CVS Plans to Overhaul How Much Drugs Cost

By Anna Wilde Mathews - CVS Health, the nation’s largest drugstore chain, will move away from the complex formulas used to set the prices of the prescription drugs it sells, shifting to a simpler model that could upend how American pharmacies are paid. Read Full Article…

VBA Article Summary

1. CVS Pharmacy's New Payment Model: CVS is set to change its payment structure in its approximately 9,500 retail pharmacies. Under this new plan, starting in the first half of 2024, CVS will be reimbursed based on the actual cost of drugs, a limited markup, and a flat fee for services related to handling and dispensing prescriptions. This model contrasts with the current complex payment methods not directly tied to the specific costs of drugs. Inspired by similar “cost plus” models advocated by entities like Mark Cuban’s pharmacy company, this approach aims for greater clarity and accountability in drug pricing.

2. Implications for Consumers and the Market: The shift is expected to have varied effects on drug prices, with some potentially decreasing and others increasing. CVS's initiative is part of a broader effort to stabilize its retail pharmacy business and address criticisms regarding the complexity and lack of transparency in drug pricing. The new model, named CostVantage, will initially be available to consumers paying cash using drug discount cards, with plans to extend it to employer plans and government-backed coverage in the future. Though not expected to significantly boost CVS's profits, the model aims to provide more stable and predictable earnings.

3. Broader Industry Impact and Concerns: The move by CVS is seen as a significant step towards transparency in drug pricing, reflecting a growing industry trend. Other pharmacy-benefit managers, like Express Scripts, are also introducing models to increase clarity. However, there are concerns about the implementation of this model, including how CVS-linked units might influence drug pricing and the overall impact on the affordability of drugs for consumers. Additionally, the new model raises questions about the application of rebates received by pharmacy-benefit managers and their effect on out-of-pocket costs for patients.

Showdown! FTC chief gets tough on private equity’s takeover of health care

By Harris Meyer - A recent Federal Trade Commission civil lawsuit accusing one of the nation’s largest anesthesiology groups of monopolistic practices that sharply drove up prices is a warning to private equity investors that could temper their big push to snap up physician groups. Read Full Article…

VBA Article Summary

1. FTC Lawsuit Against Private Equity Firm and U.S. Anesthesia Partners: The Federal Trade Commission (FTC) has filed a lawsuit against U.S. Anesthesia Partners and the private equity firm Welsh, Carson, Anderson & Stowe. This legal action, the first of its kind by the FTC against a private equity purchase of medical practices, alleges that the defendants rolled up nearly all large anesthesiology practices in Texas, leading to increased prices and engaging in anti-competitive practices. FTC Chair Lina Khan has emphasized this lawsuit as a message against such roll-up schemes in healthcare.

2. Impact of Private Equity Acquisitions on Healthcare: The article highlights growing concerns about private equity acquisitions of physician groups, particularly in terms of health costs, quality of care, and clinical autonomy. Studies, such as one published in JAMA Internal Medicine, found significant price increases post-acquisition by private equity firms. Critics argue that these acquisitions, driven by a short-term investment model, lead to higher prices and reduced staffing, ultimately jeopardizing patient care.

3. Regulatory and Market Responses: The FTC's lawsuit represents a shift in regulatory scrutiny towards roll-ups of physician groups, traditionally under-monitored due to federal law thresholds. The FTC has proposed enhanced reporting requirements for mergers to better detect and prevent unlawful roll-up schemes. However, some argue that these measures might be too late, as market consolidation has already diminished competition significantly. There are calls for more robust enforcement and even price regulation to address these issues.

Appeals court approves $2.67 billion Blue Cross settlement

By Amy Yurkanin - Judges on the 11th Circuit U.S. Court of Appeals have upheld a historic $2.67 billion settlement in a long-running antitrust case against health insurance giant Blue Cross Blue Shield. Read Full Article…

VBA Article Summary

1. Settlement Approval and Challenges: Three years ago, a federal judge in Alabama approved a significant settlement, addressing claims against Blue Cross for its anti-competitive practices. However, this settlement faced hurdles due to concerns about its implications on future antitrust law enforcement and the high compensation for attorneys involved. These challenges were eventually dismissed by an appeals court in Atlanta in late October.

2. Background of the Case: The lawsuit against Blue Cross began in 2013 when customers alleged that the company violated antitrust laws by dividing territories and agreeing not to compete with each other. This led to claims against various Blue Cross affiliates, which were consolidated in Alabama, culminating in a landmark $2.67 billion settlement, one of the largest in healthcare litigation history.

3. Current Status and Next Steps: The deadline for filing claims in this case has passed, but parties interested in contesting the settlement still have the opportunity to appeal in the first quarter of 2024. Additionally, to aid those tracking the case, a dedicated website has been established, providing updates and information related to the lawsuit and settlement.

Corporate healthcare ownership reduces care quality, physician survey finds

By Susanna Vogel - The new survey highlights frustration from providers over the growing corporatization of healthcare. Some are being pushed toward an exit, while others are embracing unionization. Read Full Article…

VBA Article Summary

1. Rising Corporate Ownership in Healthcare: The Physicians Advocacy Institute's study, highlighted by CEO Kelly Kenney, reveals a significant increase in corporate ownership of physician practices, with 13,600 acquisitions in 2021 alone. This trend is altering the traditional patient-physician relationship, emphasizing financial outcomes and potentially impacting clinical practices.

2. Impact on Physician Autonomy and Patient Care: Physicians employed by corporate entities often experience reduced autonomy, feeling pressured by incentives or penalties to see more patients. Approximately 70% of respondents reported such pressures, along with limited input in practice management and challenges with electronic health record systems. About half of the physicians indicated that cost-reduction pressures had influenced their treatment decisions, raising concerns about the quality of patient care.

3. Growing Interest in Physician Unions: Amidst these challenges, there's an increasing interest in unionization among physicians. Historically, union membership among physicians has been low (5.9% as of 2022), but the difficult working conditions highlighted by the COVID-19 pandemic have spurred a movement towards unionization for better work conditions and patient care standards. For example, 1,300 Northwestern Medicine resident physicians and fellows recently announced plans to unionize, reflecting this growing trend.

Views The peril of ignoring substance abuse in burned-out workplaces

By James Schreier - The challenges for managers in today's workplace are endless: remote work, quiet quitting, a changing regulatory environment, even lingering effects from COVID-19 — and the list goes on. One of these challenges revolves around the complexity of substance abuse with new substances emerging, addressing the legal status of marijuana in different states, and obviously, the fentanyl crisis. Read Full Article…

VBA Article Summary

1. Managerial Burnout and Oversight of Substance Abuse: This article highlights the critical issue of managers experiencing burnout and consequently failing to recognize or address substance abuse issues within their teams. Burnout not only diminishes a manager's capacity to be observant and proactive but also leads to a lack of energy and emotional resilience. As a result, these managers are navigating workplace challenges in the dark, unable to effectively identify and manage substance abuse cases among their staff.

2. Impact on Organizational Policy Enforcement and HR Challenges: The second key point focuses on the ripple effect of managerial burnout on organizational policies and human resources. This situation leads to inconsistent enforcement of policies, causing confusion and frustration among employees. The article emphasizes how this inconsistency can provoke legal challenges and strain already under-resourced HR departments. Consequently, HR's strategic role shifts from proactive talent management to reactive damage control, negatively impacting the organization's ability to attract quality talent and maintain a stable work environment.

3. Organizational Consequences and the Need for Holistic Strategies: Finally, the article discusses the broader organizational consequences of neglecting substance abuse issues due to managerial burnout. This includes the undermining of leadership credibility, the destabilization of team dynamics, and increased stress and dissatisfaction among frontline employees. To address these cascading issues, the article advocates for holistic strategies that focus on comprehensive wellness programs, supportive culture for balance and mental health, and proactive measures to openly address substance abuse. These steps require a top-down commitment from leadership and transparent communication to create a healthier, more stable, and productive work environment.

Patients Should Be at the Center of Pharmacy Care. Why Aren’t They?

By Alison Luim - When I was practicing as a community pharmacist, I saw patients walk away from the counter without their prescription because they couldn’t pay for a drug they needed. I saw patients expecting that their medications were ready for pick up, only to be turned away empty-handed because systems were not in place for a timely exchange of information between the pharmacist and doctor before the patient arrived. And I saw patients come to the pharmacy for prescriptions that could endanger their health by interacting with their other medications. Read Full Article…

VBA Article Summary

1. Challenges in Modern Pharmacy Practice: The article highlights the shift in the role of community pharmacists from being personal advisors to their patients to facing challenges due to increased demand and staffing shortages. This change has made it difficult for pharmacists to dedicate time to individual patient care, leading to a gap in the pharmacist-patient relationship.

2. Importance of Information Exchange and Team Integration: The author emphasizes the critical need for efficient communication and coordination between medical providers and pharmacists. Inclusion of pharmacists in the care team is essential for holistic and comprehensive patient care. This involves pharmacists being proactive in making therapeutic decisions and addressing prescription medication costs.

3. Innovative Solutions and Programs: The article discusses several initiatives and programs being implemented to improve pharmacy care. These include recognizing pharmacists as healthcare providers with expanded roles, pharmacy advocate programs to assist patients in navigating pharmacy benefits, access programs to address pharmacy deserts, real-time drug cost transparency services, and the adoption of value-based payment models. These innovations aim to provide more personalized care, improve access to medications, and ensure that pharmacists can practice at the top of their license.
   

What’s the Connection Between Vitamin D and COVID-19?

By Karolyn Gazella - Research linking vitamin D and SARS-CoV-2 (COVID-19) infection has been expanding. A recently published meta-analysis of 25 eligible trials featuring 8,128 participants published in the journal Clinical Nutrition intended to shed some light on this controversial topic. Read Full Article…

VBA Article Summary

1. Effectiveness of Vitamin D in COVID-19 Prevention and Severity Reduction: The meta-analysis reveals that vitamin D does not prevent COVID-19 infection; the primary prevention method is avoiding exposure. However, once infected, vitamin D can lessen the infection's severity, reducing ICU admissions and the need for mechanical ventilation. This aligns with findings that low vitamin D levels are linked to increased severity of COVID-19. Additionally, the analysis highlights the discrepancies between observational studies, which generally show vitamin D benefits, and randomized controlled trials (RCTs), like the 2022 CORONAVIT study, which indicate no significant benefit.

2. Vitamin D's Role in Respiratory Infections and COVID-19 Severity: Past research, such as a 2017 BMJ analysis, suggests that vitamin D supplementation offers protection against acute respiratory tract infections, especially in those deficient in vitamin D. Recent studies, including a 2023 review in Cureus and research in The Journal of Clinical Endocrinology & Metabolism, further support the idea that adequate vitamin D levels can reduce the severity of COVID-19 symptoms and post-infection complications, including long COVID syndrome.

3. Important Mechanisms and Clinical Implications: Vitamin D plays a crucial role in modulating the immune system, reducing inflammation, and decreasing the production of inflammatory cytokines, thereby potentially reducing COVID-19 severity. Most immune cells have vitamin D receptors, indicating its significance in both innate and adaptive immunity. However, the inconsistent findings in RCTs regarding vitamin D's benefits may be due to factors like magnesium, necessary for vitamin D metabolism. Finally, a 2023 systematic review emphasizes the global prevalence of vitamin D deficiency and its impact on COVID-19 susceptibility and severity, underscoring the importance of addressing vitamin D deficiency in clinical practice.

Moving Beyond Medicine To Treat Chronic Pain

By Jillian Ahrens - Nearly two years ago, my husband and I left home for a skiing trip, excited and hopeful for carefree days on the mountain, and a much needed escape from our everyday routines. We never expected the life-altering changes we were about to experience. Read Full Article…

VBA Article Summary

1. Personal Struggle and the Complexity of Chronic Pain: The article begins with the author's personal experience of suffering a horrific accident on the slopes, leading to traumatic brain injury and cervical spine damage. This incident sheds light on the ongoing physical and emotional pain that many people endure, emphasizing the complex nature of chronic pain. The pain is not only physical but is also influenced by psychological, social, and environmental factors. The article highlights the widespread nature of chronic pain in the U.S., affecting an estimated 50 million Americans, and underscores the varied and often inadequate treatment options available.

2. The Challenges of Living with Chronic Pain: The author describes living with chronic pain as a helplessly isolating experience, comparing it to being locked in an attic. The constant fear of exacerbating symptoms and the lack of understanding from others, even supportive friends and family, contribute to a sense of loneliness and despair. The article also touches on the risky relationship between chronic pain and substance abuse, pointing out the need for more comprehensive and accessible support systems.

3. The Need for Better Support and Digital Integration in Healthcare: The author advocates for an extension of the healthcare system to better accommodate those living with chronic pain. This includes a call for more qualified clinical experts who can provide continuous support and guidance. The article suggests digitizing certain aspects of care, such as providing digital coaching, community support, and healthcare navigation, to reach more people in need. The potential of general wellness digital therapeutics in treating conditions like chronic pain, anxiety, and depression is also discussed, emphasizing the need for these tools to be more deeply integrated into the healthcare system.

Eli Lilly obesity drug now available in US pharmacies

By Patrick Wingrove and Manas Mishra - Eli Lilly (LLY.N) on Tuesday said its recently approved obesity treatment Zepbound is now available in U.S. pharmacies and could cost $550 a month for customers whose health insurance does not cover the drug, or half the list price. Read Full Article…

VBA Article Summary

1. Market Growth and Sales Expectations: Zepbound, a new weight-loss drug, is entering a market projected to be worth $100 billion by 2030. Wall Street analysts predict Zepbound's sales to reach around $2 billion in 2024. In comparison, Novo Nordisk's Wegovy, a competing obesity drug, is expected to hit sales of approximately $7.5 billion. Both Zepbound and Wegovy are GLP-1 agonists, initially developed for type 2 diabetes but effective in reducing food cravings and slowing stomach emptying.

2. Clinical Trials and Pricing: Zepbound demonstrated a 20% average weight reduction in late-stage trials, outperforming Wegovy's 15% in separate trials. With the U.S. Food and Drug Administration's approval, Zepbound is priced at $1,059.87 per month, lower than Wegovy's $1,349. It's been added to the U.S. list of preferred medicines for reimbursement by Express Scripts and will be included in Cigna's commercial formularies. Additionally, Lilly's commercial savings card program can reduce Zepbound's cost to as little as $25 for insured patients.

3. Company Performance and Drug Availability: Eli Lilly, Zepbound's manufacturer, has seen its shares surge by 60% this year, positioning it as the 10th most valuable listed company and the leader in healthcare. Zepbound contains tirzepatide, the same active ingredient as in Lilly's diabetes drug Mounjaro, which has been used off-label for weight loss. The introduction of Zepbound has significantly contributed to Eli Lilly's market performance.