Medicare could save up to $3.6 billion by purchasing generic drugs at Mark Cuban prices

1.  Medicare could save up to $3.6 billion by purchasing generic drugs at Mark Cuban prices

Abstract: https://www.acpjournals.org/doi/10.7326/M22-0756   

URL goes live when the embargo lifts

A brief research report found that Medicare could have saved up to $3.6 billion by purchasing generic drugs at the same prices as the Mark Cuban Cost Plus Drug Company (MCCPDC) in 2020. These findings suggest that Medicare is overpaying for some generic drugs. The report is published in Annals of Internal Medicine.

 

In January 2022, the MCCPDC launched an online pharmacy selling more than 100 generic prescription drugs at the cost of ingredients and manufacturing plus 15% margin, $3 pharmacy dispensing fee, and

$5 shipping fee.

 

Researchers from Brigham and Women’s Hospital and Harvard Medical School compared the price of 89 generic drugs sold by MCCPDC to the price Medicare paid in 2020 to estimate the potential savings if Medicare Part D plans paid MCCPDC prices. They found that Medicare could have saved up to $3.6 billion, or 37% of total spending, on 77 generic drugs if it purchased generic drugs in the maximum quantity supplied by MCCPDC. The authors also found that if Medicare had purchased drugs in the minimum quantity available from MCCPDC, it could have saved $1.7 billion, or 18% of total spending, on 42 drugs.

 

According to the authors, lower drug prices from a direct-to-consumer model highlight inefficiencies in the current generic pharmaceutical distribution and reimbursement system, which includes wholesalers, pharmacy benefit managers, pharmacies, and insurers. They add that policy reforms that improve price transparency, increase competition for high-cost generic drugs, prevent annual price increases, and limit pharmacy and distribution costs could increase affordability of essential generic medicines for all Americans.

 

Media contacts: For an embargoed PDF, please contact Angela Collom at [email protected] To speak with the corresponding author, Hussain S. Lalani, MD, MPH, please contact [email protected]

————————————————-

2. ACP says Physician Payments Should Work Toward Health Equity

Abstract: https://www.acpjournals.org/doi/10.7326/M21-4484       

URLs go live when the embargo lifts

The current physician payment system does not adequately address the socioeconomic factors that impact patients’ health outcomes, says the American College of Physicians (ACP) in a new position paper. The paper makes a series of recommendations about how new payment models should be designed to better account for social drivers that impact patient health. Reforming Physician Payments to Achieve Greater Equity and Value in Health Care: A Position Paper of the American College of Physicians is published in Annals of Internal Medicine.

ACP proposes that the health care system could be reformed so that payment models no longer incentivize the volume of care that a physician provides. Instead, payment models should advance and support high-value primary and comprehensive care and health equity.

ACP’s paper recommends that in order for the system to encourage health equity, we need:

• Medicare and other payers to adopt population-based, prospective payment models for primary and comprehensive care that are structured and sufficient to ensure access to needed care and address the needs of individuals who are experiencing health care disparities and inequities.
• Research about how to best measure the cost of caring for patients who are experiencing health care disparities.
• Medicare to be modified to establish a mechanism for savings to be calculated across all aspects of the program and to allow these savings to be reinvested back into primary and preventive care, as well as into social and public health services. ACP cautions that investment in primary care must not be predicated solely on achieving short-term cost savings, given that primary care has broader societal benefit in improving population health and associated savings will often be longitudinal and take place over many years.
• The Secretary of Health and Human Services to be authorized to address the inadequacies within Medicare’s Quality Payment Program. This includes developing policies and financial approaches to ensure that the Quality Payment Program as a whole begins to address such issues as inequity, health care disparities, and social drivers of health.
• Delivery and payment systems must fully support physicians, other clinicians, and health care facilities in offering all patients the ability to receive care when and where they need it in the most appropriate manner possible, whether that be via in-person visits, telehealth, audio only, or other means, particularly for those who are experiencing health care disparities and inequities.
• Adequate funding to be made available to support the development of effective health information technology systems and communication mechanisms, including adequate broadband availability, to ensure that delivery and payment reforms are able to address the needs of all patient populations.
• Federal and state policymakers and payers, health plans, health systems, private-sector investors, and philanthropic institutions should develop and implement additional financing mechanisms beyond direct payment to clinicians and practices, such as grants and technical assistance, to support innovative approaches to address inequities, health care disparities, and social drivers of health.

 

Media contacts: For an embargoed PDF, please contact Angela Collom at [email protected] To speak with someone from ACP, please contact Jacquelyn Blaser at [email protected]

————————————————-

3. Patients with CC genotype at higher risk for azathioprine discontinuation attributed to hematopoietic toxicity and lower thiopurine doses, even after adjusting for race

Gene found in approximately half of Americans with recent African ancestry

Abstract: https://www.acpjournals.org/doi/10.7326/M21-4675      

URLs go live when the embargo lifts

A retrospective cohort study found that new thiopurine users with the rs2814778-CC genotype variant, a gene more common in persons of African ancestry, experienced azathioprine discontinuation due to hematopoietic toxicity at an almost 3-fold higher rate than patients with other genotypes. Based on their results, the authors recommend that testing for the Duffy-null phenotype be considered in all patients before azathioprine initiation or if leukopenia is detected while a patient is using azathioprine. The findings are published in Annals of Internal Medicine.

 

Thiopurine azathioprine, an immunosuppressant used to treat conditions including lupus and inflammatory bowel disease (IBD), has been associated with adverse effects, primarily hematopoietic toxicity. Researchers observed that Black patients discontinued use of azathioprine for hematopoietic toxicity at a higher rate than White patients. They hypothesized that this difference was associated with the presence of the rs2814778-CC genotype variant independent of race. The variant is found in approximately half of Americans with recent African ancestry and causes lower white blood cell counts without increased risk of infection, also known as benign neutropenia.

 

Researchers from Vanderbilt University Medical Center studied data for 1,466 new azathioprine users with indications of lupus, IBD, or other rheumatic conditions. They found that the presence of rs2814778-CC was associated with a difference in thiopurine discontinuation and tolerated dose across multiple disease settings. The authors also report that patients with rs2814778-CC had lower dosing while patients in the validation cohort had no difference in thiopurine metabolites by genotype. They note that the “normal” cell counts which clinicians typically use in decisions about dose and need to discontinue azathioprine are primarily derived from patients with European ancestry. Basing decisions for many Black patients based on low leukocyte counts rather than genotype could trigger unnecessary discontinuation or inappropriate dosing of azathioprine. Based on the results, the authors recommend that testing for the Duffy-null phenotype be considered in all patients before azathioprine initiation or if leukopenia is detected while a patient is using azathioprine.

 

Media contacts: For an embargoed PDF, please contact Angela Collom at [email protected] To speak with the corresponding author, Cecilia P. Chung, MD, MPH, please contact Craig Boerner at [email protected]

————————————————-

 

---

---