Small Doses: February eNews Roundup

February 15, 2019

2018 U.S. drug prices, OTC/coprescribing increasing access to Naloxone, standardized opioid prescribing in children, and more.

IQVIA: U.S. Drug Prices Rose Only Slightly in 2018

While high drug prices continue to come under fire by the government, healthcare professionals, consumers, and payers, a new report says net drug prices in the United States increased only an estimated 1.5% in 2018.

“Net price growth was below inflation in the wider economy in 2018, an occurrence expected to continue for the next five years,” says a report from IQVIA Institute for Human Data Science, formerly the IMS Institute. The report is titled “The Global Use of Medicine in 2019 and Outlook to 2023: Forecasts and Areas to Watch.”

U.S. drug prices are projected to rise between 0% and 3% over the next five years, IQVIA says.

Meanwhile, global drug spending reached $1.2 trillion in 2018, and is expected to top $1.5 trillion by 2023, up 50% from 2016, according to IQVIA. The United States and emerging markets will account for the majority of the drug spending increases in the next five years.

The number of new medicines launched is expected to increase from an annual average of 46 during the past five years to an average of 54 per year through 2023. The annual average spending in developed markets on new brands is expected to rise slightly to $45.8 billion in that time but will represent a smaller share of brand spending, IQVIA says.

The IQVIA report also noted that mobile apps, also called prescription digital therapeutics (DTx) are a new emerging treatment modality with indications and disease-specific treatment effectiveness claims in their prescribing labels. “Stakeholders are cautiously observing developments in DTx as this new modality could bring significant benefits but must be carefully weighed against the evidence for existing options. Where drug therapy alone has left unmet needs, particularly in the areas of behavioral health and cognition, these new technologies promise substantial advances,” the report says.

CVS Opening First Healthcare Concept Store

As part of the many joint programs that CVS Health has launched since it acquired Aetna in 2018, CVS is opening the first of its healthcare concept stores this month.

The stores “will be a testing ground for a new retail engagement model that brings healthcare services to consumers in a more convenient, more accessible, and more customer-focused manner,” said Larry J. Merlo, president and CEO of CVS Health, speaking at the J.P. Morgan Healthcare Conference.
Concept stores, the first of which is opening in Houston, will provide “enhanced personalized prescription support” in pharmacies, according to Merlo. “We will use our data and analytics capabilities to provide actionable information through our pharmacy staff in an effort to improve patient care.”

The stores will also offer an expanded suite of healthcare services, including a “care concierge and other health and wellness support,” Merlo says.

MinuteClinics in the CVS concept stores will offer new clinical services, such as enhanced screenings for chronic disease and in-clinic phlebotomy.

CVS will add “new health and wellness categories” at the front of the store, “to focus on best of category assortments”, according to Merlo. The company is also piloting a specialized program to prevent hospital readmissions for Aetna members who are being treated for cardiovascular disease.

Starting sometime in the first quarter, Aetna care managers will be able to facilitate scheduling of MinuteClinic follow-up visits within 14 days after discharge, in cases where patients are unable to see their provider, Merlo adds.

Report:  Pharmacists Should Practice at Top of Professional License

Pharmacy organizations are applauding a recent HHS report that states that pharmacists should practice at the top of their professional license-and be paid for those services.

The report acknowledges that pharmacists, advanced practice registered nurses, physician assistants, and other healthcare professionals can “safely and effectively provide some of the same healthcare services as physicians, in addition to providing complementary services.”

Unfortunately, scope-of-practice rules often “unnecessarily limit the services these ‘allied health professionals’ can offer, according to the report.

“For years, APhA has fought for the recognition of pharmacists as providers of quality patient care and the need to cover their services,” says APhA CEO Thomas E. Menighan, BSPharm, in a statement. “We’re grateful our role in healthcare is being recognized as a part of the solution to help Americans lead healthier lives-something our patients already know.”

However, APhA points out that Congress still needs to pass the Pharmacy and Medically Underserved Areas Enhancement Act (HR 592 /S 109), a bipartisan bill that would increase medically underserved Medicare beneficiaries’ access to healthcare through pharmacist-provided services. “Our approach to expanded access and patient-centered team-based care should be embraced by all,” Menighan says.

While the report acknowledges pharmacists’ vital role, some of the provisions in the new report could have a negative influence on patient choice and access to care, according to APhA. The organization “would like to work with the Trump administration on health care reform policies that balance patient access along with costs. 

Little Time Off and Lack of Sleep Impact Pharmacy Residents’ Levels of Depression

A multitude of factors-including a high number of hours worked and living with family-were associated with high levels of depressive symptoms in pharmacy residents, a new study says.

Published in the December 15, 2018, in the American Journal of Health-System Pharmacy, the study includes a nationwide online survey of pharmacy residents from 2015-2016.

Evan Williams, PharmD, assistant professor of pharmacy practice at the College of Pharmacy, Roseman University of Health Sciences in Nevada, and colleagues found that higher levels of depressive symptoms were linked to high levels of stress, a high number of hours worked, a high number of days between having a full 24 hours off duty, not having family within driving distance, and living with family.

Conversely, high levels of family support, an outpatient and/or clinic residency setting, supportive directors and preceptors, effective teaching methods, well-structured and organized programs, clear expectations of residents, having enough days off, and adequate amounts of sleep were associated with decreased reporting of depressive symptoms among pharmacy residents.

Since pharmacy residents are often tasked with weekend staffing, a typical schedule is 12 days on and two days off for residents in many smaller programs, Williams writes. “This schedule does approach the specified limits for consecutive days worked without a full 24 hours off, and our data suggest that longer periods without a full 24 hours off are associated with increasing levels of depressive symptoms.”

Pharmacy residents who reported getting adequate sleep reported depressive symptoms four to five times less frequently than those who said they were not. “Pharmacy residents and directors should be cognizant of sleep needs and ensure that an adequate amount of quality sleep is attained to improve resident well-being and prevent medical errors,” Williams writes.

OTC/Coprescribing Could Increase Access to Naloxone

New efforts from the FDA and HHS could help improve access to naloxone. The FDA says it will remove barriers and make it easier for drug manufacturers to develop over-the-counter naloxone.

To encourage manufacturers to enter the OTC naloxone market, FDA “designed, tested, and validated the key labeling requirements necessary to approve an OTC version of naloxone and make it available to patients. One of the key components for OTC availability is now in place,” says FDA Commissioner Scott Gottlieb, MD, in a statement.

In addition, HHS says that “clinicians should strongly consider prescribing or coprescribing naloxone [with opioids],” in a new guidance.

“Data clearly indicate a significant persistent gap in our response-the infrequent coprescribing of naloxone to patients who are prescribed opioids and/or those who are at high risk of experiencing (or responding to) an opioid overdose. National data on patients to whom clinicians should consider co-prescribing naloxone show that less than 1% of these patients actually receive a naloxone prescription,” HHS says.

Pharmacists can provide risk education and increase dispensing rates of naloxone, when appropriate, Carlie Traylor, PharmD, associate director for strategic initiatives with NCPA, tells Drug Topics. “There are currently several states that have standing orders for naloxone, so they are able to dispense it without obtaining a prescription from the physician.”

While coprescribing could increase the number of patients at risk of overdose gaining access to naloxone, it does not directly translate into codispensing, Traylor says. “There may be additional barriers such as price and product availability. Not all insurances cover naloxone, and if they do, the copay may not fall within the consumers’ budget. In addition, if all opioid users started filling naloxone it could lead to drug shortages.”

Hispanic Pharmacists Form Organization

A new organization for Hispanic pharmacists has formed and has the support from Walmart and CVS Health.

The National Hispanic Health Foundation (NHHF) has formed the National Hispanic Pharmacists Association (NHPA), to increase access to care for Hispanic communities across the country.

The organization was launched with support from Walmart, CVS Health, and the Pharmaceutical Research Manufacturers Association (PhRMA).

While Hispanics make up the largest ethnic minority (17.8%) in the United States, Hispanic pharmacists make up only 4.5% of the 342,000 employed pharmacists across the country, says NHHF in a statement.

“Given that by 2042, one out of four people living in the United States will be Latino, NHHF is excited to launch NHPA so that Hispanic pharmacists can develop programs and opportunities that can directly impact the health of Americans,” says NHHF President Elena Rios, MD, in the statement.

Maria M. Hearns-Rivas, PharmD, president of the NHPA Board of Directors, adds, “Through my experiences in clinical practice and in working with Spanish-speaking patients, I’m confident that the NHPA will help address the health disparities that Hispanics face in the United States.”

NHPA will start a scholarship program, develop professional and continuing education opportunities, and expand the organization through new corporate partners. “NHPA also looks to create a mentorship program and regional student chapters to increase the number of Hispanic pharmacists in the future and further the organization’s outreach,” NHHF says.

Opioid Prescribing in Children Should be Standardized

Standardized opioid use guidelines for use in pediatric emergency departments need to be developed, according to a study.

The study of 69,152 emergency department visits found that opioid prescribing rates dropped in recent years, but region, race, age, and payment method were associated with differences in opioids prescribing. The study was published in December 2018 in JAMA Network Open.

White pediatric patients had a significantly increased likelihood of being prescribed an opioid compared with nonwhite patients, the researchers found. “For instance, white patients reporting abdominal pain were almost twice as likely to receive an opioid than their nonwhite counterparts,” the researchers write.

In addition, patients in the western region of the United States were significantly more likely to be prescribed an opioid, while patients in the Northeast had the lowest likelihood of an opioid being prescribed. “Factors affecting the regional variability in opioid prescribing in pediatric patients need to be further evaluated to better understand what may be driving the overall prescribing patterns in each region, particularly those with higher opioid prescribing rates,” the researchers write. 

Christine Blank is a healthcare journalist and a frequent contributor to Drug Topics.

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