Trending Topics in Health-System Pharmacy
Invasive approach no better than meds to prevent cardiac events, study shows
Results from the international ISCHEMIA trial, the largest study to address the effect of opening blocked arteries in nonemergency situations, showed that patients who had invasive procedures to prevent cardiovascular events did no better than patients who received drug therapy treatment. The trial results were presented at the recent annual meeting of the American Heart Association.
More than 5,100 patients with stable ischemic heart disease were followed for a median of 3.5 years. One group was randomized to receive stents or bypass surgery in addition to medical therapy. The second group received medication alone. The researchers found no overall difference between the two groups in the primary endpoint—a composite of cardiovascular death, myocardial infarction (MI), resuscitated cardiac arrest, hospitalization for unstable angina, or heart failure. In addition, no difference was found in the secondary endpoint of cardiovascular death, MI, and quality of life.
The bottom line, said ISCHEMIA study chair Judith Hochman, MD, is that patients care about living longer and feeling better.
“We showed with over 5 years of follow up with an average of 3.3 years of follow up, [there was] no evidence that they would live long with the routine invasive surgery, and we saw that if they had angina at baseline that would be further improved by an invasive strategy,” Hochman said in a taped video interview on the AHA meeting’s ISCHEMIA page.
Patients having a heart attack or who had a heart attack within 2 months were excluded from the trial. Patients with low ejection fraction, heart failure, left main coronary artery disease, or symptoms that couldn’t be controlled with medication were also excluded.
The trial was funded by the National Institute of Health’s National Heart, Lung, and Blood Institute. Published results of the trial are forthcoming.
Hospital pharmacy trends for 2020
Health care promises to be a hot topic in the lead-up to the 2020 elections. A recent report from McKesson, a global health care company that partners with hospitals and health care systems, includes trends and challenges for 2020 as predicted by the McKesson RxO team. The report details five key trends that health-system pharmacists should watch:
- Increasing complexity and growth in integrated delivery networks. As more hospitals integrate with medical practices, infusion centers, and home care to form networks delivering comprehensive patient care, challenges are created with patient education, clinical workflow, systems integration, standards across care settings, and contractual obligations with group purchasing organizations, payers, suppliers, and various other vendors.
- Hospitals expanding specialty pharmacy. Health systems continue to establish their own specialty pharmacies or expand existing capabilities, leading to a positive impact on the health systems’ quality and continuity of care initiatives, but also challenges in administration of specialty drugs, given the number of new therapies and payer requirements.
- 340B delivering clinical and economic benefits. The 340B drug discount program will continue to help hospitals reduce complexity, enhance patient care, and provide financial benefits to health systems. Continued investment in 340B tools is needed to better track and manage program savings that allow funding of care for patients in underserved communities.
- Out-of-pocket costs impacting patients and revenue. As the cost of specialty medications—and patients’ out-of-pocket costs for these medications—have increased, patients are more likely to abandon their treatment plans. Embedding financial support and patient assistance programs will be key to improving patient adherence and health outcomes.
- Finance and pharmacy leadership relying on data-informed decisions. Pharmacists need to leverage data and analytics to reduce costs and support quality patient care, and tools and resources will be needed to analyze the large amount of data and deliver better care while maintaining a healthy balance sheet.
Hospital groups sue over price transparency rule
The American Hospital Association, along with other hospital groups, filed a lawsuit on December 4 in U.S. District Court in Washington alleging that CMS’s recently announced price transparency plan would violate their First Amendment rights. The plan would compel hospitals to publish the rates they negotiate with individual insurers for drugs, supplies, facility fees, and doctor care. Hospitals would face fines of up to $300 a day if they don’t share the negotiated rates.
The administration estimated the rule would cost hospitals more than $23 million annually in 2016 dollars, with annual costs of $38.7 million to $39.4 million in 2019 dollars. But the lawsuit alleges that the true cost is much higher, and that disclosing prices could actually raise prices by pushing hospitals to match rates charged by other facilities. The hospital groups argue that consumers are interested only in the out-of-pocket costs rather than the costs negotiated between hospitals and insurers. In addition, compliance would require the creation of huge spreadsheets containing hundreds to thousands of columns that they say could crash most computer systems and cause their websites to become unstable.
The hospital groups are asking for an expedited decision to prevent hospitals from preparing for a rule that may not pass the court’s judgment. Drug manufacturers used the same argument to block a rule that would have required them to include list prices for prescription medications in television ads.