Monday, August 21, 2017

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Advocacy Update



Special Session is officially done. Pharmacy Organizations work together to push pharmacy's role is what HHSC is calling Value Based Purchasing and what we call Performance Based Payment!


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Association News


Induction of New CAPA Officers
TPA CEO, Debbie Garza, had the pleasure of inducting the 2017-2018 new officers and board members for the Capitol Area Pharmacy Association last Thursday evening at Uncle Julio's in downtown Austin. Incoming officers include: Crystal Riggs- president, Jenny Dau- president-elect, Sun Seo- program director, Mikaela DeBarba- treasurer, Mike Hearn- secretary, Amanda Stallings- vhc director, Candice Chavez- director, Gretchen Dao- director, Stasha Durairaj- director. Continuing officers are: Aya Fukada- past president, Josh Smith- technician director, Amanda Garner- director, Sharon Rush-director, James Cong- UT-ASP president, and Megan Phimmasone- webmaster. She also thanked those outgoing officers who gave unselfishly of their time and talents during the past year. Outgoing officers included Mark Comfort, Gretta Leckbee, Adam Bohuslav, and Jennifer Wilbanks.


Women in Pharmacy
TPA CEO Debbie Garza attended the Capital Area Pharmacy Association's meeting and had the pleasure to join Austin's women pharmacy leaders: Pictured left to right, Gretta Leckbee, past-president, Debbie Garza, Crystal Riggs, incoming president, and Aya Fukuda, the current president.

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State and National News

Texas Medicaid Prescriber Requirement for Pharmacies - update and outreach opportunity
HHSC has provided pharmacy an update on the new federal ordering, referring, and prescribing provider enrollment requirements. Starting on October 16, 2017, prescribers must be enrolled with Texas Medicaid in order for the claim to be paid at the pharmacy. This applies to Medicaid, CHIP, Healthy Texas Women, and the Children with Special Health Care Needs Services Program.

Hearing concerns from providers and patients regarding the new requirements, HHSC is instituting a 6-month transition period to allow clients to get needed drugs and allow for more outreach. From October 16, 2017 to April 15, 2018, pharmacy claims will still be denied if the prescribing provider is not enrolled on the date of the prescription. However, HHSC will provide an override code to pharmacist that will allow them to override the denial in the case of emergency situations. HHSC is still working out some of the details and will provide pharmacy with additional information as it becomes available.

In the meantime, HHSC has asked the pharmacy please review the flyers in the red box at https://www.txvendordrug.com and if possible, please print and display them in your stores before October. The flyers are available in both English and Spanish.

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The Texas Society of Health-System Pharmacists (TSHP) is seeking a full- or part-time pharmacist to serve as its Executive Director (chief executive officer)
The Texas Society of Health-System Pharmacists (TSHP) is seeking a full- or part-time pharmacist to serve as its Executive Director (chief executive officer). The successful candidate will ideally have experience in health-system pharmacy practice and management. Experience in association management is highly desired. The Executive Director provides leadership and vision to implement the policies and programs of TSHP and related entities; manages TSHP’s office, staff and budget; represents the Society with state and federal agencies, elected officials and other professional organizations; and provides staff support for TSHP PAC and the TSHP Research & Education Foundation.

The position is available immediately. A letter of interest, CV/resume and supporting documents should be sent to: Tammy Cohen, President, rxtammy@yahoo.com., www.tshp.org

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Trump's action has not matched fiery rhetoric on drug prices
President Donald Trump renewed his criticism of prescription drug prices this week, but he has not pursued steps he discussed during the campaign. A draft executive order calls for the federal government to come up with ways to reduce out-of-pocket costs, but the move could raise costs to the government and taxpayers. Reductions in out-of-pocket spending don't force overall price cuts to medicines, meaning insurance premiums would likely have to rise. Politico (8/15)

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FDA chief says drug makers are gaming the system to slow generic competition
FDA Commissioner Scott Gottlieb said on Tuesday that brand name drug companies are "gaming the system" to block generic competition through a patient safety program that allows them to keep generic drug companies from getting enough doses of their branded drug. Generic drugmakers need up to 5,000 doses to do the studies needed to prove their products are truly equivalent, he said. FDA has received about 150 letters that generic companies have sent brand name companies complaining about access to doses for their studies. Only about half involved the patient safety program, while the others involved specialty pharmacies and restrictive contracts that prevent distributors from selling to generic companies. Gottlieb said there are ways FDA can address these tactics, including releasing the letters publicly, which FDA plans to do. Bipartisan legislation is pending in Congress to increase access to the samples. USA Today (08/15/17) O'Donnell, Jayne

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CDC data show 65% jump in US antidepressant use over 15 years
Data from the CDC's National Center for Health Statistics showed antidepressant use in the US was up by almost 65% over the last 15 years, increasing to 13% in 2011-2014 from approximately 8% in 1999-2002. Researchers said antidepressant use increased with age for both genders, but women were about twice as likely as men to report using the medications in the past month. HealthDay News (8/15)

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Express Scripts to limit opioids, concerning doctors
The country's biggest PBM is combating the opioid crisis by adding new restrictions, but it is having a tough time getting doctors on board with the plan. Based on the results of a pilot program it conducted last year, Express Scripts will approve only a week's worth of opioids for new users—even though the average prescription allows for a 22-day supply. Additionally, the company will require that short-acting formulations be prescribed first for opioid-naive patients before they are exposed to long-acting versions. Dosage also will be capped; and Express Scripts will monitor for and try to avert "pill shopping." Rival CVS Caremark already has a similar program in place. Express Scripts will take its initiative live on September 1, but not with the blessing of the American Medical Association (AMA). Patrice Harris, MD, who chairs the group's Opioids Task Force, says members are already tackling the epidemic. "We want to be proactive in making sure the alternatives are available, versus a sort of blunt, one-size-fits-all approach regarding the number of prescriptions," she says. "The AMA's take has always been that the decision about a specific treatment alternative is best left to the physician and their patient." Associated Press (08/16/17)

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Don't Blame The Surgeons: Long-Term Opioid Use Rarely Starts With Surgery, Study Finds
Don’t blame the nation’s surgeons for an opiate-abuse crisis that now claims 142 lives daily in the United States. New research suggests that patients leaving the hospital after surgeries or inpatient procedures are rarely the ones whose long-term opioid use started with a doctor’s prescription. Instead, the patients who most frequently go on to use opioid medications for six months or more got their first prescription for some sort of back pain, or for pain described in medical code as “other ill-defined conditions,” according to a research letter published Wednesday in the journal JAMA Surgery.
Los Angeles Times: (Healy, 8/17)

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Climbing Cost Of Decades-Old Drugs Threatens To Break Medicaid Bank
Skyrocketing price tags for new drugs to treat rare diseases have stoked outrage nationwide. But hundreds of old, commonly used drugs cost the Medicaid program billions of extra dollars in 2016 vs. 2015, a Kaiser Health News data analysis shows. ... Rising costs for 313 brand-name drugs lifted Medicaid’s spending by as much as $3.2 billion in 2016, the analysis shows. Nine of these brand-name drugs have been on the market since before 1970. In addition, the data reveal that Medicaid outlays for 67 generics and other non-branded drugs cost taxpayers an extra $258 million last year. Kaiser Health News: (Lupkin, 8/14)

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Survey: 96% of large employers will offer telemedicine benefit in 2018
Ninety-six percent of large employers said they intend to provide telemedicine services for employees in 2018, while 56% plan to adopt telehealth for behavioral services, according to a National Business Group on Health survey. The poll also showed that 20% of employers reported employee telemedicine utilization rates of at least 8%. MedCity News (8/9)

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The new conundrum about when to stop antibiotics
British infectious disease experts suggested in a recent BMJ article that doctors should stop making the recommendation that patients always finish their antibiotics. "We are challenging this now because antibiotic resistance is such an enormous issue," said Martin Llewelyn, a professor of infectious diseases at Brighton and Sussex Medical School in England. Llewelyn said the risk with stopping antibiotics too early is recurrence of the infection, not contributing to resistance. He adds, however, "We're not suggesting stopping antibiotics when you feel better is necessarily the right thing to do across the board." While many in the infectious disease community agree that finishing a course of antibiotics is not always necessary, the message continues in guidance from a number of health groups. A spokesperson for the World Health Organization noted, however, that it agrees with the BMJ analysis and is assessing the evidence regarding the ideal course duration for different cases. Meanwhile, Lauri Hicks, director of the office of antibiotics stewardship at CDC, said the agency changed its guidance about a year ago, to take an antibiotic as directed by a health care provider. "We are very interested in identifying opportunities to improve how antibiotics are being used, and that involves making sure the patient gets the right drug, the right dose and the right length of therapy," she said. Vance Fowler, MD, of Duke University Medical Center, says there are situations in which he abbreviates treatment, but makes sure the patient knows the signs of relapse. Fowler also leads the Antibacterial Resistance Leadership Group, a network of nearly 100 researchers worldwide that is conducting numerous studies on antibacterial resistance, such as comparing 5 and 10 days of treatment for pneumonia in children. Barbara E. Murray of the University of Texas Health Science Center in Houston also points out that it can be difficult in some situations for patients to really know when they are better, and some conditions—such as heart-valve and bone infections—necessitate taking antibiotics for extended periods. "There a patient may feel better after a week, but if they stop taking antibiotics, then they will relapse," she said. Wall Street Journal (08/14/17) Reddy, Sumathi

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CVS Health survey reveals nearly two-thirds plan to get influenza vaccine every year
A new survey from CVS Health shows that 61% of Americans said they get vaccinated against influenza every year, or plan to get vaccinated this year, a 2% increase from last year's survey results. Of those individuals, 67% said they believe getting an influenza vaccine is the best way to protect against influenza. "We recognize that staying on top of your health can sometimes be daunting, especially for busy families, and flu vaccinations are no exception to this," said Papatya Tankut, vice president of Pharmacy Affairs at CVS Health. "This year's survey demonstrates the increasing number of factors that go into deciding where, when, and how to get vaccinated, which is why CVS Pharmacy continues to strive to make health care quick, easy and accessible for patients." The annual survey, conducted in July by Harris Poll for CVS Health, included more than 2,000 adults. Among respondents who said they had ever received an influenza vaccine, 22% said they most often get the vaccine from a local pharmacy, while 44% said they most often get it from their primary care provider or other health care professional and another 22% said they got vaccinated in their workplace. The survey's release marked the availability of influenza vaccines at CVS Pharmacy and MinuteClinic locations across the country, with no appointment needed. PR Newswire (08/16/17)

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Study links poor medication adherence in diabetes to increased CVD risk
UK researchers found that type 2 diabetes patients with poor medication adherence had a higher risk for cardiovascular disease than those with good medication adherence. The findings in Diabetes Care, based on a meta-analysis of eight observational studies involving 318,125 adult diabetes patients, also revealed an association between good medication adherence and reduced risks for all-cause mortality and hospitalization. Healio Endocrine Today(8/14)

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Asthma, more deadly with age, takes heavy toll on older adults
Mortality rates for older adults with asthma are five times those for younger patients, according to a new review of asthma in people aged 65 years and older. As people age, physical changes take a toll. Individuals' lungs become less elastic, their chest walls more stiff, and the muscles that assist the respiratory system less strong, aggravating breathing problems, explained Michael Wechsler, MD, coauthor of the new review and codirector of the Cohen Family Asthma Institute at National Jewish Health, in Denver. Other biological changes range from compromised vision, which can make it difficult for older adults to use inhalers correctly, to the immune system's weakened response to inflammation, which makes it harder to fight off infections that can spark asthma exacerbations. One woman, aged 63 years, who was recently admitted to the National Jewish Health with an acute asthma exacerbation, discussed growing older with a serious chronic illness. She was diagnosed with asthma as a young child, but she says she feels less in control of her condition as she ages. "Things became very different as I got older," she explained. "I couldn't recoup from exacerbations as easily. The episodes were longer. The periods where I felt decent were shorter." Kaiser Health News (08/10/17) Graham, Judith

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What's harder than making copycat biotech drugs? Selling them
Biosimilars—copycat versions of expensive biotechnology drugs—would seem a viable response to patient and provider outcry over steep medication costs, yet efforts to bring them to market have struggled. Not only do makers of biosimilars have to contend with user and doctor loyalty to existing drugs that have been effective, but there also is payer resistance to the new alternatives. Insurance companies that exclusively cover branded products on their preferred drug lists can create an effective roadblock and make it difficult for new biosimilars to break out. Manufacturers of brand-name biotechnology drugs once balked at biosimilars as competition; however, now they are taking on production and distribution themselves. "For 20 years, until maybe this year, the brand industry's position was, 'Don't take a biosimilar, it's scary, it's dangerous," says Bruce Leicher, an executive at Momenta Pharmaceuticals, which sells generics and is developing biosimilars. "All of that has to be overcome, and it could take a year or two until this becomes routine, like generics are a routine presence." In the interim, FDA has prioritized addressing the industry's pricing issue through increased competition, with a wave of biosimilars expected to become available in coming years. Bloomberg (08/15/17) Hopkins, Jared S.

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Study: Patients more likely to get the influenza shot when it's available at community pharmacy
The results of a new study indicate that making influenza immunizations available through community pharmacy boosts the likelihood that a patient will get vaccinated. The research, published in Clinical Therapeutics, was conducted by Avalere and the National Association of Chain Drug Stores. "Overall, as states moved to allow pharmacists to administer influenza immunizations, the odds that an adult resident received an influenza immunization rose, with the effect increasing over time," wrote Laura Miller, NACDS senior economist, who conducted the study along with Avalere Health's Edward Drozd and Michael Johnsrud. "These findings suggest that pharmacies and other nontraditional settings may offer accessible venues for patients when implementing other public health initiatives." According to the research, state-level policy changes that permit pharmacists to administer influenza immunizations were connected with a nearly 8% rise in seasonal influenza immunization rates within 6 years after the policy changes between 2003 and 2013. During this time, overall seasonal influenza immunization rates increased 25% among those surveyed. Johnsrud also noted the research found that influenza immunization rates increased by age, while fewer individuals who reported access to care issues due to cost received influenza immunizations compared with those who reported no such issues (22% vs. 37%). Drug Store News (08/14/17) Johnsen, Michael

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Walgreens launches Center for Health & Wellbeing Research
Walgreens has launched its Center for Health & Wellbeing Research, a website that features more than 50 Walgreens outcomes studies completed over the past 6 years. Areas of research include access to care and patient experience, adherence and clinical outcomes, digital health and member engagement, and health care costs. "We are thrilled to be unveiling the Walgreens Center for Health & Wellbeing Research," said Harry Leider, MD, chief medical officer and group vice president, Walgreens. "Our goal is, through scientific research, to help improve patient care and outcomes while lowering health care costs. We are dedicated to providing value to health care on a national scale and the Walgreens Center for Health & Wellbeing Research will showcase the work we are doing every day to advance that mission." Researchers from Walgreens and several academic institutions—which provide guidance, expertise, and industry insight—actively collaborate on a variety of research studies. Walgreens (08/15/17)

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Monthly Free Member CE:



Stress Management Skills for Pharmacy Practice

This activity will introduce pharmacists to evidence-based approaches for managing stress. Attendees will practice mind-body skills known to short-circuit the “fright, fight, or flight” response to stressful situations. Attendees also will learn cognitive practices for changing their thinking about potentially stressful situations. Attendees will leave with a personal toolkit of strategies for controlling the amount of stress they experience both in and out of the workplace. More


TPA Educational Opportunities
TPA offers other education programs on a wide range of topics. For information on all of TPA’s upcoming educational events, visit the TPA Event Calendar & Online CE Calendar


Wildfire Defense Systems
If a fire threatens an insured property, Pharmacists Mutual Insurance Company may dispatch an engine and crew to the property for pre-fire and post-fire mitigation services. Learn more about this special service at http://wildfire-defense.com/.

Texas Pharmacy Association
Debbie Garza, CEO, TPA • 512.615.9170