Literature Review

High-risk opioid prescribing and nurse practitioner independenceJAMA Health Forum; Lucas D. Cusimano, BS; Nicole Maestas, MPP, PhD; 12/24In 2021, more than 1 in 5 opioid overdose deaths were attributed to prescription opioids in the US, and the rate of such deaths has increased 5-fold since 1999. Concerns around excessive opioid prescribing have been used to argue against the expansion of the scope of practice of nurse practitioners (NPs) ... In this difference-in-differences analysis of opioid prescribing in 16 states, there was no change in the rates of high-risk opioid prescribing in the 6 states that adopted nurse practitioner independence compared with 10 nonadopting neighboring states during the 24 months following adoption. The study found no association between legislation that granted independence to nurse practitioners and rates of risky opioid prescribing. 

PBMs secretly profited from opioid crisis: New York Times Becker's Hospital Review; by Alexandra Murphy; 12/17/24 Pharmacy benefit managers were paid by drugmakers, including Purdue Pharma, to keep opioid prescriptions flowing even as overdose deaths soared across the U.S., according to an investigation by The New York Times. The Dec. 17 report highlighted how Express Scripts, CVS Caremark and Optum Rx, which control access to medications for millions of Americans, negotiated deals with opioid manufacturers to prevent restrictions on painkiller prescriptions in exchange for lucrative rebates. Between 2003 and 2012, Purdue Pharma paid PBMs roughly $400 million annually to avoid limits on opioid prescriptions, which included measures that could have curtailed overprescribing, such as requiring additional physician justifications or limiting the number of pills dispensed. Internal documents reviewed by the Times show how the PBMs repeatedly collaborated with opioid manufacturers to influence insurers' decisions and block restrictions.

UConn John Dempsey Hospital joins National Age-Friendly Health System Movement UConn Today; by Jennifer Walker; 12/12/24 UConn John Dempsey Hospital was recently accepted for participation in the national Age-Friendly Healthy Systems Movement to improve health care for older adults. The Age-Friendly Health Systems Movement, sponsored by The John A. Hartford Foundation and the Institute for Healthcare Improvement in partnership with the American Hospital Association and the Catholic Health Association of the United States​, is a national collaboration of hospitals and health systems implementing a set of evidence-based interventions to make the care of all older adults equitable and age-friendly. This initiative addresses the reality that a growing proportion of the US population is elderly and has complex healthcare needs which challenge many institutions. This movement is built upon a framework of a set of four best practice interventions known as the 4Ms.

[KY] Attorney General Russell Coleman files lawsuit against Optum Rx for role in opioid epidemic Northern Kentucky Tribune - Kentucky Center for Public Service Journalism; 12/1/24 The Kentucky Attorney General’s Office has announced its latest lawsuit against a corporation behind the worst man-made epidemic in modern medical history. Attorney General Russell Coleman added Optum Rx and its affiliates to the list of those responsible for the opioid crisis. ... According to the Attorney General’s lawsuit, Optum Rx played a central role in the reckless promotion, dispensing, and oversupply of opioids. ... “Defendants have hidden their conduct through non-transparent business practices and by requiring each entity with whom they conduct business, such as opioid manufacturers, to enter into confidentiality agreements or otherwise keep their agreements confidential,” said the lawsuit. “No state has been harder hit by the drug crisis than Kentucky. Last year alone, nearly 2,000 Kentuckians died of a drug overdose,” Attorney General Coleman said. “These groups pushed a profit-fueled agenda at the expense of Kentucky families, who are left with empty seats at the dinner table. Our Office will continue to hold those behind the drug crisis accountable for their devastating actions.”

Early palliative care linked to better end-of-life outcomes in ovarian cancer AJMC - The American Journal of Managed Care, Cranbury, NJ; by Brooke McCormick; 11/22/24 Initiating palliative care (PC) more than 3 months before death was associated with improved quality of care and reduced care intensity at the end of life (EOL) for decedents with ovarian cancer, according to a study published in JAMA Network Open. Alongside oncologic treatment, the American Society of Clinical Oncology recommends all patients with advanced cancer receive early, dedicated PC within 8 weeks of diagnosis. PC benefits include prolonged survival, enhanced quality of EOL care, and improved patient and caregiver quality of life (QOL). Early referral to specialist PC is also linked to less aggressive EOL care. 

[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? ...

HopeHealth CMO: Hospice rules for ‘unrelated care’ getting stricter Hospice News; by Jim Parker; 9/25/24 Dr. Ed Martin began working in hospice in 1987 after hearing families talk about their experiences with those services. Today, he is chief medical officer of Rhode Island-based HopeHealth. The more than 50-year-old nonprofit organization also serves parts of Massachusetts. Martin recently spoke about the complicated issue of care that is deemed “unrelated” to a patient’s terminal diagnosis at the National Hospice and Palliative Care Organization’s Annual Leadership Conference in Denver. Hospice News sat down with Martin at the conference to discuss how he and his organization are addressing the matter of unrelated care, as well as the efficacy of requirements for an addendum to the election statement. [Click on the title's link to continue reading this interview.]

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.”