Pharmacy Industry News: Pharmacy Benefit Management Institute Recognizes Innovation in Drug Benefit Industry
Pharmacy Benefit Management Institute Recognizes Innovation in Drug Benefit Industry
The recipients of this year’s awards were selected based on the project’s overall originality, strength of reported results, and potential to improve patient outcomes. “Our 2011 award recipients have demonstrated creative thinking by designing solutions to address numerous challenges in prescription drug programs,” says Tim Watson, PharmD, MBA, Executive Director of PBMI. “Their example will inspire other plan sponsors to implement one or more of these approaches in their own populations.”
Center for Health Value Innovation
The Center for Health Value Innovation is being recognized for their pioneering work in the design, implementation and measurement of Value Based Insurance Designs. The center’s co-founder and Chief Medical Officer, Jack Mahoney led the charge behind Value Based Design with a firm resolve to prove that lowering access barriers to health care services could ultimately engage the most at risk populations, thereby improving care and lowering costs. The center’s work to measure and disseminate outcomes associated with these design strategies continues to provide guidance to others who wish to implement these programs in their population.
Cigna Pharmacy Management
Cigna Pharmacy Management is being recognized for their creative approach to contracting for pharmaceuticals that is based on achievement of specific therapeutic outcomes. In 2009, Cigna Pharmacy Management and Merck & Co., Inc. entered into the pharmacy benefit management industry’s first national outcomes based contract between a PBM and a pharmaceutical firm. A year after the contract was implemented, results showed that there was improved blood sugar control and blood sugar testing during the study. The company stated that “estimated savings for individuals and employers could be almost $8,000 per person who has diabetes per year when that individual increases adherence to over 80%.”
CVS Caremark / ArcelorMittal
CVS Caremark / ArcelorMittal are being recognized for their efforts to improve the treatment of diabetes in the steel company’s population. More than half of people diagnosed with a chronic disease, including diabetes, are either non-adherent to the prescribed medication or have a gap in care. The program designed and implemented by the companies sought to improve medication adherence in diabetics by engaging pharmacists who are expertly trained in medication therapy management principals. The program included both telephonic counseling, and face-to-face interventions, according to the patient’s preference. After six months, the program demonstrated significant improvements in closing gaps in care and increasing medication adherence compared to a control group. In addition, the program results demonstrated health care savings of nearly $1,700 annually for patients with diabetes.
InformedRx, an SXC company
InformedRx is being recognized for their efforts to minimize inappropriate prescribing of controlled substances. Use of multiple narcotics can have adverse effects on both members and plan sponsors, including: compromised patient safety, risk of addiction and diminished quality of life, risk of on the job injuries and wasting scarce health plan resources. InformedRx designed a program of pharmacist review and intervention in which targeted interventions were sent to physicians with the goal of improving prescribing patterns for this important class of medications. The program demonstrated strong results, including: 58% fewer narcotic prescriptions written, 57% fewer prescribers writing narcotic prescriptions, and an average savings per case of $105.16.
The Supreme Court and the Spying-on-Doctors Industry
Last month, the Supreme Court agreed to review a Vermont law that prohibits the use of prescription data for marketing purposes. If upheld, the law will ban pharmaceutical companies from taking the prescription records they buy from pharmacies and giving them to their sales reps to target doctors.
Vermont legislators assert that this practice drives up prescription costs and violates doctors’ privacy. Though similar laws in Maine and New Hampshire were upheld by an appellate court after a challenge by industry, Vermont’s was rejected as unconstitutional — on free speech grounds. Huh?
Let’s be clear. This case is about corporate influence over our health care system, not free speech. It boils down to one question: How much influence should pharmaceutical companies have over doctors?
If you’ve seen the movie Love and Other Drugs, starring Jake Gyllenhaal and Anne Hathaway, you have an idea of the duplicity involved in the profession of pharmaceutical sales rep. While it’s true, as the industry insists, that reps provide doctors with important information about new drugs, their real purpose is to boost drug companies’ bottom lines by convincing physicians to prescribe their most expensive drugs. The film, which follows a fast-talking salesman and womanizer played by Gyllenhaal, is based on the book Hard Sell, by Jamie Reidy, a former Pfizer and Eli Lilly rep.
In his book, Reidy shows how drug reps woo, mislead, and occasionally even lie to doctors, and that the information about new drugs they provide is often biased. In an interview for a 2006 New Republic article, Reidy told me that prescription data proved “our most effective tool in planning our approach to manipulating doctors.” How? Because the data allowed Reidy to know exactly what drugs his doctors were prescribing; if they weren’t prescribing his drugs, he’d “hammer” them until they did.
Legislators in Vermont, Maine and New Hampshire listened closely to stories like Reidy’s. They concluded that preventing prescription data from being used for marketing would help control drug costs. Since drug costs were straining state budgets, lawmakers asserted that these bills would significantly advance state interests. This last point is key, because in order to restrict commercial speech under the Constitution the bills would need to meet such criteria.
Enter the opposition. The data mining and pharmaceutical companies have fought tooth and nail to prevent these bills from becoming law. (The data-mining companies, who are the plaintiffs in each case, act as middlemen, buying prescription records from pharmacy chains and other sources before selling them to drug companies.) New Hampshire State Rep. Cindy Rosenwald told me that she never saw as many lobbyists as when her bill was being debated in her state legislature. It’s not surprising; both industries could lose money as a result of the bills, and a number of other states are considering their own. What may be surprising, however, are the grounds on which the bills are being opposed: free speech.
Since the 1940s, the Supreme Court has recognized a difference in the level of protection the Constitution offers commercial speech (advertising) compared with other speech. Commercial speech is subject to more regulation. Historically, when states have attempted to restrict commercial speech, the Court has allowed it in the name of consumer protection or an overriding public good. This is consistent with Vermont’s law: by controlling drug costs and limiting the influence of drug reps (studies have shown that increased time with reps leads doctors to prescribe against their patients’ best interests), the state is acting in the public good.
In the end, though, this law has little to do with free speech. None of these laws stop drug companies from advertising their products. They don’t even stop drug companies from collecting prescription data (they can still use it for research). The laws simply regulate the way that data is used — data which many feel should be confidential, anyway. As Judge Sandra Lynch, of the First U.S. Circuit Court of Appeals, wrote in upholding the Maine law, “the statute regulates conduct, not speech, and even if it regulates commercial speech, that regulation satisfies constitutional standards.”
So this is a no-brainer for the Supreme Court, right? Wrong. Our current Court under Chief Justice John Roberts has proved one of the most partisan, activist, and corporate friendly Courts in U.S. history. Last year, in Citizens United v. Federal Election Commission, the Court overturned decades of legal precedent by dismantling campaign finance laws and allowing corporations to spend unlimited sums of money to influence elections. And it has recently come to light that Justice Clarence Thomas, who was part of the 5-4 majority in Citizens United, is being investigated by a watchdog group for allegedly receiving an all-expenses paid trip to a four-day retreat hosted by the Koch brothers, political activists who were among the biggest beneficiaries of the Citizen United decision.
The free speech argument in this case is a straw man. What the Supreme Court will decide here is whether corporate interests trump the interests of doctors, patients and the general public. Opening arguments are set for April, with a decision expected in June. Given the track record of this court, I’ll give you one guess who they’re going to side with.
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