Literature Review

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.

Biden administration says Medicare negotiated price discounts on 10 prescription drugs USA Today; by Ken Alltucker; 8/15/24 ... The Biden administration announced Thursday that Medicare had negotiated discounts with pharmaceutical companies on 10 drugs prescribed to treat blood clots, cancer, heart disease and diabetes. The drugs are Eliquis, Jardiance, Xarelto, Januvia, Farxiga, Entresto, Enbrel, Imbruvica, Stelara, and the insulins Fiasp and NovoLog. The discounts will range from 38% to 79% when the negotiated prices take effect in 2026. The bargaining will save Medicare $6 billion when the price cuts are implemented in two years, according to U.S. Department of Health and Human Services estimates. 

Exploring AI-powered music therapy as a solution to chronic pain management and the opioid crisisNeurologyLive; by Neal K. Shah; 8/6/24While the opioid crisis continues to ravage communities across America, many with chronic pain are in dire need of solutions. As a result, healthcare providers and researchers are urgently seeking alternative treatments for chronic pain management. One innovative solution is the use of music therapy, particularly when enhanced by artificial intelligence (AI) and neurotechnology. This combination could offer a powerful, non-pharmacological intervention to help millions of Americans suffering from chronic pain while potentially reducing opioid dependence.

Top PBM executives grilled in contentious congressional hearingModern Healthcare; by Michael McAuliff; 7/23/24Lawmakers and executives from three major pharmacy benefit managers presented diametrically opposing views at a heated Capitol Hill hearing Tuesday, as major bills aimed at reining in the organizations remain stalled in Congress. Members of the House Committee on Oversight and Accountability blamed the highly concentrated PBM industry for raising drug prices and running independent pharmacies out of business, while leaders from CVS Caremark, Express Scripts and Optum Rx all countered that the sector in fact lowers prices and supports local pharmacies.

AIDS Healthcare Foundation files Antitrust Action against Express Scripts PBM AIDS Healthcare Foundation (AHF), Los Angeles, CA; by Ged Kenslea; 7/29/24 AIDS Healthcare Foundation (AHF) – the world’s largest HIV/AIDS healthcare organization which cares for more than 195,000 people in the United States and is an essential safety-net provider for disenfranchised, high-risk HIV/AIDS populations – has filed a federal lawsuit (U.S.D.C., E.D. Mo., Case No. 4:24-01043) against the pharmacy benefit manager (PBM) Express Scripts, Inc. and its subsidiary, Accredo Health Group, Inc. AHF asserts federal antitrust claims and claims of state unfair trade practices over Express Scripts’ use of its monopoly power as a PBM in Louisiana to impose anticompetitive restraints to destroy competition among specialty pharmacies like AHF’s. AHF’s lawsuit comes on the heels of a blistering 115-page FTC report documenting how powerful PBMs like Express Scripts squeeze mom-and-pop and independent pharmacies, driving many out of business.

Humana to takeover 23 Walmart Health locations with new CenterWell senior care clinics. Here's where Louisville Courier Journal; by Olivia Evans; 7/25/24 Humana, the Louisville-based health insurance giant, has announced its health care services branch of the company, CenterWell, will open 23 senior primary care centers in Walmart Supercenters. The centers will operate under the CenterWell Senior Primary Care and Conviva Care Centers brand names, according to a press release from Humana.

Education curricula need to incorporate whole-person care beyond electives Pharmacy Times; by Ashely Gallaher; 7/21/24“[Whole-person care is] simply caring for a person and not just their pills. It's making sure that we're focusing on medications as tools to help people live better, healthier lives, and not as the focus of their lives,” Kashelle Lockman, PharmD, MA, clinical assistant professor and clinical pharmacy specialist at the University of Iowa. ... 3 Key Takeaways:

New medication, staging criteria signal a potential shift in Alzheimer’s care Psychiatric News; by Linda M. Richmond; 7/12/24 The latest antibody treatment for Alzheimer's disease may prompt the industry toward the use of biomarkers--rather than traditional cognitive and functional testing--for diagnosis and staging. Will the new drug make a meaningful difference in patients' lives despite its risks and hefty price tag?

Palliative pharmacotherapy for cardiovascular disease: A scientific statement from the American Heart Association Circulation: Cardiovascular Quality and Outcomes - American Heart Association (AHA) / American Stroke Association (ASA); by Katherine E. Di Palo, PharmD, MBA, MS, FAHA, Shelli Feder, PhD, APRN, ACHPN, FPCN, FAHA, Yleana T. Baggenstos, PharmD, Cyrille K. Cornelio, PharmD, Daniel E. Forman, MD, Parag Goyal, MD, MSc, Min Ji Kwak, MD, MS, DrPH, and Colleen K. McIlvennan, PhD, DNP, FAHA on behalf of the American Heart Association Clinical Pharmacology Committee of the Council on Clinical Cardiology and Council on Cardiovascular and Stroke Nursing; 7/24 ... Compared with other serious illnesses, medication management that incorporates a palliative approach is underused among individuals with cardiovascular disease. This scientific statement describes palliative pharmacotherapy inclusive of cardiovascular drugs and essential palliative medicines that work synergistically to control symptoms and enhance quality of life. We also summarize and clarify available evidence on the utility of guideline-directed and evidence-based medical therapies in individuals with end-stage heart failure, pulmonary arterial hypertension, coronary heart disease, and other cardiomyopathies while providing clinical considerations for de-escalating or deprescribing. Shared decision-making and goal-oriented care are emphasized and considered quintessential ... across the spectrum of cardiovascular disease.

Pain management in the wake of the opioid crisis Forbes; by Web Golinkin; 7/15/24 Pain is the single most frequent reason for patient visits in the United States. An estimated 20 percent of adults experience chronic pain, and nearly seven percent experience a level of chronic pain that limits their daily activities. However, most doctors and other healthcare professionals have very little education in pain management, according to Scott Fishman, MD, an internationally recognized expert in pain management, ... This lack of education was one of the main causes of the Opioid Crisis, Fishman says ... of the part of the crisis that was caused by the over-prescribing of opioids, many clinicians have become so wary of the medical-legal issues surrounding pain management that they have gone from an overly liberal approach to a restrictive one in which some prescribers are effectively abandoning patients who need to have their symptoms treated. Both extremes are frequently fueled by lack of knowledge and training, according to Fishman. ... The solution is to close the education gap ...

2 Ketamine palliative care projects explore interdisciplinary collaborationHospice News; by Holly Vossel; 6/29/24Two ketamine-assisted therapy projects are examining ways to develop training and collaboration models for utilization among palliative care patient populations. A growing body of research is uncovering the potential benefits of ketamine therapies to help with symptom management. But greater understanding of the drug and its impacts is needed to help palliative care providers and other health professionals guide patient experiences, according to Dr. Michael Fratkin, board president of the Institute for Rural Psychedelic Care. Fratkin is also a palliative care specialist at Humboldt Center for New Growth.

Factors affecting palliative care collaboration with pain medicine specialists Clinical Pain Advisor; by James Maitlall, MD; 6/27/24 Structured collaboration between physicians working in palliative care (PC) and pain medicine (PM) may increase PC physician referral of seriously ill patients to PM specialists and potentially optimize their care, according to study results published in the Journal of Pain and Symptom Management. ... In a survey study, a multicenter team of investigators explored attitudes and beliefs among US PC physicians regarding PM specialists, as well as factors potentially impacting collaboration between physicians in these 2 areas of practice. ... The American Academy of Hospice and Palliative Medicine (AAHPM) approved the survey for distribution to 1000 of its physician members, who were selected at random. ... The investigators concluded, “Although we found that PC physicians have highly positive attitudes about the value of PM specialists, referral rates remain low, even for IDDS implantation, which has perhaps the largest body of evidence for patients with complex cancer-associated pain.”  

The Opaque Industry Secretly Inflating Prices for Prescription DrugsThe New York Times; by Rebecca Robbins and Reed Abelson; 6/21/24Pharmacy benefit managers are driving up drug costs for millions of people, employers and the government. This is the first article in a series about how pharmacy benefit managers prioritize their interests, often at the expense of patients, employers and taxpayers. Americans are paying too much for prescription drugs. It is a common, longstanding complaint. And the culprits seem obvious: Drug companies. Insurers. A dysfunctional federal government.Publisher's Note: Pharmacy costs are second only to staffing for hospices. Dr. Drew Mihalyo and I presented on the complexities of prescription drug pricing at the 2017 Louisiana~Mississippi Hospice & Palliative Care Organization conference. This article, and others like them, will likely both educate and infuriate readers. The more things change, the more they stay the same...