costs associated with each program using  a cost-minimization analysis. RESULTS: The failure mode and effects analysis resulted in scores of 184, 170 and 126 points for the health center collection, home delivery and community pharmacy collection programs, respectively. The economic evaluation, for its part, rendered estimated costs of €18,434.52, €11,417.08 and €7,986.52 for home delivery, health center collection and community pharmacy collection services, respectively. CONCLUSIONS: The results of the study indicated that collection at the community pharmacy was the program associated to the lowest risk, most likely due to the crucial role of the pharmacist regarding the custody and preservation of medicines. As regards cost, dispensation at the community pharmacy was also associated with the lowest cost. Nevertheless, this finding was biased by the fact that, given the generous collaboration of pharmaceutical distributors during the COVID-19 pandemic, the cost of transport and delivery to the pharmacy during the study period was zero. Further economic analyses are required to evaluate the costs of community pharmacy delivery and determine their impact on the public health system in cases where transport costs are different from zero.

Objetivo: El objetivo principal fue evaluar y comparar tres programas de entrega de medicamentos requeridos por los pacientes atendidos en las  consultas externas de farmacia hospitalaria: mediante centros de salud,  empresa de mensajería externa y oficinas de farmacia. El objetivo secundario fue analizar el coste económico desde la perspectiva  del sistema público de salud.Método: Se utilizó el análisis modal de fallos y efectos para el objetivo principal. El análisis económico se realizó mediante un estudio de minimización de costes.Resultados: Los resultados en índice de probabilidad de riesgo fueron 184 puntos para la entrega mediante centros de salud, 170 mediante mensajería y 126 mediante oficina de farmacia. El estudio económico mostró que actualmente el programa con menor coste económico fue la dispensación mediante oficina de farmacia respecto a mensajería y centros de salud (7.986,52 € versus 18.434,52 € y 11.417,08 €).Conclusiones: La entrega mediante oficina de farmacia tiene el menor índice de probabilidad de riesgo debido en gran parte al papel del farmacéutico en la custodia y conservación del medicamento. Respecto al estudio económico, también la dispensación mediante oficina de farmacia obtuvo el menor coste pero con una importante limitación: fue asignado un coste cero relativo a la empresa distribuidora y a la entrega del medicamento en las oficinas de farmacia por la colaboración altruista durante la pandemia. Si el coste fuese distinto de cero, serán necesarios nuevos estudios para evaluar el impacto económico el sistema público de salud.

AMCP Partnership Forum: Preparing for and managing rare diseases.

Despite the opportunity for large health gains, there are many challenges associated with rare disease therapies. Among these are striking the appropriate balance between the urgency to respond to patient needs with the uncertainty that is often inherent in rare disease therapy datasets leading to concerns with developing and interpreting clinical data; uncertainty around financial impact, value determination, and affordability; and variation in approach to coverage and potential effects on access. To discuss these challenges and opportunities to address them, AMCP held a virtual multidisciplinary stakeholder forum on September 8-10, 2020. Forum participants represented diverse sectors of the health care industry, including integrated delivery systems, health plans, pharmacy benefit managers, employer groups, biopharmaceutical companies, patient advocacy organizations, health policy researchers, and consulting firms; they evaluated strategies to plan for and manage rare disease therapies and recommended best practices and next steps. DISCLOSURES: This forum was sponsored by the following: AstraZeneca, Dicerna, Genentech, National Pharmaceutical Council, Novo Nordisk, Pfizer, Precision Value, Sanofi, Sarepta Therapeutics, Seattle Genetics, Spark Therapeutics, and Takeda. These proceedings were prepared as a summary of the forum to represent common themes; they are not necessarily endorsed by all attendees nor should they be construed as reflecting group consensus.

Meeting the affordability challenges posed by orphan drugs: a survey of payers, providers, and employers.

BACKGROUND: As an increasing number of orphan drugs are FDA approved, health care payers, employers, and providers are attempting to strike a balance between patient access to innovative treatments and overall affordability. Payers and employers are evaluating how traditional specialty pharmacy management strategies and innovative models can support continued coverage of orphan drugs. OBJECTIVE: To understand how health care stakeholders are meeting the financial challenges posed by the increasing number and cost of orphan drugs and how these strategies are affecting orphan drug acquisition for providers. METHODS: A survey was conducted with payer, provider, and employer decision makers recruited from both AMCP and a proprietary database of market-access decision makers in July and August 2020. Respondents were asked about their experiences and activities in the orphan disease space, including tactics to manage affordability of drugs to treat orphan diseases. RESULTS: Reinsurance was the most commonly utilized strategy to maintain affordability of the benefit for both payers (42%) and employers (55%). Although 31% of payers have adopted gene therapy carve-outs, no employers had done so. Approximately three quarters (76%) of payers believe that limited distribution networks impede their abilities to manage orphan drugs, compared with 4% who believe limited networks improve orphan drug management. For most payers (78%), the decision to cover orphan drugs on either the medical or pharmacy benefit depends on the specific drug. Medical benefit coverage was driven primarily by site-of-care policies (55%) and the lower drug cost of average sales price pricing (50%). Pharmacy benefit coverage was driven primarily by a greater ability to manage the orphan drug (71%) and by rebates (62%). One in 3 (33%) of providers with experience treating orphan diseases acquire orphan drugs exclusively through buy and bill, whereas 10% acquire them exclusively through a specialty pharmacy provider. Buy-and-bill acquisition by providers was driven primarily by improved patient affordability (47%) and 340b pricing (47%). Specialty pharmacy provider acquisition was driven primarily by payer requirements (64%) and reduced administrative burden (64%). CONCLUSIONS: Payers and employers are adopting innovative benefit designs and strategies to cover orphan drugs while maintaining plan affordability. Cost considerations are prominent factors in determining whether orphan drugs will be covered under the pharmacy or medical benefit and how providers will acquire orphan drugs. DISCLOSURES: This research was sponsored by AMCP and PRECISIONvalue. Lopata, Terrone, and Gopalan are employees of PRECISIONvalue. Ladikos and Richardson are employees of AMPC. The authors have nothing further to disclose. This research was presented during the AMCP Partnership Forum "Preparing for and Managing Rare Diseases" held virtually September 8-10, 2020.

THE MOST FAVORED NATIONS MODEL INTERIM FINAL RULE IS FATALLY FLAWED AND MUST BE RESCINDED-YET THE PROBLEM IT ADDRESSES DEMANDS A SOLUTION.

DISCLOSURES: No funding supported the writing of this letter. The author has nothing to disclose.

Impact of Area Deprivation Index on the Performance of Claims-Based Risk-Adjustment Models in Predicting Health Care Costs and Utilization.

Traditionally, risk-adjustment models do not address the characteristics of minority populations, such as race or socioeconomic status. This study aimed to evaluate the added value of place-based social determinants on risk-adjustment models in explaining health care costs and utilization. Statewide commercial claims from the Maryland Medical Care Database were used, including 1,150,984 Maryland residents aged 18 to 63 with ≥6 months enrollment in 2013 and 2014. Area Deprivation Index (ADI) was assigned to individuals through zip code. The authors examined the addition of ADI to predictive models of concurrent and prospective costs and utilization; linear regression was adopted for costs and logistic regression for utilization markers. Performance measures included R2 for costs (total, pharmacy, and medical costs) and the area under the curve (AUC) for utilization (being top 5% top users, having any hospitalization, having any emergency room [ER] visit, having any avoidable ER visit, and having any readmission). All performance measures were derived from the bootstrapping analysis with 200 iterations. Study subjects were ∼48% male with a mean age of ∼41 years. Adding ADI to the demographics or claims-based models generally did not improve performance except in predicting the probability of having any ER or any avoidable ER visit; for example, AUC of avoidable ER visits increased significantly from .610 to .613 when using ADI rank deciles in claims-based models. Future research should focus on patients with a higher need for social services, assess more granular place-based determinants (eg, Census block group), and evaluate the added value of individual social variables.

Alaska pharmacists: First responders to the pandemic in the last frontier.

BACKGROUND: Pharmacists are among the nation's most accessible and underused health professionals. Within their scope of practice, pharmacists can prescribe and administer vaccines, conduct point-of-care testing, and address drug shortages through therapeutic substitutions. OBJECTIVES: To better use pharmacists as first responders to coronavirus disease 2019 (COVID-19), we conducted a needs and capacity assessment to (1) determine individual commitment to provide COVID-19 testing and management services, (2) identify resources required to provide these services, and (3) help prioritize unmet community needs that could be addressed by pharmacists. METHODS: In March 2020, pharmacists and student pharmacists within the Alaska Pharmacist Association worked to tailor, administer, and evaluate results from a 10-question survey, including demographics (respondent name, ZIP Code, cell phone, and alternate e-mail). The survey was developed on the basis of published COVID-19 guidelines, Centers for Disease Control and Prevention COVID-19 screening and management guidelines, National Association of Boards of Pharmacy guidance, and joint policy recommendation from pharmacy organizations. RESULTS: Pharmacies are located in the areas of greatest COVID-19 need in Alaska. Pharmacists are willing and interested in providing support. Approximately 63% of the pharmacists who completed the survey indicated that they were interested in providing COVID-19 nasal testing, 60% were interested in conducting COVID-19 antibody testing, and 93% were interested in prescribing and administering immunizations for COVID-19, as available. When asked about resources needed to enable pharmacists to prescribe antiviral therapy, 37% of the pharmacists indicated they needed additional education or training, and 39% required access to technology to bill and document provided services. CONCLUSION: The primary barrier to pharmacists augmenting the current COVID-19 response is an inability to cover the costs of providing these health services. Pharmacists in Alaska are ready to meet COVID-19-related clinical needs if public and private insurers and legislators can help address the barriers to service sustainability.

Cost-effectiveness of pharmacist-led care versus usual care in type 2 diabetic Jordanians: a Markov modeling of cardiovascular diseases prevention.

BACKGROUND: Cardiovascular diseases (CVDs) are responsible for one third of global deaths and the main cause of death among Jordanians. Pharmacist-led care was outlined previously as a cost-effective approach in the management of chronic illness; however, this is not well studied in low to middle-income countries. AIM AND OBJECTIVES: To assess the cost-effectiveness of pharmacist-led care versus usual care in preventing CVDs in Type 2 Diabetes Mellitus (T2DM). METHOD: A Markov model of one-year cycle length and 10-year time horizon was constructed to simulate 10-year CVD events, mortality, and costs for two hypothetical cohorts; usual care and pharmacist-led care, respectively, of Jordanian patients suffering from T2DM. Public health provider perspective was adopted. Outcomes examined were incremental costs, LYGs, and incremental cost-effectiveness ratio (ICER). Deterministic and probabilistic sensitivity analysis (PSA) assessed the robustness of the results. RESULT: The pharmacist-led care generated an additional 0.3 LYG/patient at an additional cost of JD1,238.78 (US$1,747.24) comparing to the usual care in the 10-year base-case analysis. Deterministic and PSA supported the robustness of base-case findings, indicating that pharmacist-led care is cost-effective. CONCLUSION: The findings outline long-term clinical and economic benefits of expanding clinical pharmacist's roles in direct patient care services.

Alternative payment approaches for advancing comprehensive medication management in primary care

The increasing prevalence of complex, chronic conditions has profound implications on the growing demand and cost of health care. The Center for Medicare and Medicaid Innovation is testing data-driven approaches to care delivery and payment that are drawn from innovative practices of health care providers and other partners in the health care community. The shift from fee-for-service to value-based care and performance-based payment places increased priority on improved outcomes at lower costs. To advance comprehensive medication management, pharmacists need to understand the opportunities in the evolving value-based payment models and align medication optimization with the specific goals and incentives of these models

No disponible

[Expanding Pharmacy Services for Sustainable Universal Health Coverage: Lessons from the Canadian Health Care System].

Japan's health care system can be regarded as one of the best worldwide, provided it remains sustainable. It has relatively low costs, short wait times, low disease incidence, and high life expectancy. However, universal coverage in Japan faces financial challenges due to the country's rapidly aging population. Canada is another of the few developed countries that have universal health coverage. In contrast to Japan, Canada's health care spending is still sustainable according to recent studies. Effective cost control by payers has played a major role, with providers being steered toward evidence-based and cost-effective drug therapies. Furthermore, expanded pharmacy services have been important in suppressing spending on prescription drugs and minor health care services such as vaccination, government-funded smoking cessation, and medication review programs. This article outlines the services provided by Canadian pharmacists with expanded scope of practice. The pharmaceutical profession and its advocacy body in Canada have not only played a role in regulatory changes, but also put in place technological infrastructure called PharmaNet and contributed to appropriate prescribing. Given the current economic situation and demographic trends in Japan, more options should be explored in order to maintain universal health coverage by meeting the funding gap. Utilizing community pharmacies and pharmacists is proposed as one option.

Using the Delphi method to identify meaningful and feasible outcomes for pharmaceutical value-based contracting.

In an effort to demonstrate measurable value of pharmaceuticals in the United States, many payers and drug manufacturers have entered into value-based purchasing contracts that link payment for prescription medications to patient outcomes, creating shared risk between the 2 entities. These agreements have emerged as part of a larger movement within the health care landscape to transition away from volume-based payment models and towards value-based designs that promote high-quality and affordable care. Key to the success of pharmaceutical value-based contracting is agreement on meaningful and measurable outcomes that reflect drug performance. Traditional value-based contracts are developed by pharmaceutical companies and payers and may not reflect values of other important stakeholders, such as patients, providers, and employers (when applicable). One approach to more effectively align the interests of all key stakeholders and to maximize the effect and transparency of value-based pharmaceutical contracts is to use the validated Delphi surveying technique, which can gather information and build stakeholder consensus on key elements before contract development. In this Viewpoints article, we describe our experience conducting Delphi studies in 5 disease contexts to inform pharmaceutical value-based contract development, including insights learned and practical considerations for real-world application. In addition, we outline advantages to using this validated consensus-building tool to solicit vital and underrepresented stakeholder input, foster transparency in the contract development process, and promote shared learning for future value-based initiatives. DISCLOSURES: No outside funding supported this project. All authors are or were employed by UPMC Health Plan at the time of this study and have no other disclosures to declare.

Racial disparities in medication use: imperatives for managed care pharmacy.

The COVID-19 pandemic and the social unrest pervading U.S. cities in response to the killings of George Floyd and other Black citizens at the hands of police are historically significant. These events exemplify dismaying truths about race and equality in the United States. Racial health disparities are an inexcusable lesion on the U.S. health care system. Many health disparities involve medications, including antidepressants, anticoagulants, diabetes medications, drugs for dementia, and statins, to name a few. Managed care pharmacy has a role in perpetuating racial disparities in medication use. For example, pharmacy benefit designs are increasingly shifting costs of expensive medications to patients, creating affordability crises for lower income workers, who are disproportionally persons of color. In addition, the quest to maximize rebates serves to inflate list prices paid by the uninsured, among which Black and Hispanic people are overrepresented. While medication cost is a foremost barrier for many patients, other factors also propagate racial disparities in medication use. Even when cost sharing is minimal or zero, medication adherence rates have been documented to be lower among Blacks as compared with Whites. Deeper understandings are needed about how racial disparities in medication use are influenced by factors such as culture, provider bias, and patient trust in medical advice. Managed care pharmacy can address racial disparities in medication use in several ways. First, it should be acknowledged that racial disparities in medication use are pervasive and must be resolved urgently. We must not believe that entrenched health system, societal, and political structures are impermeable to change. Second, the voices of community members and their advocates must be amplified. Coverage policies, program designs, and quality initiatives should be developed in consultation with those directly affected by racial disparities. Third, the industry should commit to dramatically reducing patient cost sharing for essential medication therapies. Federal and state efforts to limit annual out-of-pocket pharmacy spending should be supported, even though increased premiums may be an undesirable (yet more equitable) consequence. Finally, information about race should be incorporated into all internal and external reporting and quality improvement activities. DISCLOSURES: No funding was received for the development of this manuscript. Kogut is partially supported by Institutional Development Award Numbers U54GM115677 and P20GM125507 from the National Institute of General Medical Sciences of the National Institutes of Health, which funds Advance Clinical and Translational Research (Advance-CTR), and the RI Lifespan Center of Biomedical Research Excellence (COBRE) on Opioids and Overdose, respectively. The content is solely the responsibility of the author and does not necessarily represent the official views of the National Institutes of Health.

Milestones in managed care pharmacy.

Managed care pharmacy has a relatively short history, but one that is defined by significant achievements. Since the late 1960s, managed care pharmacists have applied their unique skills to formulary management, clinical programs, benefit design, and contract negotiations to support patient access to life-saving therapies, while also ensuring cost-effective use of limited health care resources. Key milestones include establishing the pharmacy benefit as an essential component of the U.S. health care system, launching the Medicare Part D program, and expanding medication therapy management services. The year 2020 brings another milestone-the 25th anniversary of AMCP's flagship publication, the Journal of Managed Care + Specialty Pharmacy. This year also serves as an inflection point. As managed care pharmacy professionals prepare for change and the challenges ahead-including the imperative to address the rising costs of health care and health disparities-the use of evidence, utilization management strategies, and innovation will support our continued success. DISCLOSURES: No funding supported the writing of this commentary. The authors have nothing to disclose.