Literature Review

[UK] Multiple points of system failure underpin continuous subcutaneous infusion safety incidents in palliative care: A mixed methods analysisPalliative Medicine; Amy Brown, Sarah Yardley, Ben Bowers, Sally-Anne Francis, Lucy Bemand-Qureshi, Stuart Hellard, Antony Chuter, Andrew Carson-Stevens; 10/24 About 25% of palliative medication incidents involve continuous subcutaneous infusions. Complex structural and human factor issues make these risk-prone interventions. Primary incidents (most proximal to patient outcomes) leading to inappropriate medication use (including not using medication when it was needed) were underpinned by breakdowns in three major medication processes: monitoring and supply ... administration ... and prescribing ... Recurring contributory factors included discontinuity of care within and between settings, inadequate time, inadequate staffing and unfamiliarity with protocols. Psychological harms for patients and families were identified. System infrastructure is needed to enable timely supply of medication and equipment, effective coordinated use of continuous subcutaneous infusions, communication and continuity of care.

More Minnesotans face ‘pharmacy deserts’ with chain drugstore closures The Minnesota Star Tribune; by Dee DePass; 11/2/24 KB Brown’s phone hasn’t stopped ringing since Walgreens shut its W. Broadway store last year, leaving one pharmacy to serve 67,000 residents in the north Minneapolis area where he lives and runs his graphics design business. With Walgreens gone — and CVS shutting four other area stores — Brown, at least three times a week, transports employees, relatives and older neighbors to pharmacies in Robbinsdale or other suburbs so they can get their medications. ... North Minneapolis joins a growing number of “pharmacy deserts” rapidly dotting the state and nation as small and large pharmacies close up shop, leaving people with few options to quickly access prescription medicines. ... CVS, which closed 600 U.S. stores between 2021 and 2023, said it would close 300 more this year as leases end. On Oct. 15, Walgreens announced a plan to close 1,200 unprofitable stores, starting with 500 in 2025.

A new low? Hacker group targets end-of-life pharmacy provider TechInformed (TI); by Ann-Marie Corvin; 10/28/24 OnePoint Patient Care, an Arizona-based hospice pharmacy serving over 40,000 patients per day, has informed customers about a data breach impacting personal information. OnePoint said it first detected suspicious activity on its network in early August. A later investigation revealed that by this point, the attackers had already obtained files containing personal information from the pharmacy’s systems, including names, residence information, medical records, and prescription and diagnosis information. OPPC told the US Department of Health and Human Services that the data breach impacted over 795,000 people.

Palliative care pharmacist discusses how building relationships with patients leads to rewarding career Drug Topics - Voice of the Pharmacist; by Killian Meara; 10/22/24 A discussion with Madison Irwin, PharmD, BCPS, clinical pharmacist specialist in palliative care at University of Michigan Health and clinical assistant professor at the University of Michigan College of Pharmacy. ... Irwin currently works as a clinical pharmacist specialist in palliative care in both inpatient and outpatient settings. She supports a palliative care consult team and outpatient palliative care clinics by seeing patients who are transitioning out of the hospital or patients who have more complex medication management needs. Although there are plenty of challenges that she faces in her practice, Irwin said that really getting to know patients through her work is extremely rewarding. ... In a conversation with Drug Topics, Irwin discussed how her career has unfolded, a program that she worked on that exemplifies the value of pharmacists in patient care, opportunities out there for pharmacists to expand their role, and how high rates of chronic pain will impact the pharmacy profession in the coming years.

Why your drug store is closing CNN Business, New York, NY; by Nathaniel Meyerson; 10/16/24 CVS is closing 900 stores. Rite-Aid is closing 500. Walgreens announced Tuesday it plans to close 1,200 stores, meaning 1 in 7 will disappear. What is going on with America’s drug stores? Walgreens and other chains overexpanded during the 1990s and 2000s to drive out competitors and draw more customers. They are now shutting down because of shifting consumer habits, competition and changes in the pharmacy industry. Around 25% of Walgreens’ stores aren’t profitable, CEO Tim Wentworth said in an interview with the Wall Street Journal in June, and the chain will look to close stores that are right by one another or struggling to hold down theft. ... CVS, the largest US chain, closed 244 stores between 2018 and 2020. In 2021, it announced plans to close an additional 900 stores. Earlier this month, CVS said it planned to cut about 2,900 jobs corporate jobs. And Rite Aid filed for bankruptcy last year, closing up to 500 stores.

What the heck is a PBM, and why does it matter? Forbes; by Web Golinkin; 10/14/24... [Pharmacy Benefit Managers] PBM BasicsUnless you are a healthcare industry insider—and even if you are— it’s difficult to understand exactly how PBMs work. While they are essentially invisible to the average health plan member, PBMs have a tremendous impact on which medications are covered, the prices paid for these medications, and how patients access them. Here’s a summary of key PBM functions: Formulary Management. ... Negotiating Discounts and Rebates. ... Pharmacy Network Management. ... Claims Processing. ... Clinical Management. ... How PBMs Influence Drug Costs: Rebate System. ... High Deductible Health Plans. ... Prior Authorization and Step Therapy. ... Spread Pricing. ... What Are the Alternatives? ...

The power of collaboration: Pharmacists and nurses partner to enhance patient care American Society of Health-System Pharmacists (ASHP) News Center; by Karen Blum; 9/23/24 Pharmacists and nurses work together on today's most pressing health challenges - from managing heart failure to deprescribing in palliative care to tackling obesity in pre-transplant patients. The Collaborative Care Grant for Nurses and Pharmacists from the ASHP Foundation and American Nurses Foundation recognizes the potential impact of this interdisciplinary teamwork on improving healthcare outcomes. At UPMC Presbyterian Hospital, the grant program helped fund the creation of a medication optimization clinic (MOC) for those with heart failure with reduced ejection fraction. “It made a lot of sense to bring together our collective expertise to manage these patients to get them on more optimal medications,” said James Coons, a clinical pharmacist in cardiology at UPMC Presbyterian Hospital. Coons, an ASHP member and professor at the University of Pittsburgh School of Pharmacy, worked with nurse practitioner and longtime collaborator, Jennifer Kliner, on the project.

FTC sues big 3 Pharmacy Benefit Managers PlanSponsor; by Remy Samuels; 9/20/24 The Federal Trade Commission filed a lawsuit against the largest PBMs, following its July report exposing the ‘opaque’ business practices of the ‘powerful middlemen.’ ... The Federal Trade Commission filed an administrative lawsuit Friday against the three largest pharmacy benefit managers—Caremark Rx, Express Scripts and Optum Rx—and their affiliated group purchasing organizations. The regulator argued the firms are responsible for inflating the cost of prescription drugs, such as insulin, and preventing patients’ access to lower-cost products. The FTC’s complaint, filed under its administrative process, not a federal court, alleges that the big three PBMs, which the FTC stated administer about 80% of all prescriptions in the U.S., have “abused their economic power by rigging pharmaceutical supply chain competition in their favor, forcing patients to pay more for life-saving medication.” 

American Heart Association affirms importance of palliative care in treating cardiac conditions Hospice News; by Jim Parker; 9/4/24 Multidisciplinary palliative care offers clear benefits to patients with cardiovascular disease, particularly when it comes to medication management and goals-of-care conversations. Palliative care with effective medication management, shared decision making and symptom management can help improve quality of life for heart disease patients, according to a scientific statement from the American Heart Association (AHA) — “Palliative Pharmacotherapy for Cardiovascular Disease.” The statement offers guidance for health care providers to integrate palliative methods as part of holistic medication management at all stages of a patient’s illness, the AHA indicated. This underscores the importance of collaboration between palliative care professionals and other clinical specialties, according to Dr. Andrew Esch, director of palliative care program development at the Center to Advance Palliative Care (CAPC). 

Why one health system thinks its new PBM can disrupt the marketModern Healthcare; by Lauren Berryman; 8/23/24The University of North Carolina-affiliated health system announced a plan this month to launch UNC Health Pharmacy Solutions, a "transparent" PBM for employers seeking an alternative to CVS Health subsidiary CVS Caremark, Cigna division Express Scripts and UnitedHealth Group unit OptumRx, which dominate the market... “Our costs were skyrocketing,” DeFalco said. UNC Health has since in-sourced key PBM functions and customized its formulary to focus on lower net cost drugs. UNC Health Pharmacy Solutions is similar to others that market themselves as transparent. UNC Health will charge clients administrative fees and pass through all rebates to plan sponsors. The health system has saved 32% on employee pharmacy costs and expects to deliver similar results to employers in North Carolina and South Carolina, DeFalco said. The health system may consider partnering with businesses in bordering states down the line, she said... The landscape comprises around 70 players, but CVS Caremark, Express Scripts and OptumRx have a combined market share of about 80%, and the top six PBMs control 90%. Larger PBMs generally can use scale to extract better rebates from drugmakers, which at face value could look attractive to benefits brokers even though it may not mean lower overall savings.

Integration of palliative pharmacists to elevate oncologic care Pharmacy Times; by Alexis Beachy, PharmD and Jessica Geiger, PharmD, MS, BCPS; 8/20/24... Conclusion: This case demonstrates several aspects of care palliative pharmacists can assist with, though it is certainly not all-encompassing. All things considered, pharmacists are an essential asset of the palliative team. Their experience further enriches the interdisciplinary team and grants all patients and families many benefits. Specifically, patients receiving oncologic care benefit from collaboration with a palliative care pharmacist. In addition to offering a more individualized and holistic approach to care, palliative pharmacists can also provide patients with quicker and improved symptom management, which often improves quality of life and may also increase survival rates.Editor's Note: This article provides excellent history, definitions, and descriptions of the pharmacist's significant role in providing expert palliative and hospice care.

Humana will pay $90 million in Medicare drug fraud settlement Bloomberg Law; by Daniel Seiden; 8/16/24 Humana Inc. agreed to pay $90 million to the federal government to settle a whistleblower’s False Claims Act suit alleging that the company submitted fraudulent bids for Medicare Part D prescription drug contracts. Whistleblower Steven Scott alleged that, since 2011, Humana began offering its Medicare Part D prescription drug plan, known as the basic Walmart Plan, and “knowingly provided benefits under that plan that have been significantly less valuable than Humana promised in its bids,” according to Scott’s suit filed in 2016 in the US District Court for the Central District of California. ... This suit was among several in 2016, including suits against Humana, United Health, Cigna Corp., and Optum RX Inc., accusing health insurers of secretly overcharging for prescription drugs.