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| Spring officially begins this month, and with the new season comes the time to consider where LTC pharmacy is headed. The result of Medicare negotiated drug pricing and the impact of direct distribution by manufacturers are signals that the dispensing function of pharmacies is moving rapidly toward commoditization. Robots and massive central pharmacies have planted their flag and reimbursement models are cheering them on.
None of this is new, but unless we move the pharmacy revenue model from dispensing to the provision of valuable cognitive services, the future will be quite uninviting.
Part of the problem is that the public takes pharmacy for granted and does not really value the services that pharmacists provide. I was reminded of this again during my latest visit to pick up a prescription. I was asked to provide an electronic signature which confirmed my desire, or lack thereof, to consult with the pharmacist. The default on the screen was to decline the service. It's a small signal, but when we expect consumers to not want to talk to a professional about their meds, perhaps we need to rethink our role in the healthcare system. Maybe worth thinking about?
Paul |
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| | | | Trump Administration Targets Healthcare Fraud
HHS Secretary Kennedy says the days of 'pay and chase' are over, when it comes to catching and punishing healthcare fraudsters. In its place will be a policy of 'detect and deploy'. The initial action under this new policy is to withhold $255 million in Medicaid matching funds from Minnesota, as a result of its investigation of massive fraud in the state's Medicaid program. More
CMS Announces Strategic Roadmap for US Health and Long-Term Care
Basic on the five principles of Prevention, Quality and Safety, Coverage Innovation, Data and Technology, and Burden Reduction, CMS announced a roadmap to achieve better health and LTC outcomes. The initiative will lead with prevention, and continue with quality improvement.
CMS Fact Sheet
FDA Final Rule on NDC Format Changes The FDA published a final rule that gives manufacturers 7 years to prepare for a change from a 10-digit NDC for drugs to a uniform 12-digit code. Effective March 6, 2033, the requirement applies only to FDA-assigned NDCs and not to codes related to reimbursement.
FDA Announcement
CMS May be Considering Loosening Antipsychotic Policy in Nursing Homes
The Washington Post (subscription required) and McKnight's have reported on potential changes to longstanding blanket penalties for antipsychotic drug prescribing for residents of nursing homes. The concern among some advocates is that the government has gone so far as to discourage legitimate use of these medications.
HR 3164 Has 100 co-sponsors, but no Movement
The Ensuring Community Access to Pharmacist Services Act (HR 3164) has 100 co-sponsors, but no sign of movement. Hope springs eternal that the legislation could be folded into a bill that moves ahead, but that would depend on a CBO assessment of the cost (called a 'score' in beltway lingo). Likewise, HR 5031: Preserving Access to Long-Term Care Pharmacies Act, has 39 co-sponsors, but no score and no movement. Improve the odds by working with ASCP.
ACL Announces Theme for Older Americans Month
The Administration for Community Living (ACL) announced that the theme for Older Americans Month will be 'Champion Your Health', focusing on prevention, wellness, and personal responsibility. The ACL is making resources available to organizations willing to support this annual event, taking place in May. |
| | | | Aetna Settles Medicare Advantage Upcoding Charges
Aetna Inc., a national insurer incorporated under the laws of Pennsylvania, has agreed to pay $117,700,000 to resolve allegations that it violated the False Claims Act by submitting or failing to withdraw inaccurate and untruthful diagnosis codes for its Medicare Advantage Plan enrollees in order to increase its payments from Medicare. More
Novo Nordisk Makes Deal with Hims and Hers on GLP-1s
Drug Compounder Hims and Hers has agreed not to promote compounded versions of Novo's Wegovy, while Novo Nordisk has dropped its lawsuit against the company. Hims and Hers has determined that it will continue providing compounded versions of the GLP-1 drug for those patients that are unable to use the branded product. More
GoodRx Partners with Lilly to Offer Direct Access
GoodRx and Lilly have announced a collaboration, whereby the pharmacy discount provider will offer employer direct access to Zepbound for employee benefits programs. The direct price for all dosages is targeted to be $449. More
Does Physical Closeness Determine Bipartisan Legislating?
The word 'propinquity' seldom crosses my lips. This is an exception. The National Bureau of Economic Research (NBER) published a working paper that examines how the physical closeness of US Senators in the chamber impacts the likelihood that Senators of opposing political parties will vote the same way. According to the authors, who observed voting behavior on C-SPAN, there seems to be a relationship. Closeness is not as strong a predictor as political party and state representation, but apparently, it does make a difference.
CVS Teams with Google to Introduce Health 100
Health 100 is a 'health engagement platform' intended to, in part, marshal patient health data from disparate sources to help consumers better manage their healthcare. The system will leverage the special skills of pharmacists to facilitate care management. More
Guardian Pharmacy Services Announces 2025 and Q4 Earnings
LTC Pharmacy company Guardian Pharmacy Services announced Q4 and 2025 full year results. Company organic revenue was up 15%, while EBITDA was up 27% year-over-year. More
Tarrytown Expocare Pharmacy Announces Leadership Appointments
LTC pharmacy Tarrytown Expocare, a leading pharmacy devoted to serving patients with intellectual disabilities and behavioral health challenges announces leadership appointments |
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