Friday, September 15, 2017

Follow TPA on: Facebook | Twitter | Archives

In the State:
Texas Medicaid Updates
Mosquito-borne diseases could surge as flooding recedes

Association News:
Share your team photo! The month of October is American Pharmacists Month
Texas Federation of Drug Stores (TFDS) Annual Meeting
Follow TPA on Twitter
Texas Pharmacy Foundation Disaster Relief Fund

National News:
Medicare Card Remake to Protect Older Adults
FDA Moves To Guard Against Abuse Of ‘Orphan Drug’ Program
National Survey Reveals the Scope of Behavioral Health Across the Nation

Trending News:
Drug Companies Tie Costs To Outcomes
Specialty Drug Prices Continue Rising
Expert Warns About 3 Cybersecurity Trends in Health Care
Researchers Find Hint Of A Link Between Flu Vaccine And Miscarriage
Scientists See Progress For Cancer Vaccines
It's Time to Reform Accessibility to Prescription Drugs
Site Spotlights PBM Fees that Raise Medicare Costs for Older Adults Seeking Lifesaving Medications
Can Your 'Good' Cholesterol Be Too High?
Severe and Difficult-to-treat Asthma in Adults
Get Up At Least Once Every 30 Minutes. Failure To Do So May Shorten Your Life, Study Finds


In the State

Texas Medicaid Updates:
1) Texas Medicaid Prescriber Requirements for Pharmacies – Delayed

Due to the impact of Hurricane Harvey the Health and Human Services Commission is delaying the requirement for all prescribers to be enrolled within Medicaid by October 16 in order for pharmacy claims to be paid. The requirements will be delayed until January 2018. The Vendor Drug Program and managed care organizations will not deny any pharmacy claims in calendar year 2017 because the prescriber is not enrolled. Denials will begin in early January 2018.
For more information, call the TMHP Contact Center at 1-800-925-9126 or the TMHP-CSHCN Services Program Contact Center at 1-800-568-2413.

Back to Top


2) Updated Vendor Drug Program Managed Care Resource Documents Now Available
The Vendor Drug Program has updated their managed care resource documents for pharmacy staff and prescribers.

Updated documents included:
• Pharmacy Enrollment Chart
• Pharmacy Assistance Chart
• Prescriber Assistance Chart
• Service Delivery Area Assistance Chart

These charts denote a change to the El Paso Health managed care organization. Click Here to review the updated document.

Back to Top

3) Hepatitis C Request Form Modifications
On September 15 modifications to the prior authorization form for Antiviral Agents for Hepatitis C Virus take effect. The modifications will affect both individuals within Medicaid fee-for-service and Medicaid managed care.
Click Here to see the Antiviral Agents for Hepatitis C Virus Initial Request Prior Authorization Request Form.


Back to Top

4) Cystic Fibrosis Prior Authorization Modifications

On September 15 the Vendor Drug Program is modifying the cystic fibrosis prior authorization adding five mutations to the cystic fibrosis transmembrane conductance gene that are responsive Kalydeco (ivacaftor).

Prior authorizations for Medicaid managed care are optional. Click Here for the Pharmacy Clinical Prior Authorization Assistance Chart, which shows the prior authorization each managed care organization uses and how it relates to those used for traditional Medicaid claim processing.

Back to Top

Mosquito-borne diseases could surge as flooding recedes
Severe flooding in urban areas initially flushes out mosquito populations, but stagnant water that remains after floodwaters recede allow mosquito populations to explode, says epidemiologist and mosquito expert Chris Barker. West Nile virus is the primary concern in Houston, and Puerto Rico may see more mosquitoes carrying Zika and dengue viruses, Barker says. Mother Jones online (September 7, 2017) Mechanic, Michael

Back to Top

Association News

Share your team photo! The month of October is American Pharmacists Month
You make valuable contributions to the practice of pharmacy every day, all year long. TPA would like to recognize your pharmacy team as a way to celebrate American Pharmacists Month.

Take photos of your pharmacy team and send your photos to lwright@texaspharmacy.org. Include your pharmacy name and city in your email. We will post your photos on social media from October 1 - 31. We may also include your photo in Texas Pharmacy Magazine!

Back to Top

Texas Federation of Drug Stores (TFDS) Annual Meeting
TPA CEO Debbie Garza attended the Texas Federation of Drug Stores (TFDS) Annual Meeting on Wednesday, September 13. Besides reacquainting herself with chain pharmacy colleagues, Debbie presented her vision as new CEO of the Texas Pharmacy Association and discussed ways they can work together to advance the profession and enhance the practice of pharmacy in Texas. Gay Dodson, Executive Director/Secretary, joined by Allison Benz, Director of Professional Service, of the Texas State Board of Pharmacy, provided a Texas Pharmacy Law update. Senator Dawn Buckingham provided a legislative update and dialogued with the group on the prescription drug monitoring program and plans to monitor the program in case any legislative changes may be needed next session.



TFDS Board Members, staff and guests: L to R:
Brad Shields (TFDS staff), Brad Shields (TFDS staff),
Mike Smith (Walgreens), Debbie Mack (Walmart),
Debbie Garza (TPA), RoxAnn Dominguez (ReCept Rx),
Julie Spier (Randalls/Tom Thumb/Albertsons), Gay Dodson (TSBP), Allison Benz (TSBP), Jay Bueche (HEB), Jeff Loesch (Kroger),
and Sing Lim (Walmart)
Debbie Garza with TFDS president,
Debbie Mack (Senior Director, U.S. Ethics & Compliance at Walmart)

Back to Top

Follow TPA on Twitter
Click here to follow TPA or enter Texas Pharmacy Assn or @TXpharmAssn in the search box and click on our profile in the results. Tap “Follow” to begin following TPA. We will be notified that you are following us!

Back to Top

Texas Pharmacy Foundation Disaster Relief Fund
Help pharmacy help Texas communities in need. Contribute to the Texas Pharmacy Foundation Disaster Relief Fund today. Funds will be used to assist pharmacies in the affected areas and to help communities in Texas have access to pharmacy services. Donate Here

Back to Top


National News

Medicare card remake to protect older adults
Starting next April, Medicare will begin mailing all beneficiaries news cards as part of an effort to fight identity theft. Instead of having individuals' Social Security numbers on the cards, they will instead use unique numbers to identify patients. The massive transition will involve coordination with 58 million beneficiaries and their families, as well as hospitals, physicians, insurances companies, pharmacies, and state governments. Congress has set a deadline of April 2019 for all beneficiaries to have received the new cards. Associated Press (September 14, 2017)

Back to Top

FDA Moves To Guard Against Abuse Of ‘Orphan Drug’ Program
The Food and Drug Administration is changing the way it approves medicines known as “orphan drugs” after revelations that drugmakers may be abusing a law intended to help patients with rare diseases. In a blog post Tuesday, FDA Commissioner Scott Gottlieb said he wants to ensure financial incentives are granted “in a way that’s consistent with the manner Congress intended” when the Orphan Drug Act was passed in 1983. That legislation gave drugmakers a package of incentives, including tax credits, user fee waivers and seven years of market exclusivity if they developed medicines for rare diseases.
Kaiser Health News (September 13, 2017) Tribble, Sarah

Back to Top

National survey reveals the scope of behavioral health across the nation
The Substance Abuse and Mental Health Services Administration’s (SAMHSA) latest National Survey on Drug Use and Health (NSDUH) report provides the latest estimates on substance use and mental health in the nation, including the misuse of opioids across the nation. Opioids include heroin use and pain reliever misuse. In 2016, there were 11.8 million people aged 12 or older who misused opioids in the past year and the majority of that use is pain reliever misuse rather than heroin use—there were 11.5 million pain reliever misusers and 948,000 heroin users. Nationally, 21.1% of people aged 12 years and older with an opioid use disorder received treatment for their illicit drug use at a specialty facility in the past year. Receipt of treatment for illicit drug use at a specialty facility was higher among people with a heroin use disorder (37.5%) than among those with a prescription pain reliever use disorder (17.5%). The report also reveals that in 2016 while adolescents have stable levels of the initiation of marijuana, adults aged 18 to 25 have higher rates of initiation compared with 2002-2008, but the rates have been stable since 2008. In contrast, adults aged 26 and older have higher rates of marijuana initiation than prior years.
HHS News Release (September 17, 2017)


Back to Top


Trending News

Drug Companies Tie Costs To Outcomes
For decades, health insurers and patients have paid for prescription drugs based on the volume of pills or vials purchased—whether or not the medicines helped individual patients as intended. Now the outcry over high drug prices has raised the profile of a different approach to paying for prescription drugs. Pharmaceutical companies increasingly are offering to tie a portion of their reimbursements from insurers to how well drugs work in patients. The Wall Street Journal (September 12, 2017) Loftus, Peter

Back to Top

Specialty drug prices continue rising
Retail prices for some of the most commonly prescribed specialty drugs rose by 9.6% from 2014 to 2015, while prices for branded drugs rose by 15%, and generic drug prices dropped by 19.4%, according to an AARP analysis of data from Truven Health Research Databases. The average annual cost of specialty drugs studied was $52,486, compared with $5,800 for traditional drugs and $523 for generics, the report showed. MedPage Today (September 8, 2007) Wynn, Matt


Back to Top

Expert warns about 3 cybersecurity trends in health care
There will be new types of cyberattacks against medical devices such as insulin pumps, which could be shut down by hackers if a ransom is not paid, said Michael Daniel, president of the Cyber Threat Alliance, at the Healthcare Security Forum. Daniel also warned about trends toward greater collateral damage involving hospitals, along with data corruption, which is a "more difficult problem to solve because getting back to ground truth is incredibly difficult." Healthcare IT News (September 12, 2017) Sullivan, Tom


Back to Top


Researchers Find Hint Of A Link Between Flu Vaccine And Miscarriage

Researchers studying the impact of the flu vaccine in pregnancy have found a possible link between miscarriage early in pregnancy in women who received the flu vaccine two years in a row. It’s the first study to identify a potential link between miscarriage and the flu vaccine and the first to assess the effect of repeat influenza vaccination and risk of miscarriage. The findings suggest an association, not a causal link, and the research is too weak and preliminary, experts said, to change the advice that pregnant women should get a flu vaccine to protect them from influenza, a deadly disease that can cause serious birth defects. But the study is likely to raise questions about the safety of the vaccine as flu season gets underway.
The Washington Post (September 13, 2017) Sun, Lena

Back to Top

Scientists See Progress For Cancer Vaccines
Tumor-destroying vaccines have emerged as a new weapon in the fight against cancer. Conventional vaccines prevent people from getting sick in the first place. Now scientists are testing a new type of vaccine that treats existing cancers by spurring immune cells to go on the attack. These drugs—known as therapeutic vaccines—hold the potential to plunge cancers into remission without causing the side effects of treatments such as chemotherapy. The Wall Street Journal (September 12, 2017) Gormley, Brian


Back to Top

It's time to reform accessibility to prescription drugs
B. Douglas Hoey, CEO of the National Community Pharmacists Association, asserts that PBMs have played a central role in creating the current situation in which too many Americans cannot readily access or afford their prescription drugs. He notes PBMs face little accountability, and "increasingly ... extract considerable profit from drug manufacturer rebates, administrative fees on pharmacies, and spread pricing (the profit they take from the difference between what they bill the plan sponsor for a medication and what they reimburse the pharmacy)." Hoey calls on Congress to pass the Improving Transparency and Accuracy in Medicare Part D Drug Spending Act; the Prescription Drug Price Transparency Act; and the Ensuring Seniors Access to Local Pharmacies Act. In the meantime, he says, "we can make improvements while we press lawmakers to act. Alternatives to the traditional PBM business model do exist. If companies and organizations want to upend the status quo in their benefit plan design process, they should take the wheel instead of riding shotgun." Independent community pharmacies, which are often located in underserved areas, can enhance these efforts by ensuring adequate patient access to prescription drugs and pharmacist counseling services, according to Hoey. "All of us—policymakers, insurers, pharmacists, and even PBMs—must roll up our sleeves and create better, more cost-effective prescription drug benefit plans for Americans," concludes Hoey. The Hill (September 11, 2017) Hoey, B. Douglas

Back to Top

Site spotlights PBM fees that raise Medicare costs for older adults seeking lifesaving medications
The National Association of Specialty Pharmacy on Monday launched a new website that highlights the increasingly negative consequences of direct and indirect remuneration (DIR) fees. "Big PBMs have worked hard to make DIR fees so complicated and opaque that very few people understand how they impact sick seniors enrolled in Medicare," said Sheila Arquette, executive director of NASP. "DIR fees endanger the integrity of the Medicare Part D program, which is intended to ensure quality, satisfaction, and cost effectiveness for sick seniors across the nation." The new site, StopDIRfees.com, is a resource hub for patients, health care providers, legislators, and others, providing education materials as well as an online petition and contact information for constituents to call or write their elected officials and urge them to stop DIR fees. PR Newswire (August 14, 2017)

Back to Top

Can your 'good' cholesterol be too high?
A new study of more than 116,500 adults looked at whether it is possible to have too high levels of HDL, or "good," cholesterol. In the study, Danish researchers followed the participants for 6 years. There were 10,678 deaths. The researchers found that, after adjusting for various factors, an HDL of 73 mg/dL in men and 93 mg/dL in women was linked to the lowest all-cause mortality. By comparison, men with HDL levels of 97-115 mg/dL had a 36% increased risk for death, and two times the risk when HDL levels were greater than 116 mg/dL. For women with levels higher than 135 mg/dL, there was a 68% increased risk. The researchers note that just 2.3% of men had levels higher than 97, and 0.3% of women had levels above 135. Consistent with previous research, low LDL was also associated with higher mortality risk. For levels under 39, the researchers found that the lower the HDL level, the higher the increased risk for death. The research is published in the European Heart Journal.
New York Times (August 29, 2017) Bakalar, Nicholas

Back to Top

Severe and difficult-to-treat asthma in adults
The health care burden associated with severe and persistent asthma in adults—in terms of symptoms, exacerbations, medication costs and adverse effects, and their subsequent impact on patients' personal lives—is substantial. However, report Elliot Israel, MD, of Harvard Medical School and Helen K. Reddel, MB, BS, PhD, of the University of Sydney, great strides in understanding and treating the condition have been made over the past 5 years. A large part of that progress, they report, comes from use of an integrated approach to evaluation and management. Many patients can successfully bring their disease under control after optimizing standard treatment—by improving inhaler technique and adherence to treatment, for example, and/or systematically addressing coexisting conditions. New targeted interventions, meanwhile, have cropped up for severely asthmatic adults who have the persistent type 2 inflammation phenotype even after taking high-dose inhaled glucocorticoids. With these novel treatments coming at a significant cost, though, more study is needed to identify the patients most—or least—likely to respond to them. There additionally is a need to develop surrogate markers for exacerbations, to shorten the length of early-phase studies. Investigators especially need to focus, Israel and Reddel suggest, on the root cause of the disease and relevant treatment targets in patients without type 2 inflammation or with progressive or permanent airway obstruction. New England Journal of Medicine (September 7, 2017) Israel, Elliot; Reddel, Helen K.

Back to Top

Get Up At Least Once Every 30 Minutes. Failure To Do So May Shorten Your Life, Study Finds
You can spend a lot of accumulated time on your bottom in the course of a day. Or you can sit for lengthy spells without a break. Both, it turns out, are very bad for you. Whether you’re a heavy sitter or a binge-sitter, racking up prolonged sedentary time increases your risk of early death, according to a study published in Tuesday’s edition of the Annals of Internal Medicine. Los Angeles Times (September 11, 2017) Healy, Melissa

Back to Top




TEXAS PHARMACISTS!
THE SHOW WILL GO ON - NCPA Annual Convention!


Don’t miss out! Join other successful community pharmacists for peer-tested solutions to boost profits, reduce costs and bring new patients into your pharmacy. Register today for the NCPA Annual Convention, October 14-18, 2017 in Orlando. Check NCPA website for updated schedule of events and educational workshops.
Hotel Deadline is September 22. Register + Book your hotel at

www.ncpanet.org/convention


Free Member Monthly CE:
Strong Enough: Choosing Courage, Resilience & Triumph
We’ve all been knocked down by life, work, relationships, and everything in between. How do some people get back up more quickly than others? Why do some people conquer their fears while others are paralyzed by them?
Using the latest research, entertaining and insightful stories, and practical tools and strategies, Anne provides a one-of-a kind, life transforming experience. Leave inspired, in awe, and ready to tackle whatever life throws your way. Leave STRONG ENOUGH.


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

Back to Top


Whole Life Insurance and Term Life Insurance products from The Pharmacists Life Insurance Company offer cash value accumulation and peace of mind for you and your family, all at competitive rates! Life insurance is an important part of your financial base. Contact Pharmacists Mutual today.