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ProCare Rx Earns Full URAC Reaccreditation in Pharmacy Benefit Management

Thu, 12 Dec 2024 17:24:49 GMT

URAC accreditation reflects ProCare Rx’s commitment to achieving and maintaining the highest quality, member engagement and experience, and operational standards for PBMs in the industry

Gainesville, GA, December 12, 2024 - ProCare Rx, a leading provider of pharmacy benefit manager (PBM) and pharmacy benefit administrator (PBA) solutions that reduce plan sponsor and employee pharmacy costs and improve clinical outcomes, has received full URAC reaccreditation for our Pharmacy Benefit Management Services supporting our affiliated PBM offerings as well as those of their clients. The organization and its affiliates have been URAC accredited since 2010. In addition to earning. In addition to earning accreditations or certifications from URAC for PBM and Mail Order Pharmacy, and HITRUST, ProCare Rx holds NIST SP 800-53 cybersecurity standard, and AICPA SOC 1 Type 2 and SOC 2 Type 2 + HIPAA certifications.

“Gaining URAC Pharmacy Benefit Management accreditation is a tremendous accomplishment and is reflective of the efforts of the many dedicated professionals involved in the process at ProCare Rx,” said Marileny Lugo, President MC-Rx. ProCare Rx Chief Executive Officer Barbara Rambo added, “2025 marks the 10th year under the ProCare Rx name in the US and the 15th year under the MC-Rx/MC21 name in Puerto Rico, that our overall solution has been accredited. I am incredibly proud of everyone throughout the organization who has contributed to bringing the highest level of commitment to our industry, clients, employees, and the lives we cover, delivering clinical-based outcomes.“

ProCare Rx offers programs that bring the appropriate balance of cost management and plan management to your organization, and illuminates the way to savings for everyone. At a time when satisfaction with traditional PBMs is at the lowest level in a decade, ProCare Rx will continue to raise the bar with ClearSight Transparency – a clear, direct look into your data, pricing, and claims cost. Built upon a foundation that has supported pass-through pharmacy benefit model since the beginning, the ProCare Rx organization helps to ensure that a maximum network cost savings and, other benefits are available to its plan sponsor clients. The URAC Pharmacy Benefit Management seal shows an organization’s commitment to high quality in healthcare in the areas of risk management, consumer protection and empowerment, operations and infrastructure, as well as performance management and improvement. We are proud to recognize ProCare Rx / MC-Rx for their achievement in these areas,” said URAC President and CEO, Shawn Griffin, MD.

To learn more about ProCare Rx’s suite of pharmacy benefit solutions, please visit www.procarerx.com .

About URAC

Founded in 1990 as a non-profit organization, URAC is the independent leader in promoting health care quality and patient safety through renowned accreditation programs. URAC develops its evidence-based standards in collaboration with a wide array of stakeholders and industry experts. The company’s portfolio of accreditation and certification programs spans the health care industry, addressing health equity, workplace mental health, health care management and operations, pharmacies, telehealth, health plans, medical practices and more. URAC accreditation is a symbol of excellence for organizations to showcase their validated commit ment to quality and accountability.

To learn more about URAC’s stringent standards and evaluation process for PBMs, please visit
https://www.urac.org/accreditation-cert/pharmacy-benefit-management-accreditation/

About ProCare Rx

ProCare Rx, a privately held leader in pharmacy claims processing, pharmacy benefit management (PBM), and clinical program design, has been empowering healthcare organizations since 1986. With offices in the U.S. and Puerto Rico, we provide customizable, cost-effective solutions tailored to the unique needs of self-insured employer groups, TPAs, pharmacies, health systems, unions, and other industry leaders. Our commitment to ethical,
transparent operations and long-lasting partnerships has made us a trusted partner in optimizing pharmacy benefits and clinical performances. To learn more about how ProCare Rx is bridging the gap between cost savings and clinical innovation, visit http://www.ProCareRX.com

Media Contact:
Marc Cohen, VP, Marketing and Sales
marketing@ProCareRx.com

Mental health parity and medication adherence

Fri, 15 Nov 2024 16:28:06 GMT

Mental health parity and medication adherence

Mental health and substance use disorders are categories of conditions that affect an individual's emotions, thoughts, behaviors, and functioning, often leading to challenges in daily life and relationships. These conditions can result from a mix of genetic, environmental, psychological, and biological factors. Mental health and substance use disorders often interfere with daily functioning and relationships and may require treatment like therapy, medication, or support groups. In the United States, about 1 in 25 adults live with a serious mental illness, such as schizophrenia, bipolar disorder, or major depression. Stigma around mental health and substance use disorders is a significant social issue, creating barriers that prevent people from seeking the help they need. Stigma refers to the negative attitudes, beliefs, and behaviors directed at people due to a particular characteristic, in this case, a mental health or substance use disorder. This stigma can be internalized by the individual or expressed by others, reinforcing harmful stereotypes and discrimination. Stigma may affect access to equitable healthcare; individuals may avoid disclosing their struggles to healthcare providers for fear of judgment or dismissal. As a result, mental health and substance use disorders are often underdiagnosed and untreated, leading to increased morbidity and, in severe cases, mortality. Mental health parity is the principle that mental health and substance use disorder treatment should be covered by health insurance at the same level as physical health conditions. In other words, it ensures that benefits for mental health and substance use disorders are no less comprehensive or affordable than those for other medical conditions.

In the United States, mental health parity was established by laws like:

· Mental Health Parity Act (MHPA) of 1996 : This act was an early attempt to prohibit large group health plans from placing lower annual or lifetime dollar limits on mental health benefits than on medical/surgical benefits. However, it didn’t mandate mental health coverage and had some limitations.

· Mental Health Parity and Addiction Equity Act (MHPAEA) of 2008 : This act strengthened parity requirements by extending protections to include substance use disorders and expanding the scope to cover treatment limits, cost-sharing, and network adequacy. It also applied to large group plans, and later legislation, such as the Affordable Care Act (ACA), expanded its reach to individual and small-group markets.

· Affordable Care Act (ACA) of 2010: The ACA mandated that all individual and small-group plans must cover mental health and substance use services as essential health benefits and that they must follow MHPAEA’s parity rules.

By providing the same mental health drug benefits that are provided with other health treatments, the burden on seeking mental health care is reduced. This promotes affordability and accessibility, allowing patients to receive the medications needed without facing additional barriers to access.

Enhancing Treatment Adherence

The Mental Health Parity and Addiction Equity Act (MHPAEA) enhances medication adherence for individuals with mental health and substance use disorders by requiring health plans to cover mental health and substance use treatments on equal terms with other medical conditions. This helps people access, afford, and consistently use prescribed medications, which is essential for effective management of their conditions. Here’s how MHPAEA positively impacts medication adherence:

1. Reducing Financial Barriers

Lower Co-Payments and Deductibles: Parity laws require that co-pays, deductibles, and out-of-pocket costs for mental health and substance use medications are comparable to those for other medical conditions. Lowering these financial burdens makes it more feasible for individuals to fill and refill prescriptions regularly.

Affordable Out-of-Pocket Maximums: By capping out-of-pocket expenses at levels similar to those for physical health medications, parity laws prevent people from having to choose between medication and other basic needs, thereby supporting adherence.

2. Ensuring Access to a Full Range of Medications

Comprehensive Medication Coverage: Parity laws mean insurers can’t limit the types of medications available for mental health or substance use more than they do for physical health. Patients, therefore, have access to newer medications that may have fewer side effects or be more effective, improving adherence by reducing unpleasant side effects or complex dosing requirements.

Access to Necessary Treatments: MHPAEA encourages health plans to cover essential medications for mental health and addiction, allowing for a broader range of treatment options that might work better for individuals, enhancing their commitment with prescribed treatments.

3. Reducing Administrative Burdens

Simplified Approval Processes: Insurance plans cannot impose more stringent approval or authorization requirements on mental health medications than on physical health treatments. Simplifying these processes reduces delays in starting or continuing medications, making it easier for patients to adhere to their prescriptions.

Consistent Medication Access: Reduced administrative hurdles, such as imposing medical specialty limitations on mental health drugs, streamline prescription processing, allowing patients to get medications promptly and avoid gaps in their regimen that can disrupt adherence and treatment efficacy.

4. Increasing Provider and Medication Accessibility

Broader Provider Networks: By requiring equal network coverage for mental health services, MHPAEA makes it more likely that people can access in-network providers who can prescribe, adjust, and monitor medications. This continuous support fosters adherence by ensuring prescriptions are appropriate and well-managed.

Support for Integrated Care: Many health plans now support integrated behavioral and physical health services, helping individuals manage mental health conditions and overall health in tandem. Coordinated care improves medication adherence by allowing for close monitoring and adjustment of medications as needed.

5. Promoting Consistency in Treatment

Long-Term Access to Medications: MHPAEA mandates that health plans provide consistent support for mental health treatment, which includes long-term access to necessary medications. Continuous access to effective medications minimizes relapse or symptom recurrence, making it more likely for individuals to adhere to their treatment over time.

Conclusion

By reducing financial burdens, ensuring medication accessibility, and simplifying administrative processes, MHPAEA improves medication adherence for mental health and substance use disorder treatments. Enhanced adherence, in turn, supports better treatment outcomes, including symptom stabilization, relapse prevention, and overall quality of life.

Pharmacy Benefit Managers (PBM’s) work closely with health insurance plans to include multiple treatment options and medical services needed in order to preserve mental health. At MC-Rx, treatments for all disease states are evaluated by a multidisciplinary pharmacy and therapeutics committee. Formulary inclusion processes and utilization management strategies are applied equally and at parity to mental and physical health medications based on clinical, safety and cost effectiveness data. Via the optimal inclusion of mental health treatments in drug formularies, at MCRx, we make sure that the Mental Health Parity and Addiction Equity Act is always applied to pharmacy benefits. At MC-Rx, patients’ wellbeing and mental health is of utmost importance. Medication adherence will ensure the best possible outcomes, this is why it is very important that patients always consult with their pharmacist or physician about how to be adherent and how to keep track of their treatment. To provide the best patient care, MC-Rx promotes educational materials and interventions focused on health and wellbeing, in order to help beneficiaries achieve an excellent quality of life that includes mental health awareness.

References:

The Mental Health Parity and Addiction Equity Act (MHPAEA). CMS.gov. (n.d.). https://www.cms.gov/marketplace/private-health-insurance/mental-health-parity-addiction-equity
Centers for Disease Control and Prevention. (2023, April 25). About mental health. Centers for Disease Control and Prevention. https://www.cdc.gov/mentalhealth/learn/index.htm
Gillotte, A. (2022, December 14). Medication adherence: Why it’s important to patients. Genomind. https://genomind.com/patients/medication-adherence/#:~:text=%E2%80%9CTaking%20your%20medication%20the%20right,end%20up%20in%20the%20hospital.%E2%80%9
RefereAcma. (2023, April 19). Understanding the role of the PBM. Prior Authorization Training. https://www.priorauthtraining.org/understanding-the-role-of-the-pbm/#:~:text=PBMs%20are%20responsible%20for%20determining,use%20the%20most%20effective%20treatments.

Understanding GLP-1 Medications

Wed, 07 Aug 2024 12:29:21 GMT

Understanding GLP-1 Medications

The landscape of obesity management is evolving, with GLP-1 receptor agonist (RA) medications emerging as a significant player. These FDA-approved drugs have proven effective in helping individuals lose weight, prompting a shift in how they are viewed and covered by health plans. However, the cost implications and strategic decisions surrounding these medications require careful consideration by employer groups and their members.

The Case for GLP-1 Medications

GLP-1 RAs, originally developed for diabetes management, have shown remarkable efficacy in weight loss. With the growing prevalence of obesity and its associated healthcare costs, there's increasing pressure on health plans to cover these medications. Despite their high cost—annual retail pharmacy expenses can exceed $10,000 per patient—GLP-1 RAs offer potential downstream savings by reducing obesity-related comorbidities such as diabetes, hypertension, and cardiovascular disease.

Balancing Coverage and Cost

Historically, weight loss medications were deemed "lifestyle" drugs and excluded from coverage. However, the rising popularity of GLP-1 RAs and their demonstrated benefits are challenging this perspective. For plan sponsors, the decision to cover these medications involves balancing the high upfront costs with the potential for long-term savings on medical expenses related to obesity.

Cost-Containment Strategies

For payers choosing to cover GLP-1 medications, several cost-containment strategies can be employed:

Formulary Management : Deciding on the placement of these medications within the formulary is crucial. Options range from not covering the drugs to placing them on a high-cost tier with patient cost-sharing.
Prior Authorization and Step Therapy : Implementing these measures ensures that only patients with a proper diagnosis (e.g., ICD-10 code for obesity) access these medications, preventing misuse and overutilization.
Prerequisite Programs : Requiring participation in wellness or nutrition programs before approving weight loss medications can encourage lifestyle modifications that complement pharmacological treatment.
Specialist Restrictions : Limiting prescriptions to weight loss specialists, such as bariatric doctors or endocrinologists, ensures appropriate therapy and monitoring.
Duration Limits : Establishing treatment guidelines, such as discontinuing medications if a target weight loss is not achieved within six months, helps manage long-term costs.

The Role of Brokers and Employer Groups

Brokers play a pivotal role in guiding employer groups through the complexities of covering GLP-1 medications. Understanding the cost-benefit dynamics and available cost-containment strategies enables brokers to provide informed recommendations that align with their clients' financial and health objectives. Employer groups, in turn, must weigh the potential benefits of covering these medications against their budgetary constraints and the overall well-being of their workforce.

Member Education and Engagement

Effective communication with members is essential to ensure they understand the coverage options and adhere to prescribed treatments. Educational initiatives can include:

Patient Communication Programs : Providing information on medication adherence, compliance, and lifestyle modifications.
Continuing Education : Ongoing programs to keep members informed about the benefits and proper use of weight loss medications.
Monitoring and Support : Utilizing pharmacy and medical data to track outcomes and adjust strategies as needed.

Balance the Scale with Expert Guidance from MC-Rx

The adoption of GLP-1 medications for weight loss represents a significant advancement in obesity management. However, the high costs associated with these drugs necessitate careful planning and strategic implementation by brokers, employer groups, and members. By employing robust cost-containment strategies and prioritizing member education, health plans can navigate the financial challenges while delivering meaningful health benefits to their populations.

MC-Rx, as a full-service pharmacy benefits manager, offers the expertise and tools to help clients optimize their coverage decisions and manage the complexities of incorporating GLP-1 medications into their health plans.

Here are just a few of the GLP-1 strategies we use to shield our clients from excessive costs:

Implementation of Drug Management Tools, which is critical to ensure proper utilization for GLP-1s.
Strategic Benefit Design, which also protects clients from improper GLP-1 utilization.
Clear Member Communication, which is crucial for proper adherence and compliance.

When implemented with an existing client, the above-listed strategies helped them achieve $382,000 in cost avoidance for GLP-1s. With the right approach, the benefits of these medications can be realized, contributing to better health outcomes and potentially lowering overall healthcare costs in the long run.

For more information on managing GLP-1 medications and other pharmacy benefits, reach out to an MC-Rx expert today .

Mental Health Parity and Medication Adherence

Fri, 02 Aug 2024 15:19:51 GMT

Mental Health Parity and Medication Adherence

Mental Health and Substance Use Disorders are terms that include a wide variety of concepts. Both include our emotional, psychological, and social well-being. Mental Health affects how we think, feel, and act. It also helps to determine how we handle stress and make choices that will widely influence our future. In the United States, about 1 in 25 adults live with a serious mental illness, such as schizophrenia, bipolar disorder, or major depression. However, in today's world there exists some fear when discussing the diagnosing and equal treatment of both mental health problems and/or substance use disorders. Given the importance of this topic in our society,

a federal law ‘ The Paul Wellstone and Pete Domenici Mental Health Parity and Addiction Equity Act of 2008 (MHPAEA) ’ was established to ensure and prevent health plans and insurance issuers that provide mental health or substance use disorder benefits from imposing less favorable benefit limitations on those benefits than on medical/surgical benefits.

Equal Treatment for Mental and Physical Health:

The MHPAEA establishes that insurance plans provide mental health benefits equally with medical and surgical benefits. By ensuring equal access to mental health drugs, patients with mental health conditions will be treated without discrimination, fostering a more holistic approach to healthcare.¹

Improving Overall Health Outcomes :

Mental health is completely aligned with physical health. Achieving parity in mental health drug benefits ensures that individuals receive complete medical and pharmaceutical care to improve their quality of life.¹

Preventing Barriers to Treatment:

Enhancing Treatment Adherence:

Ensuring that the Mental Health Parity and Addiction Equity Act is applied correctly is crucial for the wellbeing of our society. When applied correctly, adherence is promoted by assuring equal access to mental health treatments – an important factor in the success of a treatment plan. It allows patient and healthcare providers to conduct an accurate assessment of how well a drug works as a treatment plan. If patients do not take their medication consistently and as directed, they won’t truly know if it can help relieve symptoms or not. For example,

antidepressants usually require daily administration for two or more weeks in order to be effective in improving symptoms.³ Poor adherence to these medications may lead to detrimental effects in a person suffering from depression.

Pharmacy Benefit Managers (PBMs) work closely with health insurance plans to include multiple treatment options and medical services needed to preserve mental health. At MC-Rx, treatments for all disease states are evaluated by a multidisciplinary pharmacy and therapeutics committee. Formulary inclusion processes and utilization management strategies are applied equally and at parity to mental and physical health medications based on clinical, safety, and cost-effectiveness data. Via the optimal inclusion of mental health treatments in drug formularies, at MC-Rx, we make sure that the Mental Health Parity and Addiction Equity Act is always applied to pharmacy benefits – patient well-being and mental health is of utmost importance. Medication adherence will ensure the best possible outcomes; this is why it is so important that patients always consult their pharmacist or physician on how to be adherent and how to keep track of their treatment. To provide the best pharmaceutical and patient care, MC-Rx provides educational materials and interventions focused on health and well-being that help patients achieve excellent quality of life – including good mental health.

References:

1. The Mental Health Parity and Addiction Equity Act (MHPAEA). CMS.gov. (n.d.).

https://www.cms.gov/marketplace/private-health-insurance/mental-health-parity-

addiction-equity

2. Centers for Disease Control and Prevention. (2023, April 25). About mental health.

Centers for Disease Control and Prevention.

https://www.cdc.gov/mentalhealth/learn/index.htm

3. Gillotte, A. (2022, December 14). Medication adherence: Why it’s important to patients.

Genomind. https://genomind.com/patients/medication-

adherence/#:~:text=%E2%80%9CTaking%20your%20medication%20the%20right,end%

20up%20in%20the%20hospital.%E2%80%9

4. RefereAcma. (2023, April 19). Understanding the role of the PBM. Prior Authorization

Training. https://www.priorauthtraining.org/understanding-the-role-of-the-

pbm/#:~:text=PBMs%20are%20responsible%20for%20determining,use%20the%20most

%20effective%20treatments

MC-Rx to Present Abstract at 2024 AMCP Conference, Focusing on Improving Adherence

Thu, 21 Mar 2024 23:00:58 GMT

MC-Rx, powered by ProCare Rx, has been notified by the Academy of Managed Care Pharmacy (AMCP) of the acceptance of their abstract, “Improving Adherence to HIV PREP via a PBM-Driven Educational Intervention” , for presentation at AMCP 2024 Conference in April.

This marks MC-Rx’s second acceptance at the prestigious event.

The abstract will be showcased and deliberated among attendees nationwide, with publication in the JMCP Abstract supplement. The intervention aims to disseminate current HIV PREP guidelines to physicians and pharmacists, while identifying and addressing barriers to compliance. Presentations are scheduled for Wednesday, April 17, from 11:30 am to 2:30 pm, at the Ernest N. Morial Convention Center in New Orleans, LA, during the AMCP 2024 Conference, April 15-18.

Marileny Lugo, President of MC-Rx, expressed gratitude, stating, "We are honored to present our research at AMCP, another significant milestone for our organization. In alignment with our commitment to patient health and safety, our project underscores the strategic role PBMs play in promoting educational efforts and fostering medication adherence strategies to achieve optimal HIV PREP efficacy while ensuring significant cost avoidance. Being selected for presentation is an opportunity to advance patient safety and health."

About MC-Rx:

MC-Rx is a leading direct-source pharmacy benefit management solutions provider dedicated to enhancing cost containment, clinical optimization, and member satisfaction. Focusing on innovative PBM strategies, MC-Rx delivers customized programs supported by clinical expertise, analytics, operations, and compliance, ultimately improving patient health outcomes while reducing costs.

Cost-Containment Strategies for Chronic Weight Management

Fri, 23 Feb 2024 13:29:17 GMT

Exploring the rising costs and demands of weight-loss medication and how to combat those costs, significantly lowering drug costs for payors and increasing access for patients who need them.

Glucagon-like peptide-1 (GLP-1)-based therapies have been gaining steam in the general population and are currently being viewed by patients as an alternative to lifestyle modifications and diet, as opposed to a supplementary intervention. Due to the attention given by social media and news outlets, this therapeutic area has become vulnerable to medication misuse. 1 Some of these medications include Ozempic, Mounjaro, and Trulicity, which are all GLP-1 receptor agonists that are FDA-approved for the treatment of diabetes. Drug utilization reports have shown an increase in these anti-diabetes medications that suggest inappropriate use. In contrast, GLP-1-based therapies such as Wegovy, Saxenda, and Zepbound are FDA-approved for weight loss but require specific criteria for use (e.g., for use in adult patients with an initial body mass index (BMI) of 30 kg/m2 or greater).

A recent report showed that GLP-1 therapy utilization had increased 152% as of February 2023 when compared to the previous year, which was only lessened by the shortages developed as a consequence of their over utilization. 2,3 The increase in GLP-1 utilization poses a major budget impact for plan sponsors, as the cost of these drugs can range from $12,000-$18,000 per year. 4 Consequently, cost-containment measures are of great value for plan sponsors and payors to ensure appropriate use of weight management programs while minimizing costs for coverage of medications.

Cost-containment methods can be divided as follows:

Formulary Management Strategies
Prior Authorization (PA) is a commonly used cost-containment method for plan sponsors that has clinical requirements for the use of certain specialized or high-cost medications. In this approach, specific medical and diagnostic criteria must be met for a plan sponsor to cover a drug. For weight management drugs, ICD-10 diagnosis for obesity is commonly used as a prerequisite for medication coverage. This guarantees that weight-loss drugs are used only by patients that have the proper diagnosis. This prevents potential misuse and overutilization of these medications which, in turn, lowers costs for payors. According to the National Bureau of Economic Research, ensuring proper access to medications with Prior Authorization can reduce utilization by approximately 27%. 5

Prerequisites, Limits & Restrictions

A common benefit adjustment strategy is the implementation of prerequisite programs that precede access to a service or coverage. An example would be the requirement of active member participation in a wellness or nutrition program before getting a prescription for weight-loss medications. Similarly, payors can restrict the coverage of medications to certain specialists to ensure their beneficiaries are receiving the appropriate medications and monitoring. Weight-loss specialists like bariatric doctors or endocrinologists can be established as the sole prescribers for these medications to prevent overuse. This intervention can also help establish the proper duration of therapy as progress and drug discontinuation can be monitored by a specialist. Duration limits for weight-loss medications are also established by taking into account current treatment guidelines for obesity. These guidelines state that if the target weight loss of 5% is not met in a six (6) month period, weight-loss medications should be discontinued or reevaluated. 6

Another approach is to offer multiple plan benefit designs that include or exclude weight-management medications. Drug formularies with an open (more inclusive) plan benefit design may have increased cost sharing for members versus drug formularies with a closed or more restricted benefit. This approach provides members with economic flexibility and the choice in selecting a plan benefit that best adapts to their needs, while also possibly lowering payor costs.

Claims Data Monitoring

Medication prescriptions and claims data should be monitored using retrospective drug utilization reports to ensure the cost-containment strategies are being met and appropriate medication use is being implemented.

Cost-Benefit Analysis Strategies

Cost-benefit analyses are used to evaluate the necessity and effectiveness of additional programs and preventive measures to reduce costs due to weight-loss drugs. Most importantly, in the case of weight management, the internal economic impact should be evaluated to determine if the coverage of weight-loss drugs and programs has produced a noticeable reduction in spending among common obesity comorbidities . Specifically, medical spending in conditions like diabetes, hypertension, dyslipidemia, and osteoarthritis should be evaluated, as weight loss is commonly related to improvement and lower costs in the management of these comorbidities. According to an article from the Journal of Occupational and Environmental Medicine , reductions in 5-20% of BMI (Body Mass Index) can produce significant savings in medical care expenditures ranging from around $500-$6,500 based on the condition studied and the initial BMI of the patient. 7 This report suggests that higher initial BMI, higher percentage of weight loss, and the quantity of initial comorbidities can help predict savings in healthcare costs.

Additional Services

Nutritionist and gym services : These interventions have the potential to prevent obesity on a larger scale. Diet and nutritional services can be offered in the form of practical access to healthy meals and a nutritionist. Furthermore, payors may perform cost-benefit and effectiveness analyses after the implementation of these strategies to demonstrate the economic benefit of these programs.

“In-house” medical services and wellness facilities: The possible financial impact of offering these should be evaluated against the needs of the beneficiaries. The addition of preventive educational programs can aid in highlighting the benefits of lifestyle modifications and boost member motivation. However, cost-benefit analyses should also be completed for these additional strategies since data has not been able to definitively show a relationship between these benefits and the overall cost burden of obesity. 8

In Summary

As weight-loss medications gain popularity with beneficiaries due to their promotion on popular social media platforms, supporting proper medication use accompanied by lifestyle modifications is a priority in the healthcare system. Potential misuse of these medications can cause or worsen drug shortages, which, in turn, limits access for patients. Moreover, improper use and overutilization of these medications can make it impossible for payors to cover weight loss drugs as part of their formulary, which can lead to higher monthly premiums for overall patient health care. The cost-containment strategies expressed above can have a significant impact in lowering drug costs for payors and help promote access to these medications for patients that benefit from their use.

References:

Chiappini, S., Vickers‐Smith, R., Harris, D. R., Pelletier, G., Corkery, J., Guirguis, A.,

Martinotti, G., Sensi, S. L., & Schifano, F. (2023). Is there a risk for semaglutide misuse? Focus on the Food and Drug Administration’s FDA Adverse Events Reporting System (FAERS) Pharmacovigilance dataset. Pharmaceuticals, 16(7), 994. https://doi.org/10.3390/ph16070994

2. Wojtara, M. S., Syeda, Y., Mozgała, N., & Mazumder, A. (2023). Examining Off-Label Prescribing of Ozempic for

Weight-Loss. Qeios. https://doi.org/10.32388/t6y97s

3. FDA drug shortages. (n.d.). FDA.

https://www.accessdata.fda.gov/scripts/drugshortages/default.cfm

4. Green, L., & Taddei-Allen, P. (2023). Shifting paradigms: Reframing coverage of

Antiobesity medications for plan sponsors. Journal of Managed Care & Specialty Pharmacy, 29(5), 564–568. https://doi.org/10.18553/jmcp.2023.29.5.564

5. Brot-Goldberg, Z., Burn, S., Layton, T. J., & Vabson, B. (2023). Rationing medicine

Through bureaucracy: Authorization restrictions in Medicare. https://doi.org/10.3386/w30878

6. Jensen, M. D., Ryan, D. H., Apovian, C. M., Ard, J. D., Comuzzie, A. G., Donato, K. A.,

Hu, F. B., Hubbard, V. S., Jakicic, J. M., Kushner, R. F., Loria, C. M., Millen, B. E., Nonas, C., Pi‐Sunyer, F. X., Stevens, J., Stevens, V. J., Wadden, T. A., Wolfe, B. M., & Yanovski, S. Z. (2014). 2013 AHA/ACC/TOS Guideline for the Management of Overweight and Obesity in Adults. Journal of the American College of Cardiology, 63(25), 2985–3023. https://doi.org/10.1016/j.jacc.2013.11.004

7. Thorpe, K. E., Toles, A., Shah, B. R., Schneider, J., & Bravata, D. M. (2021). Weight

Loss-Associated decreases in medical care expenditures for commercially insured patients with chronic conditions. Journal of Occupational and Environmental Medicine, 63(10), 847–851. https://doi.org/10.1097/jom.0000000000002296

8. Sherman, B., & Addy, C. (2016). Improving engagement in employer-sponsored weight

management programs. PubMed, 22(1), 37–40. https://pubmed.ncbi.nlm.nih.gov/26799123

Our Pillars of Excellence and Why They Should Matter to You

Tue, 16 Jan 2024 23:49:28 GMT

A message from Marileny Lugo, President, MC-Rx

Part 2

5. Direct Source/Data Analytics and Reporting: Enabling Informed Strategies

Driven by data, our proprietary claims processing and adjudication system, eProCare, allows for benefit and formulary design rules to be applied at the point of service – this enables drug utilization rules to be applied, optimizing the pharmacy benefit, increase safety, and control costs. Our advanced data analytics and reporting capabilities provide insight into medication usage trends and therapy effectiveness, enabling proactive interventions for improved health outcomes and cost management.

6. Benefit Integrity: Upholding Ethical Practices

At MC-Rx, we take pride in our unwavering commitment to integrity and transparency. Our integrity program encompasses real-time monitoring, a dedicated fraud investigation team, and extensive auditing, all tailored to meet the needs of the payers. In addition, our collaborative education efforts align with Medicare requirements to ensure the highest possible standards of practice.

7. Regulatory Compliance and Security: Ensuring Data Protection

Industry compliance and the protection of our clients’ health information are paramount at MC-Rx. We adhere to all relevant standards and best practices, ensuring the highest level of data security for our clients and their members.

8. Best-in-Class Service: Your Trustworthy Partner

Our dedicated account managers ensure prompt response times, and our bilingual (English/Spanish), US-based Member Call Center is available to assist members 24/7/365. Audio impaired TTY capability is also available, enabling us to assist all of your members without exception.

Understanding the critical role of Pharmacy Benefit Management in the healthcare ecosystem, MC-Rx stands out as a trusted partner. Our commitment to transparency, comprehensive care, and data-driven strategies ensures your pharmacy benefit management needs are in capable and caring hands.

Experience the next level of pharmacy benefit management and care with MC-Rx.

Redefining Pharmacy Benefit Management

Tue, 16 Jan 2024 23:30:44 GMT

A message from Marileny Lugo, President, MC-Rx

In the fast-evolving landscape, having a loyal partner with which to navigate the complexities of medication management is not just important, but essential. It is particularly challenging for small and medium sized companies and health plans that want to offer pharmacy benefit coverage at a reasonable cost. At MC-Rx, powered by ProCare, we are dedicated to being that reliable partner, committed to ensuring comprehensive care and effective cost management for our clients and their members.

Our Pillars of Excellence and why they should matter to you:

1. Transparency: Empowering Informed Decision Making

Transparency is the foundation of our operations. We understand the significance of clear pricing and cost-containment strategies for our clients. With MC-Rx, expect complete disclosure of pricing, rebates, and discounts, which empowers you to make well-informed decisions about your pharmacy benefits. MC-Rx aims to be your partner in providing access to medication, while controlling the associated costs.

2. Clinical Support and Member Services: Driving Optimal Health Management

Our Clinical Team comprised of Pharmacy Doctors, partners with our clients to develop medication management programs to achieve the best possible clinical and economic outcome for members and payers. Our clinically proven, custom-tailored formularies and programs focus on the lowest overall net drug spend, while optimizing medication therapies that align with your member needs. Our robust member services focus on enhancing medication adherence, therapy management, and support for specialty medications, ensuring your members receive appropriate treatment for their medical needs.

3. MC-Rx CARES

Matching member-centric services with superior clinical programs, MC-Rx CARES is a direct-sourced system designed to manage chronic conditions and patient medication compliance, all while reducing costs. Our program highlights include customizable formulary design, cost-containment clinical programs, and high-cost medication management initiatives.

4. Formulary and Network Access: Enhancing Accessibility and Choice

Our formularies ensure a diverse range of medications to meet the varying needs of your members. Moreover, our expansive network of pharmacies provides convenient access for members, ensuring they receive timely care when they need it the most.

Stay tuned to learn more about our pillars of excellence!

Importance of Prevention Strategies to Lower Healthcare Cost

Wed, 10 Jan 2024 17:48:16 GMT

To decrease the burden on healthcare costs, at MC-Rx we strive to create awareness by educating our community regarding the importance of prevention.

Chronic diseases contribute significantly to health and economic costs in the United States. The leading chronic diseases, heart disease, stroke, cancer, and diabetes, account for $4.1 trillion in annual healthcare expenditures (1) . Approximately one third of the deaths in the U.S. are caused by heart disease or stroke, which adds approximately $216 billion annually in healthcare system costs, and $147 billion (2) in job productivity losses. In 2017, diabetes diagnoses cost an estimated $327 billion (2) . In addition, almost 600,000 people die from cancer each year, which is expected to add $240 billion to healthcare system expenses by 2030. To decrease the burden on healthcare costs, at MC-Rx we strive to create awareness by educating our community regarding the importance of prevention. Prevention is the effort to improve health, such as screening, health education, adherence to therapy, and adopting an overall healthy lifestyle. There are three different types of prevention (8) :

Prevention can be accomplished individually, however, managed care organizations, health plans and employers can contribute by establishing strategies to help the insured adhere to prevention and treatment regimens to manage their health conditions. For the insured, this may represent a better quality of life, better health, and improved work performance.

One strategy that may help the insured optimize their treatment and help lower healthcare costs is a Diabetes Prevention Program (DPP). These programs have proven to reduce risk of diabetes, especially in people with pre-diabetes, via management of lifestyle changes (4) . A DPP is a lifestyle management program proven to reduce the risk of diabetes among people with pre-diabetes through improved eating patterns, physical activity, and weight loss. For example, DPP has shown to cost effectively reduce diabetes by 58% and demonstrate healthcare savings of more than $3,000 in 3 years (4) . DPP participants have lost an average weight of 4.3%, and program participation is associated with preventing other health conditions such as obesity, hypertension, and dyslipidemia. Another tool in the arsenal of prevention includes wellness programs. A wellness program is a social/lifestyle program intended to improve and promote health and fitness, usually offered through the workplace or through insurance plans directly to their enrollees (10) . This has many benefits – for example, more productivity, increased employee morale, reduced absenteeism, and improved recruitment and retention of employees.

For primary prevention strategies , MC-Rx promotes access and appropriate utilization of immunizations, such as influenza, Covid-19, and pneumonia vaccines. Every year the U.S. spends approximately $27 billion treating diseases that could have been prevented by vaccinations (3) . For every $1 spent on childhood vaccinations, there is a cost avoidance of $10.90 (3) . According to the CDC, by 2021, 2.9 million medical visits, 65,000 hospitalizations, and 3,900 deaths were prevented by influenza vaccination6. Most recently, Covid-19 vaccines have prevented 18.5 million hospitalizations, and 3.2 million deaths in the United States (9) . As for secondary prevention , MC-Rx supports screening, early detection, and management of diseases via educational platforms and health fairs. In addition, MC-Rx provides educational material aimed at patients, providers, health plans, employers, and other insurers to promote health literacy and commitment to a healthy lifestyle. You may visit the company webpage and view our comprehensive educational program including videos and blogs on the latest health topics (https://www.mc-rx.com/).

Finally, for tertiary prevention, MC-Rx ensures appropriate and timely access to important cost-effective, first-line, preventative medications such as statins, to prevent kidney disease in patients with diabetes. We also promote the integration of disease management programs into the pharmacy benefit. These programs exist for a variety of health conditions, including diabetes, hypertension, and obesity. To increase access and convenience, disease management programs can be available through digital platforms. For example, digital therapeutics are innovative applications aimed to treat or alleviate a disease, disorder, condition, or injury, by generating and delivering a medical intervention. It may benefit payers by reducing the overall cost of care by enhancing and optimizing current medical treatments, improving provider communication efficiency, and support value and outcome-based care initiatives (5) . Data from digital wellness programs have shown a 9.3% reduction in healthcare utilization, 23.5% reduction in hospitalizations, and $5,077 reduction in cost for cardio metabolic conditions like diabetes (5) .

At MC-Rx, we are committed to providing innovative care solutions that support patient access to treatment. One example of our commitment to provide access to affordable, cost-effective care was the early onset adoption of our Biosimilar/Biologic Program. Based on MC-Rx drug utilization data, after one year of implementing this program, the annual savings for our client was approximately 25% and beneficiaries experienced approximately 40% lower out-of-pocket costs.

In conclusion, prevention efforts at the primary, secondary, and tertiary levels help reduce development of chronic conditions and prevent complications of existing medical conditions. At MC-Rx, we challenge ourselves to constantly look for strategic innovation, but keep our focus on the basic clinical principles of patient care, service, and individualized attention. The MC-Rx clinical team of experts is composed of pharmacy doctors that partner with clients to develop drug formularies and clinical programs which focus on delivering access to evidence-based, cost-effective care.

References:

Health and Economic Benefits of Chronic Diseases. (2023). Centers for Disease Control and Prevention. https://www.cdc.gov/chronicdisease/about/costs/index.htm .

Health and Economic Benefits of Chronic Disease Interventions. (2023). Center for Disease Control and Prevention. https://www.cdc.gov/chronicdisease/programs-impact/pop/index.htm

Vaccines Are Cost Saving. (2020). Vaccinate Your Family. https://vaccinateyourfamily.org/why-vaccinate/vaccine-benefits/costs-of-disease-outbreaks/

Cost Savings and Reduced Health Care Utilization Associated with Participation in a Digital Diabetes Prevention Program in an Adult Workforce Population. (2020). Journal of health economics and outcomes research. https://doi.org/10.36469/jheor.2020.14529

Value of DTx. Digital Therapeutic Alliance. https://dtxalliance.org/

Estimated influenza illnesses, medical visits, hospitalizations, and deaths prevented by vaccination in the United States – 2022-2023 influenza season. (2023). Centers for Disease Control and Prevention. https://www.cdc.gov/flu/about/burden-averted/2022-2023.htm

Prevention. Centers for Disease Control and Prevention. https://www.cdc.gov/pictureofamerica/pdfs/picture_of_america_prevention.pdf

Use of updated COVID-19 vaccines 2023–2024 formula for persons aged ≥6 months: Recommendations of the Advisory Committee on Immunization Practices. (2023). Centers for Disease Control and Prevention. https://www.cdc.gov/mmwr/volumes/72/wr/mm7242e1.htm#:~:text=Introduction,the%20United%20States%20(1)

Wellness Program. Healthcare.gov. https://www.healthcare.gov/glossary/wellness-programs/

Medication Adherence Lowers Healthcare Costs and Improves Patients’ Outcomes

Thu, 28 Sep 2023 22:56:02 GMT

Increased medication adherence has been linked to better clinical and financial outcomes.

More than just compliance, which is taking medication as instructed by your prescriber, medication adherence requires active and collaborative participation between the patient and their healthcare team. Increased medication adherence has been linked to better clinical and financial outcomes. At MC-Rx, we are committed to promoting medication adherence by targeting its key components at the patient, healthcare professional, and managed care levels.

The benefits of medication adherence are significant, especially in chronic conditions like diabetes, hypertension, and hypercholesterolemia. Studies have demonstrated that, for these conditions, higher medication costs were more than offset by medical cost reduction, producing a net reduction in overall healthcare cost.1 The main drivers of this financial benefit are decreased complications and hospitalization rates in patients with high medication adherence.1 It is important to note that this benefit increases as patients get older, where benefit-cost ratios range from 2:1 for adults under age sixty-five with dyslipidemia, to more than 13:1 for older patients with hypertension.2

For all its benefits, medication adherence is not an easy goal; it is estimated that 50% to 60% of patients demonstrate poor medication adherence.3 Efforts to improve adherence rates must target the issue holistically to promote the skills and attitude required for active and collaborative participation between the patient and the healthcare team.

First things first, education. To properly engage patients in their treatments, they must understand their condition and their treatment goals. At MC-Rx, relevant clinical education articles are constantly being published so that patients and healthcare personnel remain updated and have readily available materials to engage in patient conversations. Our many medication access opportunities complement the educational efforts. Concierge pharmacy services, mail order pharmacy, specialty pharmacies, and customer and provider support are but a few of the strategies in place to ensure that the patients have access to the appropriate medications and that they are supported at every step of the way. For our payers, an auditable, claim-level transparent model coupled with data analysis and outcomes reviews ensures the appropriate use of resources to provide the lowest net cost.

In conclusion, there is no downside to promoting medication adherence; it improves patient outcomes, reducing the risk of complications and hospitalizations. This benefit is reflected as a cost-saving opportunity in overall healthcare expenditure. At MC-Rx, we offer unique and tailored solutions for businesses with a proven record of creative, innovative, client-focused solutions within a cost-containment environment while promoting medication adherence at every level.

References:

Sokol, M. C., McGuigan, K. A., Verbrugge, R. R., & Epstein, R. S. (2005). Impact of medication adherence on hospitalization risk and healthcare cost. Medical care, 43(6), 521–530. https://doi.org/10.1097/01.mlr.0000163641.86870.af
Roebuck, M. C., Liberman, J. N., Gemmill-Toyama, M., & Brennan, T. A. (2011). Medication adherence leads to lower health care use and costs despite increased drug spending. Health affairs (Project Hope), 30(1), 91–99. https://doi.org/10.1377/hlthaff.2009.1087
Massot Mesquida, M., de la Fuente, J. A., Andrés Lorca, A. M., Arteaga Pillasagua, I., Balboa Blanco, E., Gracia Vidal, S., Pablo Reyes, S., Gómez Iparraguirre, P., Seda Gombau, G., & Torán-Monserrat, P. (2021). Primary Care Records of Chronic-Disease Patient Adherence to Treatment. International journal of environmental research and public health, 18(7), 3710. https://doi.org/10.3390/ijerph18073710

What is a Direct-Source PBM? (And Why It Pays to Partner with One)

Thu, 21 Sep 2023 13:05:58 GMT

Drug prices are on the rise—it’s an inescapable reality at this point.

Prescription drugs can range anywhere from “just affordable” to “sky high”, and inflation isn’t making anything better. With medication costs growing fast, it’s essential to have a PBM with a proven cost-containment strategy.

Yet, even pharmacy benefit managers have their own hidden costs. For example, over 90% of PBMs lack their own pharmacy networks and in-house claims processing platforms. This means those services must be outsourced, resulting in even more costs.

Direct-source PBMs, however, don’t have that problem. With wholly owned systems and in-house claims processing, you eliminate the need to pay yet another fee—everything you need is right there. Not only does this mean lower costs, it also means added transparency.

Let’s take a look at what makes a direct-source PBM different – and how they can help you.

PBMs

Generally, PBMs serve to manage prescription drug costs for health insurers, employers, and others. They tend to have a heavy impact on determining drug costs for insurers, as they negotiate with pharmacies and drug manufacturers to control drug spending. It goes unsaid that this results in a significant influence in determining pay and shaping patient access to medications.1

If we were to summarize, the role of a pharmacy benefit manager is to:

Develop formularies of covered medication for health insurers, determining out-of-pocket costs and influencing the types of drugs individuals use
Directly contract with pharmacies to reimburse drugs dispensed to beneficiaries
Negotiate discounts and rebates from drug manufacturers by using their purchasing power1

As mentioned earlier, over 90% of these PBMs do not have their own pharmacy networks or in-house claims processing platforms. This means that their transparency has a limit. When these services are contracted with a third party, a level of transparency is lost and it is guaranteed at least one piece is out of the PBM's hands – and out of sight.

The Direct-Source Difference

Direct-source pharmacy benefit managers cut the cost – and risk – of outsourcing. With that, exploring the distinction between direct-source PBMs and regular PBMs is simple. When it comes down to it, ownership defines the difference. Only direct-source pharmacy benefit managers have:

Wholly owned systems
Wholly owned pharmacy contracts
Transparent rebate structure

The name speaks for itself. A direct-source PBM offers everything you need from one trusted, accessible source. Your system and services are unbiased, privately owned, and independent—all while retaining high quality. Instead of having to rely on one or more third parties to help manage your plans, direct-source PBMs keep everything in one place, from all your capabilities to all your solutions.

And the benefits of direct-source stretches beyond just that. The clear and transparent business model provides a window into the world of claims and costs, allowing you to trace the path of patient claims. You get direct system access and private label options, so your benefit program remains undoubtedly your own. Instead of losing track of your claims process through the tangled field of outsourcing, our direct-source system allows you to see the full scope of patient claims, ensuring that you can see the full picture, every step of the way.

As a direct-source, transparent PBM ourselves, MC-Rx, powered by ProCare Rx, knows the value of strong programs and services that are wholly owned. Our technology allows us to account for each and every dollar of drug spend -- something most other PBMs can’t claim. We control our entire process, allowing us to oversee every step and provide you with accurate data and representation.

Since our founding, we’ve remained committed to our clients’ best interests. With innovative cost-reduction programs for high-cost medications, clinical programs focused on the lowest net costs, and fully transparent pass-through models that provide you with full accountability of spend, our solutions are customized to ensure the greatest level of success.

At MC-Rx, we’re happy to walk you through our processes or answer your questions 24/7/365.

It pays to partner with a direct-source PBM. Ready to start today?

References:

https://www.commonwealthfund.org/publications/explainer/2019/apr/pharmacy-benefit-managers-and-their-role-drug-spending

Important Updates on Immunization for the 2023-2024 Season, It’s not just the flu!

Mon, 11 Sep 2023 14:33:25 GMT

As the leaves change and the weather gets cooler, it's not just pumpkin spice lattes that make their return.

Influenza, COVID-19, and other respiratory viruses such as the respiratory syncytial virus or RSV, also start making their rounds during the fall and winter months. But why should you be concerned about this season, and why is getting vaccinated so important? Let's break it down in simple terms.

Adaptation of the Virus:

Viruses are constantly changing, which is why a new flu vaccine is developed each year to match the most prevalent strains. By getting vaccinated, you help slow the spread of the virus and its potential to mutate into more dangerous forms.

Protect Yourself and Protect Others:

Getting sick isn't just getting a bad cold; it can knock you off your feet for days or even weeks. Getting vaccinated can reduce your chances of getting sick. Plus, it isn't just about you; it's about your friends, family, and the community. When you get vaccinated, you create a shield around you, making it less likely that you'll spread the virus to those around you. This is especially crucial for vulnerable populations like young children, the elderly, and people with underlying health conditions.

Reduce Missed Work and School:

Nobody likes missing work or school, but getting sick can force you to do just that. By getting vaccinated, you lower your chances of falling ill and missing out on important responsibilities.

Avoid Complications:

Getting sick isn't just an inconvenience; it can lead to serious complications like pneumonia and hospitalization. Getting vaccinated significantly reduces your risk of these severe outcomes, providing peace of mind for you and your loved ones.

Important Updates on immunization

At MCRx, we want you to be informed on the latest immunization updates. In February 2023, the CDC published their vaccination schedules.

General changes in the vaccination schedule of Children and Adolescents

Vaccines added:

Vaccines for COVID-19
Priorix® – new measles, mumps and rubella vaccine
Pneumococcal 15-valent conjugate vaccine (PCV15)
Dengue vaccine is recommended for HIV-positive children living in endemic areas, NOT for children traveling to or visiting dengue endemic areas

General Information: Vaccination Schedule for Adults

Vaccines added:

COVID-19
PreHevbrio™ : Hepatitis B virus infection prevention
Priorix: Measles, mumps, and rubella vaccine

For more information on schedules for Children, Adolescents and Adults, please visit the CDC website: https://www.cdc.gov/vaccine

Influenza Vaccine Updates

There are several influenza vaccines available for the 2023-2024 season. Talk to you pharmacist or provider about getting your flu shot this fall season.

COVID Vaccine Updates

COVID-19 vaccines were added to the regular vaccination schedule

Original Monovalent mRNA vaccines should NOT be used
Updated vaccine available for vaccination
Janssen vaccine not available in the United States
Novavax vaccine is the only monovalent vaccine available (only in special circumstances)

Information on the Updated Vaccine for COVID-19 also known as "Bivalent"

Ingredients: components of the original virus strain and the Ómicron variant
Attributes: prevents serious illness, decreases hospitalizations and deaths by COVID-19
Indicated for people > 6 months of age
Immunocompromised patients may require additional doses

For more information: https://www.cdc.gov/vaccines/covid-19/downloads/COVID19-vaccination-recommendations-most-people.pdf

Updates on Respiratory syncytial virus (RSV)

RSV is a virus that affects mostly the lower respiratory tract
It mainly affects young children (< 5 years) and elderly (> 65 years)
Main cause of bronchiolitis and pneumonia in children under 1 year
Seasonal virus (peak in autumn-winter)

Strategies approved for the immunization against RSV

Vaccines against Respiratory Syncytial Virus (Adults > 60 years): Arexvy® and Abrysvo®
The CDC recommends that adults 60 years or older receive the vaccine against RSV after consulting your health provider and reaching a joint decision where you assess the risks vs. benefits of receiving the vaccine.
Biologic drug known as Monoclonal antibody (infants < 8 months*): Nirsevimab (Beyfortus™)
CDC recommends administering a single dose of 50mg intramuscular to all infants <8 months of age born during or facing their first season of RSV

*It is also recommended for a select group of children between the ages 8-19 months who are at risk of severe illness from RSV during their second season of RSV (eg immunocompromised)

Nirsevimab has been shown to reduce the risk of hospitalizations and visits to health institutions in infants

In Conclusion:

We should all value the role of the pharmacy staff in immunization efforts. This season getting vaccinated isn't just a recommendation; it's a crucial step in protecting yourself and those around you. At MCRx, we promote vaccinations as a simple, yet effective way to stay healthy, keep the community safe, and reduce the burden on healthcare systems. So, roll up your sleeve and get vaccinated. It's a small action that can make a big difference in the battle against respiratory illness.

Ensuring Benefit Integrity: The Role of PBMs in the War against Fraud, Waste, and Abuse

Tue, 15 Aug 2023 09:50:38 GMT

The Unceasing Peril of Healthcare Fraud

In the ever-evolving landscape of healthcare, Pharmacy Benefits Management (PBM) companies serve as critical intermediaries, facilitating access to medications and ensuring cost-effective solutions for payers and patients alike. However, with the escalating threat of fraud, waste, and abuse in the healthcare industry, the role of PBMs in preventing, detecting, and correcting these unethical practices has never been more crucial. PBMs deliver a vital contribution in safeguarding payer interests and patient well-being through robust integrity programs.

The Unceasing Peril of Healthcare Fraud

Healthcare fraud continues to present a significant challenge in the United States and globally. The National Health Care Anti-Fraud Association (NHCAA) estimates that healthcare fraud costs the U.S. healthcare system tens of billions of dollars each year 1 , impacting both private and public payers. This staggering figure highlights the urgency of implementing robust measures to combat fraudulent activities and protect the integrity of the healthcare system.

The U.S. Department of Health and Human Services reported that in 2020, the total estimated improper payment in the Medicare program was $28.9 billion 2 , with a significant portion attributed to fraud. According to a report by the U.S. Government Accountability Office (GAO), improper payments under Medicare Part D reached $4.9 billion in 2020 3 .

The PBM's Role in Preventing Fraud, Waste, and Abuse:

Contractual Oversight: Serving as representatives for payers, PBMs negotiate and oversee contracts with pharmacies, drug manufacturers, and healthcare providers. With a thorough focus on contractual compliance, PBMs ensure all parties adhere to ethical and legal standards, effectively reducing the potential for fraudulent activities.

Transparent Pricing: PBMs hold a vital responsibility in establishing drug pricing and reimbursement rates. Their commitment to transparency and fair negotiations helps diminish the motivation for pharmacies to participate in fraudulent billing practices or manipulate prices. As a result, the system is fortified against unethical behaviors, ensuring equitable access to medications for all stakeholders involved.

Fraud Detection Algorithms: By harnessing cutting-edge technology, PBMs utilize sophisticated fraud detection algorithms that scrutinize prescription claims and other data to detect patterns suggestive of fraudulent activities. Swift identification facilitates prompt intervention, mitigating financial losses for payers and safeguarding the integrity of the system.

Prior Authorization: PBMs design prior authorization procedures to confirm medical necessity and compliance with established criteria for prescribed medications. This measure effectively decreases the risk of medication abuse and inappropriate utilization, ensuring that patients receive appropriate and essential treatments.

Network Credentialing: PBMs conduct stringent credentialing processes for pharmacies and healthcare providers in their networks. Through verifying qualifications and legitimacy, they shield payers from fraudulent entities seeking to take advantage of the system. This rigorous approach ensures the integrity and trustworthiness of the network, safeguarding the interests of all involved parties.

Pharmacy Audits: PBMs perform thorough examinations of pharmacy claims to confirm adherence to contractual terms, industry regulations, and correct billing procedures. These audits involve verifying drug pricing accuracy, adherence to formularies, and appropriate medication usage. Additionally, PBMs use these reviews to detect and prevent instances of fraud, waste, and abuse within the pharmacy benefits management system.

MC-Rx’s Benefit Integrity Program: A Beacon of Ethical Practices

At MC-Rx, we take pride in our unwavering commitment to integrity, transparency, and ethical practices. Our integrity program is designed to address the specific needs of payers, offering a multi-faceted approach to prevent, detect, and correct fraud, waste, and abuse. Our program highlights include:

Real-time Monitoring: Our state-of-the-art fraud detection algorithms continuously monitor prescription claims, identifying anomalies and suspicious activities promptly.
Dedicated Fraud Investigation Team: MC-Rx has a dedicated team of experts skilled in investigating potential fraud, waste and abuse. Their vigilance ensures that any potentially fraudulent activities are swiftly detected and reported to appropriate authorities.
Extensive Auditing: We conduct regular audits of pharmacy claims, ensuring compliance with contractual terms and industry regulations.
Training and Education: Our Benefit Integrity Program includes comprehensive training for employees, pharmacies, and related entities to increase awareness of fraud, waste, and abuse, empowering them to uphold ethical standards.
Collaborative Efforts: We work closely with law enforcement agencies, payers, regulatory bodies, and industry stakeholders to share insights and combat fraudulent activities collectively.

As healthcare continues to evolve, MC-Rx stands at the forefront of safeguarding the integrity of the pharmacy benefits. By actively preventing, detecting, and correcting fraud, waste, and abuse on behalf of payers, MC-Rx plays a pivotal role in promoting transparency, cost-effectiveness, and patient-centric care. At MC-Rx, our robust Benefit Integrity Program exemplifies our dedication to upholding ethical practices and protecting the interests of both payers and patients. Together with collaborative efforts from all stakeholders, we can fortify the healthcare system against the threats of fraud, waste, and abuse, ensuring a healthier and more sustainable future for all.

References:

1 https://www.nhcaa.org/tools-insights/about-health-care-fraud/the-challenge-of-health-care-fraud/

2 https://www.cms.gov/newsroom/press-releases/fiscal-year-fy-2019-medicare-fee-service-improper-payment-

rate-lowest-2010-while-data-points

3 https://www.gao.gov/highrisk/medicare_program/why_did_study

How to Identify Authorized Generic Products

Mon, 07 Aug 2023 16:28:34 GMT

Authorized Generic Products

At the pharmacy, how often have patients heard the term generic/bioequivalent? What about the term authorized generic (AG) ? From a patient’s perspective, an authorized generic is synonymous with bioequivalent generic.

However, from a pharmacist’s perspective, an authorized generic has its own set of hurdles that must be reviewed before the drug can be dispensed at the pharmacy counter. In this article, the aim is to provide pharmacists the needed tools to identify authorized generics and feel confident to dispense them to patients. A great example that will be discussed is the AG Budesonide/ Formoterol (Symbicort®).

Is it an Authorized Generic or a Generic?

An AG and a generic share many similarities, including the same: active ingredient, formulation, route of administration, and many more. Nevertheless, what makes an AG different from a generic? There are two (2) main differences:

An AG will have the same inactive ingredients , whereas a generic may have different excipients.
An AG will have the same new drug application (NDA) as the branded product, whereas a generic will have an abbreviated new drug application (ANDA)

When looking at Symbicort®, both the AG and the generic will say Budesonide/Formoterol at the pharmacy. However, behind the scenes, the AG will keep the Symbicort NDA, whereas the generic will be submitted under an ANDA.

What Reference Tools Help Determine if a Product is an Authorized Generic or a Generic?

In the pharmacy world, there are so many different services and reference tools provided by commercial and/or governmental vendors; so which reference tool is the best to help determine if a product is an AG? Since the Food and Drug Administration (FDA) reviews and approves drug applications, they serve as a great resource to provide comprehensive information surrounding any product. For example, the FDA provides three (3) great online resources:

The Orange Book , identifies approved drug products based on safety, effectiveness, related patent, and exclusivity information, while also identifying which products are bioequivalent.
The FDA List of Authorized Generic Drugs , updated quarterly and provides an ongoing list of AG products based on confirmation of distribution data in the NDA applicant’s most recent annual report.
The National Drug Code Directory , updated daily and provides a list of all drugs manufactured, prepared, propagated, compounded or processed for sale in the U.S.A.

How to tell if there is an Authorized Generic at the Pharmacy Counter?

At the pharmacy, the pharmacist is reviewing drug-drug interactions, processing insurance, handling patient questions, reviewing medications for accuracy, and so much more. So, among their other functions, how should pharmacists identify an AG? Overall, there is a general structure (see Figure 1):

Remembering that bioequivalent generics are found in the Orange Book with a code that starts with an "A" (AA, AB, among others), while products with codes beginning with any other letter are not bioequivalent (BC, EE, ZZ, among others). When evaluating Budesonide/Formoterol in the Orange Book, an AB generic for Symbicort® is found, but it does not correspond to the product in the pharmacy; therefore, the pharmacist should be considering that Budesonide/Formoterol might be an AG. The pharmacist then reviews the FDA List of Authorized Generic Drugs & The National Drug Code Directory, which shows that an AG is available. After confirmation, the pharmacist can be confident that the Budesonide/Formoterol product is an AG of Symbicort®.

In conclusion, there are tools available to determine if a product is an AG or a generic. The pharmacist can utilize the Orange Book or the FDA Listing of AG/NDC Directory to confirm their findings about a new product. Because the authorized generic is identical to the brand name drug, and shares the same NDA, it is not specifically listed in the Orange Book; however, MC-Rx considers it clinically equivalent to its brand name drug. Each pharmacist should consult applicable State Laws on interchange of a prescription written for a brand name drug that has authorized generic versions. In Puerto Rico, authorized generics are not contemplated in the Pharmacy Law ; therefore, since they are not specifically identified in the Orange Book, AGs are not interchangeable at the point of sale .

*Note: This is a clinical summary prepared by MC-Rx and is not intended to replace or add to the regulatory reference. It is the responsibility of all pharmacy professionals to keep up to date with applicable regulations and updates to each State's Pharmacy Law.

Use of ASA for the Prevention of CVD

Sun, 06 Aug 2023 20:02:58 GMT

Aspirin for the primary prevention of heart disease – is it safe?

Heart and blood vessel disease, also known as cardiovascular disease (CVD), causes thousands of deaths in the United States each year.5 Examples of the consequences of CVD include heart attacks and stroke. Thus, finding ways to reduce the chances of patients having these diseases is important for healthcare providers. Exercise and eating healthy can help maintain a healthy heart, however, when the risk of heart problems is too high, providers may prescribe medication to help prevent them. Often, many providers suggest aspirin for this purpose. Aspirin protects the heart and blood vessels by stopping the formation of blood clots. Because of this, it can be used either for primary or secondary prevention of CVD.2,4

Primary Prevention = Prevention in people without signs, symptoms, or history of heart problems, but at risk of having a heart disease.
Secondary Prevention = Prevention in people who have suffered a heart disease.

The use of aspirin for primary prevention of CVD has been questioned by recent studies. For this reason, new recommendations have been developed.4 Through this article, current recommendations and precautions with aspirin use will be discussed.

Health groups often study the scientific evidence for a specific topic and give medical advice to healthcare providers. This advice helps caregivers treat their patients in the best way possible. One of these groups is the U.S. Preventive Services Task Force (USPSTF), composed of experts in disease prevention. This group of experts has provided new recommendations for the use of aspirin to prevent heart problems.6 The new recommendations were published on April 2022 and consist of important updates to the 2016 version. Their past and current recommendations for the prevention of heart disease are found in the next table.

Based on these updated recommendations, providers should only prescribe aspirin for CVD prevention to patients aged 40 to 59 years. Patients should also be at high risk of having heart problems to be considered. However, not all patients may qualify for aspirin use, as some may be at high risk of bleeding.4 Thus the USPSTF now recommends each case be assessed one by one. When doing so, healthcare providers should focus on the individual traits of each patient. Even so, predicting which patients may benefit from aspirin use is not an easy task. Therefore, these new recommendations guide the providers on the criteria they should review when prescribing aspirin to prevent heart disease.

Consider the following case: “John is a 55-year-old male that works at the post office. He likes to take Sunday walks, he does not smoke, and he has a history of diabetes. Overall, he has been very healthy. However, his recent cholesterol levels were high and he is starting to worry about future heart problems when he gets older.” The provider may go through the following steps to evaluate this case.

Age: the patient has an age where aspirin can be recommended for primary prevention of heart disease.
CVD risk: the patient’s history of diabetes and high cholesterol put him at risk of CVD.
Bleeding risk: the patient does not seem to have factors that could increase his bleeding risk. For example, older age, high blood pressure, or stomach ulcers.
Recommendation: the provider may decide to initiate aspirin in this patient as the benefits appear to be greater than the risks.

In conclusion, aspirin is beneficial to heart health because it may prevent the formation of blood clots. By doing so, aspirin reduces the risk of heart and blood vessel problems. However, the risks of bleeding due to its use may be greater than the possible benefits.1,3 For this reason, recommendations now focus on evaluating each patient on a one-by-one basis. Thus, one should only use aspirin if a healthcare provider assures it is safe to do so. However, its use in adults aged 60 years or older should be avoided. Lifestyle choices can always be made to reduce the risk of having a heart disease (examples include eating healthy and exercising). Even so, you may be taking aspirin or thinking about the need to do so. Whichever the case, you should always ask your medical provider before making decisions that can affect your wellbeing.

At MC-Rx, our commitment to health is paramount. Our purpose is to maintain a healthy and informed community with the most up-to-date recommendations.

References

Berger JS. Aspirin for Primary Prevention—Time to Rethink Our Approach. JAMA Network Open. 2022 Apr 26;5(4):e2210144.
Berger JS, Brown DL, Becker RC. Low-Dose Aspirin in Patients with Stable Cardiovascular Disease: A Meta-analysis. The American Journal of Medicine. Elsevier; 2008 Jan 1;121(1):43–49.
Cofer LB, Barrett TJ, Berger JS. Aspirin for the Primary Prevention of Cardiovascular Disease: Time for a Platelet-Guided Approach. Arteriosclerosis, Thrombosis, and Vascular Biology. American Heart Association; 2022 Oct;42(10):1207–1216.
Guirguis-Blake JM, Evans CV, Perdue LA, Bean SI, Senger CA. Aspirin Use to Prevent Cardiovascular Disease and Colorectal Cancer: Updated Evidence Report and Systematic Review for the US Preventive Services Task Force. JAMA. 2022 Apr 26;327(16):1585–1597.
Tsao CW, Aday AW, Almarzooq ZI, Anderson CAM, Arora P, Avery CL, Baker-Smith CM, Beaton AZ, Boehme AK, Buxton AE, Commodore-Mensah Y, Elkind MSV, Evenson KR, Eze-Nliam C, Fugar S, Generoso G, Heard DG, Hiremath S, Ho JE, Kalani R, Kazi DS, Ko D, Levine DA, Liu J, Ma J, Magnani JW, Michos ED, Mussolino ME, Navaneethan SD, Parikh NI, Poudel R, Rezk-Hanna M, Roth GA, Shah NS, St-Onge MP, Thacker EL, Virani SS, Voeks JH, Wang NY, Wong ND, Wong SS, Yaffe K, Martin SS, null null. Heart Disease and Stroke Statistics—2023 Update: A Report From the American Heart Association. Circulation. American Heart Association; 2023 Feb 21;147(8):e93–e621.
US Preventive Services Task Force, Davidson KW, Barry MJ, Mangione CM, Cabana M , Chelmow D, Coker TR, Davis EM, Donahue KE, Jaén CR, Krist AH, Kubik M, Li L, Ogedegbe G, Pbert L, Ruiz JM, Stevermer J, Tseng CW, Wong JB. Aspirin Use to Prevent Cardiovascular Disease: US Preventive Services Task Force Recommendation Statement. JAMA. 2022 Apr 26;327(16):1577.

Adherence

Sun, 06 Aug 2023 18:15:49 GMT

What does it mean to be adherent?

Being adherent means following your medication treatment correctly:

1. Taking the correct medication.

2. Taking the correct dose.

3. Taking it at the indicated time and with the correct frequency.

Complying with your treatment has great advantages:

1. You achieve your goals of therapy.

• It is important to adhere to all treatments to achieve the goals of therapy, but it

becomes more difficult when we have chronic conditions that require the use of long-

term medications such as diabetes and hypertension.

2. You keep your health conditions under control.

• Diabetes: control and maintain adequate blood sugar levels.

• Hypertension: keep your blood pressure under control.

3. You avoid complications associated with these conditions that can affect other parts of the body, such as heart, kidney, eye, and nerve problems, among others.

Tips to improve your adherence:

1. Ask your doctor and/or pharmacist questions:

 What is this medication for?
 When should I take it?
 What is the goal of treatment?
 How long will it take to produce results?
 Health professionals can help you better understand your therapy.

2. Create a routine:

Take your medications always at the same time.

Incorporate medications into your daily routine.

Use a pillbox to organize your medication.

Preparing the pillbox weekly will help you review the important points of your treatment.

3. Keep a medication diary:

 A diary will help you remember to take your medications.
 Write down how you feel when taking them.
 Write down all the questions that you have to share them with a healthcare professional.

4. Consult with your healthcare professional about changes in your therapy and notify them if you

experience unwanted side effects.

Your active participation is essential. Stay adherent to live a healthier life and enjoy the full benefits of

your treatment!

At MC-Rx, our commitment to health is paramount. Our purpose is to continue providing the necessary

tools so that each person can live a healthy life. This is one of many efforts bringing our patients closer

to their health goals.

What’s Going On With the FTC and PBMs?

Thu, 27 Jul 2023 14:19:51 GMT

A Message from Doyle Jensen, CEO, Enterprise Business Development, ProCare Rx

The Federal Trade Commission (FTC) and Congress have officially put pharmacy benefit managers (PBMs) on notice. Through separate investigations, the two regulating bodies are reviewing various PBM practices, including potential rebate schemes. Let’s take a closer look at what this could mean for PBMs.

The Connection with Health Plans

PBMs work with health insurance companies and pharmacies to help control drug spend. The PBMs essentially act as a middleman, negotiating rebates, creating drug formularies, and reimbursing pharmacies for patients’ prescriptions.

This relationship can influence what drugs are prescribed, which pharmacies patients can use, and how much patients pay for their prescriptions.

The Investigation

The FTC believes some PBM rebate practices could be preventing fair and needed competition in the industry by blocking access to competing lower-cost drugs with:

Fees and clawbacks charged to unaffiliated pharmacies
Methods to steer patients toward pharmacy benefit manager-owned pharmacies
Potentially unfair audits of independent pharmacies
Complicated and opaque methods to determine pharmacy reimbursement
The prevalence of prior authorizations and other administrative restrictions
The use of specialty drug lists and surrounding specialty drug policies
The impact of rebates and fees from drug manufacturers on formulary design and the costs of prescription drugs to payers and patients

As part of their investigation, the FTC issued compulsory orders to six of the largest PBMs and two group purchasing organizations (GPOs) that would require them to provide information and records on their practices negotiating drug rebates on behalf of PBMs.

As far as Congress, efforts are being taken to dispel hidden practices with the Pharmacy Benefit Manager Transparency Act of 2023. This would require PBMs to report formulary changes, reimbursement rates, and clawbacks to the FTC each year to further identify ways to reduce prescription drug prices for patients.

An Inside Look into MC-Rx’s Practices

While we weren’t asked by the FTC or Congress to share our specific practices with them, we’d

like to share our practices with you.

MC-Rx, powered by ProCare Rx, has a member-first philosophy that is built on four pillars: ingenuity, integrity, innovation, and information. These are at the forefront of everything we do.

As one of the only direct-source PBMs in the industry, our proprietary technology allows you to see the complete life of a claim. With direct system access, there’s no practice, rebate, or formulary that goes overlooked or unseen. That’s because only direct-source PBMs have wholly owned systems, wholly owned pharmacy contracts, and wholly managed rebate contracts.

We believe in benefit integrity, which is why we offer an unbiased, monthly transparent rebate structure that boasts an industry-leading yield. But that’s not all. As an MC-Rx client, whenever you might have a question or need a closer look at something, you have instant access to a dedicated account manager and a 24/7/365 customer support team. We’re always glad to walk you through our processes, with complete transparency -- anytime.

How Transparent Is Your PBM Really?

Thu, 29 Jun 2023 16:20:23 GMT

A message from Doyle Jensen, CEO, Enterprise Business Development, ProCare Rx

Just about every pharmacy benefit manager (PBM) in the industry claims to be “fully transparent.” But what does this mean?

Over the years, PBMs have received a bad reputation for engaging in hidden, dishonest practices to make large profits. To restore their reputation, PBMs are now more transparent about their health pricing. Or at least they claim to be.

The PBM Transparency Act is about to pull back the veil on many companies and expose the extent of their transparency and their practices for what they are.

The bipartisan bill would allow the Federal Trade Commission (FTC) to increase drug pricing transparency by requiring PBMs to report how much money they make through spread pricing.

Spread pricing is when a PBM makes a profit off a prescription drug. The PBM will charge more for the medication than they reimburse the pharmacy and keep the difference. For example, when a pharmacist fills a prescription, the PBM handles the processing and informs the pharmacy they will be reimbursed $75 for a particular drug. The PBM then charges the health insurance plan $100 for the same medication, pocketing and profiting from the $25 spread difference.

In addition to preventing spread pricing, the PBM Transparency Act will prohibit clawbacks.

A clawback is when an insurance company assigns a higher copay for a prescription than the cost of the drug. For example, a patient is charged a $50 copay for a common prescription medication. However, the drug itself only costs $30, allowing the PBM to profit from the $20 difference.

The truth is: many PBMs engage in spread pricing, clawbacks, and other forms of dishonest profiting. If you don’t know how your PBM is making money, then you’re PBM probably isn’t being completely honest with you.

Are you aware of your PBM’s revenue streams? Ask yourself these 6 questions. If you can answer yes to all of them, your PBM is truly transparent and sets forth practices to ensure you’re getting the most out of your drug spend.

Do you know what you are paying for each drug- including purchase, price, channel discounts, volume guarantees, and rebate agreements?

2. Do you know what you are paying in the aggregate by drug category?

3. Do you know if the cost is going up and by how much? Do you know what is driving the increase?

4. Do you know the current and target clinical metrics for your beneficiaries? Are your providers aligned in the right direction?

5. Do you know if contracted discounts and guarantees are really being met?

6. Do you know early enough so you can course correct?

What were your results? If you answered “no” to any of these questions, it’s time to give MC-Rx a call.

MC-Rx, powered by ProCare Rx, believes in being fully transparent. The new regulations of the PBM Transparency Act will impact many companies but not MC-Rx. Since our founding, we’ve run our business openly and with our clients’ best interests in mind.

We are proud to be one of the only PBMs with internally developed and maintained technology. This allows us to account for each dollar of drug spend, unlike other PBMs. Since we control our whole process, we oversee every step to ensure we’re providing accurate data and representation.

Transparency lives in the details. If you can’t see what’s happening at the rebate level, if you can’t see the contracted discounts or the clinical metrics, then you can’t see exactly what you’re getting.

Are you ready to discover superior pharmacy benefits from a partner you can trust? Look no further than MC-Rx.

Making Narcan® Over-the-Counter Could Increase Accessibility, But Will Cost Halt Public Uptake?

Tue, 27 Jun 2023 17:36:06 GMT

This past March, the Food and Drug Administration (FDA) approved the Narcan® (naloxone) nasal spray
for nonprescription, over-the-counter (OTC) useᶦ. This FDA decision will make Narcan® the first OTC
naloxone product to treat a known or suspected opioid overdose. However, there are important
implications for accessibility for patients that need this medication, especially as it relates to public
image and cost. The goal of this article is to provide patients with key considerations when seeing
Narcan® on pharmacy shelves.

There are several factors that may affect the uptake of OTC naloxone in the public, however, the two
(2) largest reasons relate to cost and stigma associated with opioid use. Currently, naloxone is only
available with a prescription at a pharmacy, which helps maintain confidentiality and is billed through
insurance. As the product changes from prescription only to OTC, how will cost and stigma affect
access?

Cost : Many health insurance plans offer prescription naloxone at no, or reduced cost sharing to
ensure that patients have accessᶦᶦ. Now that non-prescription OTC naloxone will be available, there
is a potential access barrier since some insurers do not cover OTC products and patients would have
to pay out-of-pocket for OTC naloxone at an approximate price between $35 and $65. The expected
price of OTC naloxone could limit access to the medication, especially since people living below
the poverty line accounted for 24.6% of opioid overdose deathsᶦᶦᶦ. However, one pharmaceutical
company, Harm Reduction Therapeutics, is in the process of making a free or low-cost over-the-
counter (OTC) naloxone nasal spray available to the publicᶦᵛ.
Stigma : OTC naloxone will likely be behind a glass case or behind the pharmacy counter, which
could create a barrier for people who wish to buy it confidentially. Major pharmacy chains have
commented that individual retailers will work with manufacturers of OTC naloxone regarding in-
store placement.

Conclusion: More details will become available as OTC naloxone begins to hit shelves. MC-Rx will
continue to support efforts to minimize any access barrier to these important medications.

References
ᶦ FDA Approves First Over-the-Counter Naloxone Nasal Spray. Available at https://www.fda.gov/news-
events/press-announcements/fda-approves-first-over-counter-naloxone-nasal-spray . Accessed June 6th,
2023.
ᶦᶦ Over-the-Counter Narcan Could Save More Lives. But Price and Stigma Are Obstacles. Available at
https://www.nytimes.com/2023/03/28/health/narcan-otc-price.html . Accessed June 6th, 2023.
ᶦᶦᶦ Altekruse SF, Cosgrove CM, Altekruse WC, Jenkins RA, Blanco C. Socioeconomic risk factors for fatal
opioid overdoses in the United States: Findings from the Mortality Disparities in American Communities
Study (MDAC). PLoS One. 2020 Jan 17;15(1):e0227966. doi: 10.1371/journal.pone.0227966. PMID:
31951640; PMCID: PMC6968850. Accessed June 6th, 2023.
Harm Reduction Therapeutics' New Drug Application for RiVive™ Over-the-Counter Naloxone Nasal Spray
ᶦᵛ Accepted and Granted Priority Review by FDA. Available at https://www.prnewswire.com/news-
releases/harm-reduction-therapeutics-new-drug-application-for-rivive-over-the-counter-naloxone-nasal-
spray-accepted-and-granted-priority-review-by-fda-301710002.html . Accessed June 6th, 2023.

Embracing Biosimilars: Unveiling New Trends in Healthcare

Mon, 19 Jun 2023 18:38:05 GMT

Biologics have revolutionized the treatment of various diseases, including cancer, autoimmune disorders, and chronic conditions.

In recent years, biosimilars have emerged as a transformative force in the healthcare industry. These innovative biologic medications offer cost-effective alternatives to originator biologics, providing patients with increased access to life-changing treatments. As the President of MC-Rx, I am thrilled to share the latest developments and trends surrounding biosimilars, highlighting their potential to revolutionize patient care and drive positive change. Join me in exploring the world of biosimilars and understanding why embracing them is key to shaping the future of healthcare.

The Rise of Biosimilars

Biologics, derived from living organisms, have revolutionized the treatment of various diseases, including cancer, autoimmune disorders, and chronic conditions. However, their high costs have often limited patient access. Biosimilars, on the other hand, are highly similar versions of approved biologics, offering comparable efficacy and safety profiles at reduced prices. This exciting class of medications has gained momentum globally, representing a game-changing opportunity for healthcare systems.

Promoting Access and Affordability

Enhanced Patient Access : Biosimilars broaden access to vital therapies by offering cost-effective alternatives. They enable patients to receive optimal treatment outcomes while reducing the financial burden associated with biologic medications. By expanding access, biosimilars contribute to improved patient care and population health.

Cost Savings : The introduction of biosimilars drives market competition, leading to lower prices for both originator biologics and biosimilars. These cost savings benefit not only patients but also payers, including insurance companies and government healthcare programs. The redirection of resources can be reinvested in innovative therapies and healthcare initiatives, further enhancing patient care.

Sustainable Healthcare Systems : The adoption of biosimilars promotes financial sustainability within healthcare systems. By reducing expenditures on biologics, healthcare providers can allocate resources to other critical areas, such as research, infrastructure development, and patient education. This shift supports the long-term viability of healthcare systems while ensuring high-quality care delivery.

Exploring New Trends

Regulatory Advancements : Regulatory bodies worldwide are increasingly streamlining the approval pathways for biosimilars, encouraging their development and market entry. The implementation of clear guidelines and robust regulatory frameworks fosters confidence in the safety and efficacy of biosimilars, driving their adoption.

Therapeutic Expansion : Biosimilars are expanding beyond traditional treatment areas, venturing into new therapeutic domains. The potential application of biosimilars in oncology, dermatology, rheumatology, and gastroenterology is unlocking novel treatment options for patients, with the promise of improved outcomes and increased treatment options.

Provider and Patient Education : Educational initiatives aimed at healthcare providers and patients are crucial to maximizing the benefits of biosimilars. These efforts focus on raising awareness, dispelling misconceptions, and building trust in biosimilars as effective and safe alternatives. Enhanced education empowers healthcare professionals and patients to make informed decisions and embrace biosimilars with confidence.

MC-Rx's Commitment to Biosimilars

At MC-Rx, we are at the forefront of embracing biosimilars as a catalyst for change in healthcare. Our commitment to promoting access, affordability, and innovation drives our support for biosimilars. We actively collaborate with manufacturers, healthcare providers, and payers to develop strategies that optimize the utilization of biosimilars and ensure patient-centric care.

By fostering partnerships, advocating for biosimilar adoption, and prioritizing patient education, MC-Rx aims to lead the way in facilitating the widespread acceptance and integration of biosimilars into healthcare.

Mental Health Awareness Month

Mon, 22 May 2023 21:51:05 GMT

Since 1949, Mental Health Awareness Month has been observed in the United States.

Every year during the month of May, campaigns from various organizations help fight stigma, provide support, and educate the public. These interventions have provided support for millions of people in the U.S., whether affected by mental illness or not. As part of MC-Rx's commitment to leadership in all aspects of patient care, we recognize the importance of achieving and maintaining mental health goals. For this purpose, this article will promote awareness of some of the ongoing mental health campaigns and their main objectives.

This year, the National Alliance on Mental Illness (NAMI) is celebrating Mental Health Awareness Month with the More Than Enough campaign! Their objective is to remind everyone of the inherent value we each hold, no matter where we come from, how we look, or where we are going. “Showing up, just as you are, for yourself and the people around you, is more than enough (NAMI, 2023)”.

Mental Health America’s (MHA) campaign, Look Around, Look Within, aims to consider every part of our environment and its effect on our mental health and well-being. By taking a look at our environments, whether personal, familiar, or professional, MHA provides guidance for adapting our environment to promote mental health, as well as useful tips to cope when change seems to be out of reach. “We all have mental health, and we all have unique environments. Making our environments as healthy as possible goes a long way in improving our mental well-being (MHA, 2023)”.

The Substance Abuse and Mental Health Service Administration (SAMHSA) takes a more holistic approach by dividing their mental health campaign’s messages into various steps. From spreading acceptance, support and compassion, to providing strategies to promote mental health, to focusing on hope and positivity, everyone can benefit in one way or another from their messages. “No matter the situation, there is always help and there is always hope (SAMHSA, 2023”.

Mental health is different for everyone, but in no way does that mean we are alone. Whether it means that we need to remember our worth or try to maintain a positive perspective, there are tools available to help us move forward. As part of providing the best pharmaceutical care, the MC-Rx healthcare team is promoting these mental health and wellbeing campaigns. It is our hope that, with our help, every single individual continues moving towards a healthier future.

References:

National Alliance on Mental Illness (NAMI): Mental Health Awareness Month (2023) Recovered from https://www.nami.org/Get-Involved/Awareness-Events/Mental-Health-Awareness-Month

Mental Health America’s (MHA): Mental Health Month Toolkit. (2023). Recovered from https://mhanational.org/mental-health-month/toolkit

Substance Abuse and Mental Health Service Administration (SAMHSA): Mental Health Awareness Month Toolkit. (2023). Recovered from https://www.samhsa.gov/programs/mental-health-awareness-month/toolkit

How to Prevent Colorectal Cancer

Fri, 14 Apr 2023 23:38:29 GMT

Colorectal cancer is a severe health condition affecting many people worldwide.

The colon and rectum are part of the large intestine. Both work together to help rid our bodies of waste and keep our bodies healthy. When someone has cancer in either of these sites, it's called colorectal cancer. This article will teach you how to lower your chances of getting this type of cancer.

Colorectal cancer is a severe health condition affecting many people worldwide. Your risk increases after the age of 50, but certain unchangeable factors can increase the risk of developing this disease, these include:

Being of African American descent
Family history of colorectal cancer
Personal or family history of certain genetic conditions

If you have any of these factors, it is important to speak with your physician to find out if you may need to begin screenings earlier than usual.

You can take steps to lower the risk of getting the disease. Organizations like the United States Preventive Services Task Force (USPSTF), Centers for Disease Control and Prevention (CDC), American Cancer Society, and The National Cancer Institute provide recommendations to help prevent colorectal cancer that include:

Getting screened for colorectal cancer

Regular check-ups are important in preventing colon cancer. A gastroenterologist can do tests like colonoscopies and stool tests to check for problems. You should begin having these screenings at age 45 and continue on your physician’s recommended schedule, as risks increase after the age of 50.

Regular exercise

Regular exercise and a healthy weight are important in lowering your risk of colorectal cancer. This means exercising for at least 30 minutes daily, 5 days a week. Take regular breaks from sitting or lying down too much by standing and stretching.

Lowering alcohol consumption

Drinking too much alcohol daily can increase your chances of getting colorectal cancer. It's best not to drink alcohol at all. If you do drink, the American Cancer Society suggests that men should have no more than two drinks per day and women have no more than one.

Quit Smoking Tobacco

Smoking can cause many health problems, including colorectal cancer. Quitting smoking can help reduce your chances of getting colorectal and many other types of cancer.

Aspirin

Studies have shown that taking low-dose aspirin can reduce the risk of colorectal cancer. It's important to talk to your doctor to discuss whether this is a good option.

Maintaining a healthy diet

Overeating red and processed meat may increase the risk of colon cancer. Include more fruits, veggies, and whole grains in your diet to lower your risk.

In summary, colorectal cancer is a significant health concern, but there are steps you can take to lower your risk of developing the disease. The most important is regular screenings starting at age 45. Daily exercise, limiting alcohol consumption, quitting smoking, and following a healthy diet can also help reduce your risk. While certain factors are out of your control, you should speak with your doctor if any of these apply to you. Taking proactive steps to prevent colorectal cancer can improve your chances of living a healthy, cancer-free life.

References

American Cancer Society. (2020). Colorectal cancer prevention: How to prevent colorectal cancer. Colorectal Cancer Prevention | How to Prevent Colorectal Cancer. Retrieved from https://www.cancer.org/cancer/colon-rectal-cancer/causes-risks-prevention/prevention.html

American Cancer Society. Six ways to lower your risk for colon cancer. Six Ways to Lower Your Risk for Colon Cancer. (2021). Retrieved from https://www.cancer.org/latest-news/six-ways-to-lower-your-risk-for-colon-cancer.html

Centers for Disease Control and Prevention. (2022). Colorectal cancer screening tests. Centers for Disease Control and Prevention. Retrieved from https://www.cdc.gov/cancer/colorectal/basic_info/screening/tests.htm

Centers for Disease Control and Prevention. (2022). What can I do to reduce my risk of colorectal cancer? Centers for Disease Control and Prevention. Retrieved from https://www.cdc.gov/cancer/colorectal/basic_info/prevention.htm#:~:text=Healthy%20Choices,alcohol%20consumption%2C%20and%20avoiding%20tobacco.

MD Anderson Cancer Center, & Underferth, D. (2020). Colorectal cancer prevention: What you need to know. MD Anderson Cancer Center. Retrieved from https://www.mdanderson.org/publications/focused-on-health/Colorectal-cancer-prevention-What-you-need-to-know.h24Z1591413.html

National Cancer Institute. (2022). Colorectal cancer prevention (PDQ®)–patient version. National Cancer Institute at the National Institutes of Health. Retrieved from https://www.cancer.gov/types/colorectal/patient/colorectal-prevention-pdq

United States Preventive Services Task Force. (2016). Final recommendation statement: Screening for colorectal cancer. United States Preventive Services Taskforce. Retrieved from https://www.uspreventiveservicestaskforce.org/uspstf/announcements/final-recommendation-statement-screening-colorectal-cancer#:~:text=The%20USPSTF%20recommends%20screening%20for,health%20and%20prior%20screening%20history.

Compounded Semaglutide: Is it worth the risk?

Fri, 10 Mar 2023 16:10:21 GMT

Semaglutide is a drug developed by Novo Nordisk that has become a revolutionary treatment for weight management.

This drug was first approved in 2017 by the brand name Ozempic® for the treatment of diabetes. Due to its effects on weight loss, semaglutide was also approved in 2021 for weight management under the name Wegovy®. The sheer popularity of this drug has resulted in supply shortages, prompting some people to seek out compounded versions of the drug instead.

In general, federal regulations prohibit compounding pharmacies from producing identical copies of commercially available drugs unless the FDA places a commercial drug on its official shortage list. Currently, semaglutide is on the list, and some compounding pharmacies and healthcare professionals are capitalizing on this loophole and the demand for the drug. They are offering compounded semaglutide (sometimes even marketed as “generic” Ozempic) at lower prices and easier access.

Concerns regarding compounded Semaglutide

There are several risks associated with compounded semaglutide. The most concerning aspect is that the source of the semaglutide is unknown or whether what they sell is even semaglutide at all. Novo Nordisk is the only FDA-approved supplier of the drug and they do not sell it for compounding purposes. Furthermore, semaglutide is patent protected in the United States for at least until 2026. As a result, it is unclear where pharmacies and healthcare professionals are obtaining the semaglutide, but it is certainly not from an FDA approved manufacturer.

Where are compounding pharmacies obtaining the Semaglutide?

There are reports that some compounding pharmacies are obtaining a sodium salt of semaglutide from sources outside the United States. Semaglutide Sodium is a research product that can be purchased online. The Alliance for Pharmacy Compounding (APC) has issued a warning to its members that semaglutide sodium “should not be used in human drug compounding”. This salt is not used in FDA-approved products and it has not been evaluated for safety and effectiveness in clinical trials. While different salts of active pharmaceutical ingredients are frequently considered pharmaceutical alternatives by the FDA, there are currently no therapeutic equivalents to semaglutide listed in the FDA's Orange Book.

Furthermore, some compounding pharmacies are also thought to be purchasing brand-name versions of the drug in their highest-dose formats. The medication is then diluted and mixed with other ingredients such as Vitamin B6, Vitamin B12, and L Carnitine. These combinations have not been evaluated in clinical trials for safety and effectiveness. This practice also carries risks such as loss of sterility and stability of the drug, which can compromise its safety and cause contamination.

Legal Issues regarding Compounded Semaglutide

Obtaining semaglutide from a non-FDA-approved source not only jeopardizes the patient's health, but may also lead to litigation, as semaglutide is patent protected in the United States. Novo Nordisk has already issued cease-and-desist letters to some compounding pharmacies, claiming that selling compounded semaglutide infringes on its intellectual property.

Recommendation to Health Care Specialists

Healthcare providers, particularly endocrinologists, and obesity medicine specialists, must be cautious when considering prescribing compounded semaglutide because of the potential hazards associated with its preparation and ingredient sourcing. It is crucial to prioritize patient safety by avoiding medications that have not undergone rigorous testing for efficacy and safety.

The FDA provides guidance on human drug compounding, including guidelines for compounding pharmacies and healthcare providers on the appropriate use of compounded drugs and regulatory requirements to ensure their safety and effectiveness. The Alliance for Pharmacy Compounding also provides resources and information for compounding pharmacies, including warnings about the dangers of using semaglutide sodium. Providers can consult with Novo Nordisk, the FDA-approved supplier of semaglutide, for more information on the drug and its proper usage.

Conclusion

Compounded semaglutide poses significant risks to patients, as there are considerable questions about its preparation and the source of the active ingredient. Compounding pharmacies and healthcare professionals who offer this medication may be jeopardizing their patients’ health and infringing on Novo Nordisk's intellectual property rights. Therefore, MC-Rx recommends that healthcare specialists exercise caution when prescribing compounded semaglutide, as its efficacy, safety, and quality cannot be guaranteed. Ultimately, the risks of compounded semaglutide outweigh the potential benefits. Keeping up with drug safety and efficacy information can assist providers in making responsible decisions about their patients' health and well-being.

References:

Alliance for Pharmacy Compounding. (n.d.). Tempted to compound semaglutide sodium? Don't. APC Website. Retrieved February 22, 2023, from https://web.archive.org/web/20221105070430/https://a4pc.org/2022-11/tempted-to-compound semaglutide-sodium-dont/

Center for Drug Evaluation and Research. (n.d.). Bulk drug substances used in compounding. U.S. Food and Drug Administration. Retrieved February 22, 2023, from https://www.fda.gov/drugs/human-drug-compounding/bulk-drug substances-used-compounding

Center for Drug Evaluation and Research. (n.d.). Human Drug Compounding. U.S. Food and Drug Administration. Retrieved March 1, 2023, from https://www.fda.gov/drugs/guidance-compliance-regulatory-information/human-drug-compounding

Novo Nordisk. (n.d.). Updates about Wegovy®. Wegovy supply. Retrieved February 22, 2023, from https://www.novonordisk us.com/products/product-supply-update.html

Putka, S. (2022, July 7). Demand rising for 'bootlegged' weight-loss drug. Medical News. Retrieved February 22, 2023, from https://www.medpagetoday.com/special-reports/exclusives/99625

Orange Book: Approved Drug Products with Therapeutic Equivalence Evaluations. [Rockville, Md.]: U.S. Dept. of Health and Human Services, Food and Drug Administration, Center for Drug Evaluation and Research, Office of Pharmaceutical Science, Office of Generic Drugs

VLS Pharmacy. (2022, September 23). The Potential Risks Associated with Compounded Semaglutide: What Medical Professionals Should Know. New Drug Loft and VLS Pharmacy. Retrieved February 22, 2023, from https://newdrugloft. com/the-potential-risks-associated-with-compounded-semaglutide/ FDA Drug Shortages. Food and Drug Administration (FDA). (2023) from https://www.access.fda.gov/

MC-Rx Awarded for Effective Implementation of a Clinical Program to Reduce Opioid and Benzodiazepine Prescriptions

Thu, 02 Mar 2023 23:01:30 GMT

The distinction was awarded during the Puerto Rico Manufacture Association's Health Summit 2023.

Based on the most recent reports produced by the Center for Disease Control and Prevention (CDC) which reveal an upward trend in the use and abuse of opioids and benzodiazepines as a cause of death, the clinical team of MC-Rx developed an educational project aimed at reducing the medical prescriptions of such drugs in Puerto Rico. The project entitled " Improving patient safety by decreasing co-prescribing of benzodiazepines and opioids " was recognized by the Health Committee of the Puerto Rico Manufacture Association during the celebration of the Health Forum 2023. Previously, the project was presented during the annual convention of the Academy of Managed Care Pharmacy (AMCP) held last October in Maryland.

The project, developed between March and December 2021, consisted of an in-depth analysis of a sample of prescriptions produced by 266 physicians for 181 patients located in Puerto Rico. Of the sample of physicians, more than 146 agreed to receive at least one educational intervention from the MC-Rx pharmacist team. The interventions were related to the health effects of concurrent opioid and benzodiazepine use. At the conclusion of the program, the physician group had reduced prescriptions of these medications by 48%.

On the occasion of the award, Marileny Lugo president of MC-Rx, stated that the project focused on the urgent need to improve patient health and safety while highlighting and raising awareness of the critical link between opioid and benzodiazepine use and abuse and life-threatening respiratory diseases.

As reported by the Addiction and Mental Health Services Administration (ASSMCA), 534 opioid overdoses were reported in Puerto Rico in 2020. It was recently reported that Puerto Rico would receive $100 million for the management of the opioid crisis. This financial compensation will be used to pay for addiction prevention and treatment services in the affected communities.

Pictured above is Dr. Eimeira Padilla, MC- Rx Clinical Services Manager.

About MC-Rx

MC-Rx, powered by ProCare Rx, is a premier pharmacy benefit administrator, whose knowledge has been crucial for the successful development, implementation and administration of PBM services and programs for clients and their members. MC-Rx services commercial health plans, Medicaid and Medicare/PACE programs, dynamic health systems, private label PBMs, complex TPAs, employer groups, unions, hospices and many other client types. MC-Rx has a commitment to innovation, efficiency and excellence, and to guarantee an optimal level of client satisfaction and on-going savings in the management of pharmacy benefits.

March 1, 2023

Contact: Madeline Ramírez Rivera 787 225 3466

Glucagon Like Peptide-1 Receptor Agonists (GLP-1): An Increasing Trend in Potential Misuse

Mon, 27 Feb 2023 17:50:06 GMT

The purpose of this article is to create awareness of potential misuse of GLP-1 RAs for non-FDA approved indications.

For the last couple of years, glucagon like peptide-1 receptor agonists (GLP-1 RA) have been used to effectively treat type 2 Diabetes Mellitus due to their ability to aid in arteriosclerotic cardiovascular disease (ASCVD) by providing diabetes improvement and weight loss with low risk of hypoglycemia. Recently, the New England Journal of Medicine published articles on the use of GLP1-RAs: tirzepatide and semaglutide as effective medications for the management of obesity. It is important to note that currently only two GLP-1 RA agents have the indication for management of obesity: Wegovy (semaglutide) and Saxenda (liraglutide).

In 2021, Wegovy (semaglutide), a product with the same active ingredient as Ozempic (semaglutide) was released for the treatment of obesity showing a reduction of 15% body weight in clinical trials. The clinical evidence resulted in a rising trend in GLP-1 RAs utilization with a potential for misuse. Our goal is to review some of the factors that led to the GLP-1 RAs increase in utilization and offer recommendations to providers and payers.

As research advances, GLP-1 RAs represent another treatment option for patients that struggle with obesity along with other comorbidities such as: hypertension and dyslipidemia. Upon the release of information regarding the benefits of GLP-1 RAs in weight loss, news spread on social media about the medication that labels it as a simple way to lose weight. However, in order to receive Wegovy, patients should meet specific criteria for weight loss. According to the drug package insert, to qualify for Wegovy treatment, adult patients must have 30 kg/m2 or greater (obesity) or 27 kg/m2 or greater (overweight) in the presence of at least one weight-related comorbid condition (e.g., hypertension, type 2 diabetes mellitus, or dyslipidemia). Wegovy is also indicated for pediatric patients aged 12 years and older with an initial BMI at the 95th percentile or greater for age and sex (obesity). There are concerns that patients receiving prescriptions for Wegovy do not meet these criteria, which is leading to overutilization and a shortage of these medications (Wegovy and Ozempic) as reported by the ASHP and other health organizations. It is important to note that Wegovy and Ozempic are not interchangeable, have different indications, and are used at different dosage strengths as established by the FDA. Due to this shortage, patients may not have access to Ozempic for the treatment of diabetes.

During the Ozempic shortage, there are treatment alternatives that may be recommended for patients with type 2 diabetes mellitus. It is important for patients to consult with their doctor regarding other GLP-1 RA options such as Victoza (liraglutide), Trulicity (dulaglutide), Byetta or Bydureon BCise (exenatide), Rybelsus (oral semaglutide), Mounjaro (tirzepatide), Adlyxin (lixisenatide), etc.

For persons diagnosed with obesity and unable to access Wegovy, there may be other treatment options or weight loss programs available. It is important to note that not all insurance benefits cover weight loss treatments. Beneficiaries diagnosed with obesity should confirm their insurance benefits first and consult with their doctor regarding treatment options. Other FDA approved medications for weight loss include: Saxenda (liraglutide), Contrave (naltrexone/bupropion), Qsymia (topiramate/phentermine), Xenical (orlistat; generic: Alli). In addition, establishing a healthy diet and exercise recommended by health professionals may aid in weight loss and general health.

References:

American Diabetes Association. (2023). Standards of Care in Diabetes (Vol. 46, Ser. Suppl 1).
Drug shortage detail: Semaglutide injection. ASHP (2023). from https://www.ashp.org/drug-shortages/current-shortages/drug-shortage-detail.aspx?id=813&loginreturnUrl=SSOCheckOnly
Dungan, K., & Desantis, A. (2022). Glucagon-like peptide 1-based therapies for the treatment of type 2 diabetes mellitus. Retrieved from https://www.uptodate.com/contents/glucagon-like-peptide-1-based-therapies-for-the-treatment-of-type-2-diabetes-mellitus?search=GLP1%20shortage&source=search_result&selectedTitle=1~150&usage_type=default&display_rank=1#references.
FDA Approved Drugs. Food and Drug Administration (FDA). (2023) from https://www.access.fda.gov/
FDA Drug Shortages. Food and Drug Administration (FDA). (2023) from https://www.access.fda.gov/
Food and Drug Administration (FDA). (2017). OZEMPIC (semaglutide) injection, for subcutaneous use.
Food and Drug Administration (FDA). (2021). WEGOVY (semaglutide) injection, for subcutaneous use.
Jastreboff, A., Alves, B., Connery, L., Wharton, S., Ahmad, N., Aronne, L., Stefanski, A., Bunck, M., Liu, B., Zhang, S., & Kiyosue, A. (2022). Tirzepatide once weekly for the treatment of obesity. New England Journal of Medicine, 387(15), 1433–1435. https://doi.org/10.1056/nejmc2211120
Landwehr, J. (2022). Ozempic shortage: How a viral trend could be putting people with diabetes at risk. Health. Retrieved from https://www.health.com/ozempic-wegovy-shortage-weight-loss-diabetes-risk-6823914
Wilding, J., Batterham , R., Calanna, S., Davies, M., Van Gaal, L., Lingvay, I., McGowan, B., Rosenstock, J., Wadden, T., Wharton, S., & Yokote, K. (2021). Once-weekly semaglutide in adults with overweight or obesity. New England Journal of Medicine, 385(1). https://doi.org/10.1056/nejmc2106918

Heart Failure: Condition Overview and Treatments Available

Mon, 20 Feb 2023 18:20:03 GMT

What is heart failure?

Heart failure is a disorder that occurs when the heart is unable to pump blood at a rate that meets a patient’s bodily needs. This causes the organs to not receive enough blood and oxygen.

What are the most common symptoms?

Tiredness, fatigue, or weakness
Swelling in your feet, ankles, legs, or abdomen
Trouble breathing when active or laying down
Racing heartbeat
Reduced ability to exercise.

How is it diagnosed?

If you have any of the symptoms, your provider may run a series of tests to determine if you have heart failure. Some of these include:

A blood test known as "brain natriuretic peptide" (BNP): The BNP level is high in people with heart failure.
An electrocardiogram (ECG): this test measures the electrical activity in your heart.
An echocardiogram: this test uses sound waves to create a picture of your heart while it is beating.
A chest X-ray: by performing an x-ray the doctor may determine the general shape of the heart and if there is fluid in the lungs.

A stress test: this test uses physical activity such as running or walking on a treadmill to determine if the heart is getting enough blood when under stress.

Cardiac catheterization: in this test, the doctor puts a thin tube into a blood vessel in your neck, leg, or arm to measure the blood vessels and spot narrowing or blockage.

How is heart failure treated?

To treat heart failure, one or more medications may be used to avoid further complications and slow down the progression of the condition.

The medications mentioned above may be used to treat other cardiac conditions apart from heart failure. Talk with your prescriber about your treatment plan options and consult with your health plan provider to ensure medication coverage.

References:

Mayo Foundation for Medical Education and Research. (2021). Heart failure. Mayo Clinic. Retrieved January 16, 2023, from https://www.mayoclinic.org/diseases-conditions/heart-failure/diagnosis-treatment/drc-20373148
MC-Rx. (2021). Heart Failure Class Review. Pharmacy and Therapeutics Meeting. Retrieved January 2023.
Medications to help treat heart failure. Cleveland Clinic. Retrieved January 16, 2023, from https://my.clevelandclinic.org/ health/treatments/23528-heart-failure-medications
Patient education: Heart Failure (The basics). (2023). Retrieved 2023, from https://www.uptodate.com/contents/initial-pharmacologic-therapy-of-heart-failure-with-reduced-ejection-fraction-in-adults?search=heart%20failure%20treatments&source=search_result&selectedTitle=4~150&usage_type=default&display_rank=3#H3360837436.

Biosimilar Knowledge

Thu, 02 Feb 2023 22:44:59 GMT

Biosimilars are safe, effective treatment options.

Biological products are the fastest growing class of therapeutic products in the United States. When patients are prescribed a biological product, biosimilar and interchangeable products can offer additional treatment options, potentially lowering healthcare costs.

What is a biological product?

Biological products are regulated by the Food and Drug Administration (FDA) and are used to diagnose, prevent, treat, and cure diseases and medical conditions. These products may be produced through biotechnology in a living system, such as a microorganism, plant cell, or animal cell, and are often more difficult to characterize than small- molecule drugs.

What is a reference product?

A reference product is the single biological product, already approved by the FDA, against which a proposed biosimilar product is compared. It is approved based on, among other things, a full complement of safety and effectiveness data.

What is a biosimilar product?

A biosimilar is a biological product that is highly similar to and has no clinically meaningful differences from an existing FDA-approved reference product. A manufacturer developing a proposed biosimilar demonstrates that its product is highly similar to the reference product by extensively analyzing the structure and function of both the reference product and the proposed biosimilar.

Biosimilars have the same expected benefits and risks compared to original biologics:

Route of administration to patients
Strength and dosage form
Potential side effects

What is an interchangeable biosimilar?

A biosimilar product that meets additional requirements, such as: produces the same clinical result as the reference product in any given patient, poses no additional risk or reduced efficacy if a patient switches back and forth between an interchangeable product and a reference product. Efficacy and safety must remain equal compared to using the reference product without switching.

What is an unbranded biologic?

It’s an approved brand name biological product that is marketed under its approved Biologic License Application without its brand name (proprietary name) on its label.

For example, Sanofi manufactures an unbranded version of insulin Lantus: unbranded insulin glargine. Another example: Mylan manufactures an unbranded version of insulin Semglee-yfgn: unbranded insulin glargine-yfgn.

Below is a summary of key highlights from the current and proposed legislations at a national level:

Biologics Price Competition and Innovation Act in 2009: As part of the Affordable Care Act, the Biologics Price Competition and Innovation Act created an abbreviated pathway to approve biosimilars and increase the biosimilars’ market presence.
Advancing Education on Biosimilars Act in 2021: The Advancing Education on Biosimilars Act works to provide more public information to providers and patients about the safety, efficacy, and cost-savings of biosimilars.
State Legislations Pertaining To Biosimilars:
Currently, all 50 states and the District of Columbia have laws pertaining to interchangeability; however, pharmacy laws and practices vary from state to state, including:

- Requirements related to provider notification/permission,

- Patient communication, and

- Documentation practices

Disclaimer: The above represents a summary provided by the MCRX clinical te am and does not replace the full reference related to federal, state, and local ordinances.

Key Points to consider:

Biosimilar products may be approved for all or a subset of the same indications as the reference product. Healthcare prescribers and pharmacists should review the specific product labeling (prescribing information) and approved indications to determine the most appropriate product for the patient.
Not all biosimilars are interchangeable. Healthcare professionals should reference the FDA’s “Lists of Licensed Biological Products with Reference Product Exclusivity and Biosimilarity or Interchangeability Evaluations,” known as the “Purple Book,” to locate information about approved biological products and interchangeability status.
Insurers and pharmacy benefit managers (PBMs) have a key role in promoting the utilization of the most cost-effective formulary alternative(s), whether they are biosimilars, interchangeable biosimilars, unbranded biologics, and/or the reference product.

How can insurance plans/PBMs optimize biosimilar utilization and reduce drug spend?

PBMs and insurance companies represent key drivers for implementation of biosimilars and interchangeable biosimilars by:

Promoting education for patients and providers regarding the efficacy, safety, and interchangeability status of biosimilars
Enhancing plan flexibility to improve biosimilar acceptance and uptake
Fostering formulary optimization (examples: via the use of pre-authorization and/or step therapy requirements) involving the use of the most cost-effective alternati ve first.

How do biosimilars impact the pharmacy practice?

As medication experts, pharmacists are in a key role as educators, advocates, and trailblazers of biosimilar integration into clinical practice across all settings. Pharmacists may:

Consistently engage with patients to confirm adherence to treatment regimens so patients may continue to receive benefits and patient assistance
Be involved in therapeutic drug monitoring, evaluating patients for efficacy, signs of immunogenicity or drug toxicity
Be educators and advocates for biosimilars through continuing education programs, in-services, or other presentations to explain the basic principles of biosimilars and increase confidence in their use

The time is now for pharmacists to get involved with biosimilar introduction into clinical practice. The path to biosimilar uptake is very dynamic and represents an opportunity for the profession to improve patient care.

Pharmacists are well positioned to take a lead by preparing and adapting to the changes biosimilars are expected to bring.

Staying Informed

The following references are available for more information on biosimilars:

FDA - Biosimilars, Purple Book
American Cancer Society - Understanding Biosimilars
APhA - Biosimilar Basics
Biosimilars Council - Biosimilars: What you need to know
International Generics and Biosimilar Medicines Association
U.S. Pharmacopeia (USP) – Biosimilars: Are they the same quality?

References

About Biosimilars and Interchangeable Products. (2017, October 23). Biosimilar and Interchangeable Products FDA. Retrieved December 9, 2022, from https:// www.fda.gov/drugs/biosimilars/biosimilar-and-interchangeable-products
Biosimilars. (2022, September 16). Biosimilars | FDA. Retrieved December 9, 2022, from https:// www.fda.gov/drugs/ therapeutic-biologics-applications-bla/biosimilars
Hobbs, A. L., & Crawford, J. P. (2019). Biosimilars and implications for pharmacy practice: Ready or not, here they come!. Pharmacy practice, 17(3), 1659. https://doi.org/10.18549/PharmPract.2019.3.1659
Patient Materials. (2022, September 16). Patient Materials | FDA. Retrieved December 9, 2022, from https://www.fda.gov/drugs/biosimilars/patient-materials
Prescribing Biosimilar and Interchangeable Products. (2017, October 23). Prescribing Biosimilar and Interchangeable Products | FDA. Retrieved December 9, 2022, from https:// www.fda.gov/drugs/biosimilars/prescribing-biosimilar-and- interchangeable-products
Ley de Farmacia de Puerto Rico, Ley Número 247 de 3 de septiembre de 2004, según enmendada. https://www.cfpr. org/files/LEY%20DE%20FARMACIA%20NUM%20247%20DE%20PUERTO%20RICO.pdf
Understanding State Laws for Interchangeable Biosimilars. Retrieved January 27, 2023 from https://www.hlc.org/post/understanding-state-laws-for-interchangeable-biosimilars/

What is RSV?

Thu, 19 Jan 2023 20:43:42 GMT

Respiratory Syncytial Virus (RSV) is an acute virus in the lungs that may lead to severe disease.

Respiratory Syncytial Virus (RSV) is a common virus that causes an acute illness in the lungs and may lead to severe disease in people with weakened immune systems. This virus is known as the leading cause of bronchiolitis, or inflammation in the lungs, and pneumonia in children less than one year in the United States1 – it may, however, affect older adults as well. The virus is transmitted through close personal contact or mucus droplets to the lower part of the lungs causing inflammation, which may result in difficulty breathing.

When is RSV season?

RSV season usually begins in late fall and runs through early spring. This year, RSV activity has increased in the United States after the mandated use of masks and physical distancing was suspended2. As a result, hospitalization rates of both children and older adults have increased due to RSV infection.

What are the symptoms?

Symptoms of RSV usually include1, 3:

Congested or runny nose
Dry cough
Decreased appetite
Low-grade fever
Sneezing
Sore throat
Wheezing
Irritability in Children

Though most people tend to have mild, cold-like symptoms, severe cases of RSV may cause:

Pneumonia
Difficulty breathing
Lack of oxygen
Worsening of respiratory conditions [Asthma, Chronic Obstructive Pulmonary Disease (COPD) or Congestive Heart Failure (CHF)]

People who are infected with RSV become contagious one or two days before demonstrating symptoms and are usually contagious for three to eight days.

How do I prevent RSV infection?

Similar to the flu virus, RSV is transmitted through close contact with sick people and contaminated surfaces. Steps taken to prevent the spread of RSV include1:

Wearing a mask
Covering your mouth and nose when coughing or sneezing with a tissue or upper shirt sleeve
Washing your hands often with soap and water, or hand sanitizer when soap and water is not available
Avoiding close contact with sick individuals
Cleaning frequently touched surfaces such as doorknobs, tables, and mobile devices constantly

What are the treatment options for Infants?

Treatment of RSV is based on the direct management of symptoms which includes hydration, respiratory support, and frequent monitoring of the disease’s status.

The only approved therapy for the prevention of RSV is Palivizumab whose brand name is Synagis®. However, this treatment is only available for premature infants.

Other therapies include inhaled bronchodilators, inhaled hypertonic saline, and corticosteroids. Corticosteroids are not routinely recommended for symptom treatment unless the RSV infection has triggered a worsening of the existing lung disorder in older children and adults4.

What are the treatment options for Adults?

For adults with a higher risk of RSV infection, including those with chronic heart and lung disease, those with weakened immune systems, and the elderly (65 years of age and older), there is no approved therapy for prevention or treatment of RSV. Patients who have been hospitalized due to RSV infection are treated with oxygen and fluids for hydration to manage their symptoms. Other therapies that may be used include bronchodilators and corticosteroids.

Although there are few treatment options for RSV infection, studies to develop vaccines and medications are ongoing. The approval of these drugs will help lower RSV infection and healthcare costs in the community.

Know your Pharmacy Benefit Management (PBM) Pharmacist

Wed, 30 Nov 2022 22:23:36 GMT

Pharmacists are medication experts that play a critical role in helping patients achieve optimal results from their medications.

Some of the tasks that pharmacists perform include preparing and dispensing prescriptions, ensuring medications and doses are correct, preventing potentially harmful drug interactions, and counseling patients on the safe and appropriate use of their medications, among other responsibilities. Also, pharmacists are considered the most accessible healthcare professionals.

Most people are familiar with the role of the community pharmacist. Community pharmacists provide services in an independent or chain retail pharmacy. They interpret, dispense, verify, and provide medication counseling regarding the appropriate and correct use of your medications. They also have an important role in vaccination efforts for influenza, pneumonia, COVID-19, and others.

In addition, pharmacists may have other roles in the healthcare industry within the different fields in which they may work. These fields include:

Hospital Pharmacy, inpatient and/or outpatient setting
Pharmaceutical Industry
Academia (i.e. school, college or university)
Research
Managed Care (Pharmacy Benefit Management (PBM), Managed Care Organization (MCO), Health Plans)
PBM: The intermediary between employers, MCOs, beneficiaries, drug wholesalers, pharmacies, and drug companies, working to optimize cost-effective strategies to achieve the best possible health outcomes.
MCO: A managed care organization (MCO) is a healthcare provider or group of medical service providers who offer managed care health plans. It is an organization that contracts with insurers or self-insured employers, and finances and delivers healthcare using a specific provider network and specific services and products.
Health Plan: An individual or group plan that provides or pays the cost of medical care.
Government (Food and Drug Administration (FDA), National Institute of Health (NIH), Military)
Specialty Pharmacy: Pharmacists who work in specialty disease states such as oncology , organ transplant , inflammatory conditions, or infectious disease, and are trained to be experts on complex drug therapy regimens that usually require close monitoring and follow-up with patients and providers.
Mail Order Pharmacy: Pharmacists that work in a pharmacy setting in which prescription medications are sent to the patient by mail.

MC-Rx is a Pharmacy Benefit Manager (PBM) , a company that manages prescription drug benefits on behalf of health insurers, Medicare Part D drug plans, large employers, and other payers. PBMs are your advocates in the healthcare system working to ensure the appropriate, most effective, and safe medications are available to beneficiaries. A PBM optimizes the formulary (a list of prescription drugs covered by a health plan) according to scientific evidence and clinical guidelines. Optimal formulary design and management services offered by PBMs help achieve lower prescription drug costs for patients and payers. The PBM pharmacist focuses on managing medication-specific outcomes in a way that drives down total health utilization costs and improves patient care.

A PBM pharmacist works with clients (e.g. health plans, employers, MCOs) to evaluate and improve their pharmacy benefit. The responsibilities of a PBM pharmacist may include:

Formulary and Drug Utilization Management – Managing the list of medications covered by the health plan and monitor prescription drug trends.
Coordinating and participating in the Pharmacy and Therapeutics Committee (P&T) – The P&T committee is a multidisciplinary team that evaluates effectiveness and safety of medications in order to make evidence-based decisions for disease management. P&T committees are generally composed of the following disciplines: physicians with specialties in different areas of medicine and pharmacists.
Account Management – The responsibilities of an account manager include retaining client (e.g. employers, MCOs, health plan) business by identifying strategic growth opportunities based on the client’s formulary design. An example may be offering effective drug management tools (e.g. prior authorization criteria or quantity limits) to ensure cost-effective access to medications.
Prior Authorization Process – Pharmacists evaluate the prescriptions based on the diagnoses and supporting documentation sent by the pharmacy/physician to determine the appropriate use of the medication according to the patient/beneficiary pharmacy coverage.
PBM pharmacists ensure the pharmacy benefit plan provides individual patients with medications that are: clinically appropriate, cost effective, and delivered through the appropriate channel; for example, via specialty pharmacy, retail pharmacy, or mail order pharmacy.

MC-Rx PBM pharmacists are committed to serve beneficiaries by ensuring access to the best care and achieving optimization of their pharmacy benefit.

References:

https:// www.commonwealthfund.org/publications/explainer/2019/apr/pharmacy-benefit-managers-and-their- role-drug-spending

https:// www.mc-rx.com/

Amoxicillin Shortage

Sat, 12 Nov 2022 18:43:14 GMT

How Severe is the Amoxicillin Shortage in the United States?

Background:

Recent reports, in late October, mention a potential Amoxicillin shortage. The shortage is predominantly due to supply concerns among the three (3) largest manufacturers, Hikma Pharmaceuticals, Teva Pharmaceutical Industries and Sandoz.

Is There Actually a Shortage of Amoxicillin?

As of October 31st 2022 via the Food and Drug Administration (FDA), there is a shortage of Amoxicillin, specifically, the oral suspension. Unfortunately, the oral suspension is used predominantly in pediatric populations for upper respiratory infections.

What Should We Do?

As a healthcare organization, we should be guiding our clients and patients to remain calm and not stockpile Amoxicillin, which may exacerbate the current situation.

What Are Our Recommendations?

As we approach the cold season, it is important for clients to notify providers and patients about the shortage. It is the duty of the patient’s provider to consider therapeutic alternatives for Amoxicillin. However, for the treatment of respiratory illness, it is important to note the American Lung Association (ALA) cites that anywhere from ten to forty percent (10-40%) of common colds are viral in nature, which means it is of utmost importance that providers are prudent and judicious when prescribing antibiotics in order to promote effective antibiotic stewardship, especially in times of a national shortage.

If antibiotic therapy is needed, for people unable to get their amoxicillin, work with a pharmacist or with the prescriber to find another pharmacy that might have the drug in stock. There may be a different concentration or a dosage form that’s available, but there’s also several other options that can be used as far as antibiotics go.

Although this is not an exhaustive list, please see some of our recommendations:

Infections of the ear, nose, and throat:
Consider topical therapies, if appropriate, especially in the ear (example: antibiotic ear drops)
Consider alternative oral therapies if patient’s symptoms are systemic
Infections of the genitourinary tract
Consider alternative oral therapies
Infections of the skin and skin structure
Consider topical therapies, if appropriate.
Consider alternative oral therapies if patient’s symptoms are systemic or disease is progressing
Infections of the lower respiratory tract
Consider alternative oral therapies
Gonorrhea, acute uncomplicated (ano-genital and urethral infections)
Consider alternative oral therapies
H. pylori eradication to reduce the risk of duodenal ulcer recurrence
Dual or Triple Therapy
Consider alternative antibiotics such as Clarithromycin, Metronidazole, Tetracycline, etc.

When Is the Shortage of Amoxicillin Expected to End?

As health-systems and insurers monitor the situation closely, there is a speculative release date for new batches of generic Amoxicillin (oral suspension, chewable tablets, and capsules) for November to December 2022.

In Conclusion:

As we approach the cold season and expect to see increased cases of provider visits for respiratory infections, we also expect to see an increase in utilization for generic Amoxicillin. It is important for us to notify clients about the shortage, so the client can inform their patients and providers. Additionally, providers should be prepared to recommend therapeutic alternatives for Amoxicillin based on the patient’s signs and symptoms.

References:

1. https://thehill.com/policy/healthcare/3705290-companies-report-shortages-of-common-childhood-antibiotic-amoxicillin/

2. https://www.accessdata.fda.gov/scripts/drugshortages/dsp_ActiveIngredientDetails.cfm?AI=Amoxicillin+Oral+Powder+for+Suspension&st=c&tab=tabs-4&panels=1

3. https://www.ashp.org/drug-shortages/current-shortages/drug-shortage-detail.aspx id=875&loginreturnUrl=SSOCheckOnly

New Treatments for Diabetes

Fri, 11 Nov 2022 00:06:25 GMT

Benefits of new treatments for diabetes: Focus on Glucagon-like peptide 1 (GLP-1) agonists

and Sodium-glucose co-transporter 2 (SGLT2) inhibitors

What is Diabetes?

Diabetes mellitus (DM) is a chronic health condition that affects how your body turns food into energy. Most of the food we eat is broken down into sugar, which causes our organ called the “pancreas” to release insulin. Insulin is a substance produced naturally and is needed to help move sugar from the blood into other parts of the body, like your legs to help you walk. Insulin is the key to letting sugar into your body.

If you have diabetes, your body either doesn’t make enough insulin or can’t use insulin. When there isn’t enough insulin or cells stop responding to insulin, too much sugar stays in your blood which causes damage to your body. Over time, that can cause serious health problems, such as vision loss, heart disease, and kidney disease. Initially, none of these health problems may have symptoms.

Common complications in diabetic patients

Cardiovascular complications in diabetes: People with diabetes are at increased risk of cardiovascular disease (CVD), which can lead to problems like heart attack, stroke, or even death.
Kidney complications in diabetes: Diabetes can alter the normal function of the kidneys. Kidney problems related to diabetes are referred to as "diabetic kidney disease" or by the older term, "diabetic nephropathy." Over time, this can lead to chronic kidney disease and even kidney failure.
Weight complications in diabetes: People who take insulin often gain weight. Insulin is a hormone that regulates how the body absorbs sugar, also known as glucose. The weight gain can be frustrating because keeping a healthy weight is important to manage your diabetes.

Benefits of SGLT2 Inhibitors and GLP-1 Agonists:

SGLT2 Inhibitors like Empagliflozin, Canagliflozin, and Dapagliflozin have demonstrated benefit in lowering heart failure (HF) hospitalization, risk of kidney disease progression, and mortality. Current guidelines for diabetes place SGLT2 Inhibitors as possible first-line treatments, especially in patients that have high risk of suffering from heart failure in the future, currently have heart failure, or currently have chronic kidney disease (CKD).
GLP-1 Agonists like Semaglutide, Dulaglutide, and Liraglutide have also demonstrated benefits in reducing the risk of cardiovascular events. Semaglutide and Dulaglutide are also approved for weight management. These agents have reported significant results in helping patients reduce up to 15% of their Body mass index (BMI). Unfortunately, the weight loss benefit of GLP-1 receptor agonists does go away when you stop the medication. Patients can regain some or all of the weight they lost.

Covid-19 Treatment & Vaccine

Wed, 09 Nov 2022 23:01:03 GMT

MC-Rx is performing outreach now to give each healthcare payer enough time to determine coverage of each treatment and preventive option.

Background

The current public health emergency (PHE) has been renewed until January 2023. However, the Centers for Medicare and Medicaid Services (CMS) has released a roadmap to ending the COVID-19 PHE. Once that occurs, it is expected that the government will no longer purchase COVID-19 vaccinations and treatments, which will put a financial and administrative burden on all healthcare payers.

As a result, MC-Rx has developed educational material to help healthcare payers begin internal conversations regarding coverage of these treatments and preventive options.

What Are We Waiting On?

MC-Rx is waiting on some key events (“triggers”) before presenting recommendations for healthcare payers. Each trigger will allow MC-Rx to customize future proposals for healthcare payers. These triggers include:

End of COVID-19 PHE

a. Individual client outreach from MC-Rx to determine if they would like to cover COVID-19 vaccinations and FDA-approved treatments.
End of COVID-19 PHE AND addition of annual COVID-19 vaccinations to CDC guidelines
If the client’s Benefit Plan Design (BPD) includes CDC-recommended vaccinations → MC-Rx will recommend covering COVID-19 vaccinations. The final determination will be discussed with the client.
Individual client outreach from MC-Rx to determine if they would like to cover FDA-approved treatments.
End of COVID-19 PHE AND addition of annual COVID-19 vaccinations to CDC guidelines OR addition to Affordable Care Act (ACA) coverage
If the client’s Benefit Plan Design (BPD) includes CDC-recommended vaccinations OR ACA-covered medications→ MC-Rx will recommend to cover COVID-19 Vaccinations. The final determination will be discussed with the client.
Individual client outreach from MC-Rx to determine if they would like to cover FDA-approved treatments.

COVID-19 Treatment & Vaccine Commercialization Outreach

Why Are We Reaching Out Now?

MC-Rx is performing outreach now to give each healthcare payer enough time to determine coverage of each treatment and preventive option. Depending on the healthcare payer’s Benefit Plan Design (BPD) or Plan Implementation Questionnaire (PIQ), coverage of these treatments and preventive options may align with their mission and values.

What Products Are Authorized Under the Emergency Use Authorization (EUA) for COVID-19?

The current landscape for treatment options under EUA for COVID-19 are vast, but some prime examples are:

Paxlovid (nirmatrelvir and ritonavir)
Lagevrio (molnupiravir)
Actemra (tocilizumab)
Bebtelovimab
Evusheld (tixagevimab co-packaged with cilgavimab)

What Products are FDA-Approved for COVID-19?

There are only two (2) FDA-approved products for the treatment of COVID-19

Veklury (remdesivir)
Olumiant (baricitinib)

What Should a Healthcare Payer Consider for COVID-19 Coverage?

Healthcare payers have to consider a multitude of different perspectives when evaluating coverage of treatment and preventive options:

FDA approval
EUA approval
Plan benefits for vaccinations based on CDC recommendations and statutory regulations (i.e. ACA)

How Should a Healthcare Payer Prepare for the End of the COVID-19 PHE?

Privately insured individuals could incur additional out-of-pocket costs for tests and related services when the PHE ends. Healthcare payers should begin internal discussions and determine what will align best with their mission and values and what are the statutory implications of the CARES Act, among other regulations. Some considerations are:

Should healthcare payers only cover preventive services?
Should healthcare payers only cover treatment options that are FDA approved?
What would be the potential cost impact of covering treatment and/or preventive options?
What are the requirements for coverage based on national regulatory bodies’ guidance?

MC-Rx to Have Abstract Published in Journal of Managed Care & Specialty Pharmacy

webmaster@procarerx.com (Matthew Shockley) — Tue, 04 Oct 2022 13:09:12 GMT

Poster presentation displayed at AMCP Nexus 2022 in National Harbor, MD.

Members of the MC-Rx Clinical Staff were informed by the Academy of Managed Care Pharmacy (AMCP) that their Clinical Services Department abstract entitled “Improving patient safety by decreasing co-prescribing of benzodiazepines and opioids” was accepted for a poster presentation at AMCP Nexus 2022 this month. The abstract will be displayed and discussed amongst thousands of attendees from across the nation, the majority of whom are pharmacists, physicians, nurses and other practitioners who manage medication therapies for over 270 million Americans served by health plans, pharmacy benefit management firms, emerging care models and the government. Over 300 abstract submissions were received for AMCP Nexus 2022 for possible publication in the Journal of Managed Care & Specialty Pharmacy (JMCP). Each abstract was reviewed and scored via a 2-tier peer-review process: by independent reviewers and then by a JMCP editor. The department’s abstract will be published in the JMCP Abstract supplement and authorship of the abstract will be included in the meeting program.

MC-Rx President Marileny Lugo said, “We are very proud of the Clinical Staff’s accomplishment and to have each and every one of them as part of our winning team.”

MC-Rx is passionate about improving patient safety, helping decrease co-prescribing of benzodiazepines and opioids and providing members with the care they need to not only treat their medical conditions, but to also support their hopeful transition to a medication-free lifestyle.

Posters will be on display at AMCP Nexus 2022 on Wednesday October 12th from 4-7pm, and poster presentations will be Thursday, October 13th from 11am-2:30pm. AMCP Nexus 2022 will be held in National Harbor, MD, October 11th thru the 14th.

Strategies to Optimize Your PBM Dollars

Tue, 27 Sep 2022 21:38:27 GMT

By: Sylvia Flores, Group VP of Operations, MC-Rx

As drug cost and utilization of specialty products increase, it is critical to meticulously assess your member’s utilization patterns and outline a custom strategy that allows you to provide the best clinical outcomes to your members at the lowest possible cost.

In MC-Rx our approach to cost containment and cost reduction strategies is customized to help you achieve that critical balance. It is evident, nowadays, that the one size fits all approach is not the best strategy to follow.

Let’s review some important considerations when evaluating and optimizing your Pharmacy Benefit Manager (PBM) Services:

Transparency – when contracting your PBM services, it is critical to understand how are you going to obtain the lowest net cost, and which are the fees associated with the services to be contracted. Focusing only on the dollars to be saved, without knowing the source of those savings, can be a misleading approach not bringing overall value to you and your members.
Lower Cost Approach Our team of Pharmacy Doctors design formularies that include the best clinical alternatives based on efficacy and safety, while also evaluating the drug cost and manufacturer discount negotiations. Focusing only on savings driven by manufacturer’s rebates may result in unnecessary costs that could be offset by an effective formulary design.
Drug Management Tools –It is perceived that limiting access to medications may help achieve the lowest net cost, but this is not entirely true for many reasons: 1) The use of non-clinical Prior Authorization Strategies, may limit the rebates obtained from drug manufacturers. It is important to evaluate if the utilization reduction with the PA will offset the economic benefit projected from rebates. 2) It is also important to evaluate how the timely use of a medication may help reduce costs associated with other medical interventions, such as; hospitalizations, emergency visits, dialysis, etc. For these, in many cases, the costs surpass the cost of the medication.
Drug Discount at the Pharmacy Network Contracts – PBMs must ensure a healthy relationship with their providers in order to obtain the best outcome for their clients. The PBM’s ability in negotiating drug discounts with their Pharmacy Network is critical in establishing a cost effective Pharmacy Benefits Program.
Cost Containment Strategies – Nowadays it is important that PBMs provide cost containment strategies, such as Smart Co-Pay Programs, Personal Importation of Medication support, Alternative Funding Programs, Discount Cards, etc. As the cost and utilization of specialty products and drugs for chronic conditions increase, manufacturers and independent entities provide an increasing number of programs to support and drive access to patients in need. The combination of these programs with the benefits offered by employers and insurers increases the access to innovative medications that will improve your member’s quality of life at an affordable cost for both. Many of these programs could result in $0 or a very low copay for your member and significant cost reduction for you as the payer.

Finally, discussing with your PBM provider the way they handle the above strategies is critical, asking the right questions and truly evaluating the entire program offerings, beyond rebates, is imperative to drive member satisfaction at an effective cost.

Drug Management Tools

Mon, 26 Sep 2022 15:59:25 GMT

Drug Management-Tools: Pre-authorizations & Step Therapies

Drug management tools (DMTs) are mechanisms designed to optimize patient outcomes and ensure the most appropriate use of medications, while reducing waste, error, and unnecessary prescription drug use and cost. DMTs are developed by a Pharmacy and Therapeutics (P&T) committee to promote the use of cost-effective and high-quality prescription medication. The P&T committee is comprised of physicians, pharmacists, medical researchers, and other healthcare experts. Examples of DMTs are Prior Authorizations (PA), Step Therapies (ST), Specialty Limits (SL), Quantity Limits (QL), and Age Limits (AL). The P&T Committee is in charge of determining the appropriate DMT for a drug based on the clinical data, FDA package insert, clinical guidelines, and cost-implications. The implementation of a drug management tool ensures that the patient will receive the more effective and safe treatment, while ensuring the best outcomes.

Prior Authorization
A ‘PA’ or prior authorization is a process that reviews if a treatment plan is medically necessary for the patient. This encourages clinically indicated, safe, and cost-effective medication use by allowing coverage when the prescription is adequate to treat the patient's condition. Treatments that may require a prior authorization usually have the following characteristics:

Medical treatments that have lower cost and equally effective alternative
Drugs and therapies that must be used for a specific health condition
Treatments or medications that are frequently misused
Medications that are approved only for rare diseases
Drugs with dangerous side effects or that can be harmful when combined with other medications
Drugs that require previous use of other treatments or laboratory tests

When your pharmacy is processing a claim for a drug that has a drug management tool, the claim will show a ‘ Prior authorization required’ message. The pharmacy will then start the prior authorization process. Usually, medical diagnosis and justification are needed to validate why the treatment is necessary. If clinical criteria is met and the prior-authorization is approved, treatment will be covered. If the pre-authorization is not approved, you and your health care provider may request a reconsideration.

Step Therapy
Step Therapy is a process where a prerequisite drug is required first before the prescribed drug is covered. This ensures that the patient has tried preferred medications with a proven track record that may be better tolerated, less expensive, or less likely to cause interactions. A Step Therapy follows a mechanism where the adjudication system reviews the medication history to determine if the patient has already been treated with the ‘Step 1’ drug, before approving ‘Step 2’ drugs. This ensures that the most cost-effective alternatives are used before the patient is treated with more expensive and/or non-preferred options.

Don’t more expensive drugs work better?

A higher cost does not automatically mean a better drug. For example, a brand drug may have a less-expensive bioequivalent, generic, or brand alternative that might be an option. Bioequivalent/generic and brand drugs must meet the same standards set by the U.S. Food and Drug Administration (FDA) for safety and effectiveness. Talk to your provider to determine which medication options are best for you.

Drug Management Tools encourage safe and cost-effective medication use, and also help manage the rising cost of prescription drugs for everyone. They also provide a patient benefit that reduces treatment prescription costs providing low-cost alternatives.

It is recommended that you review your plan benefit documents or call for more information about treatments, services, and supplies that require any DMT under your health plan coverage.

Monkeypox

Mon, 26 Sep 2022 15:09:29 GMT

What is Monkeypox?

Though the COVID-19 pandemic has yet to completely subside, we are currently in the midst of another

government declared emergency due to Monkeypox. The first confirmed case in the U.S. was in May 2022. As of

September 14, 2022, a total of 23,117 cases have been reported and the number keeps growing. 1 As a result, the

government declared Monkeypox an emergency in August 2022.

What is Monkeypox?

Monkeypox is a disease caused by the monkeypox virus. This virus is part of the same family as smallpox, but

less fatal.

How does Monkeypox spread?

Monkeypox is spread from person-to-person by close contact of the skin, which includes touching a shared

object, hugging, kissing, and sexual contact. 2

What can I do to prevent Monkeypox?

Monkeypox is spread through close contact with infected persons. Everyone should be mindful of activities that

involve large crowds and avoid close contact with individuals that may be infected.

Can I prevent Monkeypox by getting the vaccine?

There are two (2) Monkeypox vaccines available, one is called JYNNEOS and the other is ACAM2000. These

vaccines are extremely limited due to the large number of cases in such a short timeframe. If there has been

close contact with someone with Monkeypox and you think there is a risk of getting infected, contact your

doctor to see if the vaccine is an option. Due to the limited availability of the vaccine, your doctor may refer you

to the local health department.

What happens if I get Monkeypox?

People with the Monkeypox infection present with a rash on the area that was in contact with the virus, which

may include hands, feet, face, chest, and genitals. Other symptoms may include fever, chills, exhaustion, and

muscle aches, which may resemble flu-like symptoms. From start to finish, the symptoms generally appear three

(3) weeks after exposure and will last about two (2) to four (4) weeks.

What can I do if I get Monkeypox?

There are no FDA approved drugs for Monkeypox. However, there is a drug used to treat smallpox that can be

used in severely ill Monkeypox patients called tecovirimat (TPOXX). Similar to the Monkeypox vaccine, the

treatment is very limited and should only be used in patients with severe symptoms or those at high-risk for

severe disease (i.e. people with a weakened immune system, children, pregnancy, etc.) 3

In conclusion, Monkeypox has been declared an emergency with an increasing number of cases. Due to its

ability to spread through close skin contact and delay in the presentation of symptoms, many cases go

unnoticed. However, there are options to prevent the spread of Monkeypox with lifestyle modifications (e.g.

safe sex and avoiding close contact with infected persons) and vaccination, if applicable. If your healthcare

provider thinks you have Monkeypox and are at high risk, then treatment options are available.

If you have any questions, please contact your healthcare provider.

References:

1 2022 Outbreak Cases and Data. Centers for Disease Control and Prevention, National Center for Emerging and Zoonotic Infectious Diseases (NCEZID),

Division of High-Consequence Pathogens and Pathology (DHCPP). August 22, 2022

2 Prevention. Centers for Disease Control and Prevention, National Center for Emerging and Zoonotic Infectious Diseases (NCEZID), Division of High-

Consequence Pathogens and Pathology (DHCPP). August 22, 2022

3 Treatment Information for Healthcare Professionals. Centers for Disease Control and Prevention, National Center for Emerging and Zoonotic Infectious

Diseases (NCEZID), Division of High-Consequence Pathogens and Pathology (DHCPP). August 22, 2022

Diabetes Mellitus Medication Storage

Fri, 16 Sep 2022 20:56:39 GMT

Proper Storage for Diabetes Medication

Diabetes Mellitus is a complex condition that can progress to severe complications if not treated properly.

Patients with diabetes need to be aware of all the things that could affect blood sugar control.

It is important to store medications properly to ensure that they work properly. In this article we will discuss proper medication storage with a special focus on insulin.

EFFECTS OF IMPROPER STORAGE

Medications that are kept in places accessible to children, animals, or individuals other than the patient, may cause accidental poisoning.
Storing medications in very cold or very hot places can cause changes in the drug, reduce their potency, and possibly make them less effective. The patient may even receive less medication than they actually need.

INSULIN STORAGE

Insulin can lose its activity if it is stored in very cold or very hot places.
Insulin should not be left in the sun or exposed to household light bulbs.

FOLLOW THESE RECOMMENDATIONS

CHECK TO SEE IF THE INSULIN SHOWS ANY CHANGE IN COLOR OR CLARITY

Make sure it contains no lumps, particles or crystals.

DO NOT SHAKE THE INSULIN

Shaking the insulin causes air bubbles to be created that can affect the amount of insulin that is drawn from the bottle into the needle for delivery.

NEW insulin should be kept in the refrigerator.

IN-USE insulin can be kept at room temperature for up to 28 days.

DO NOT FREEZE INSULIN

DO NOT USE INSULIN that has been frozen.

DO NOT use insulin that has expired.

EMERGENCY INSULIN STORAGE

Keep insulin at the coolest possible temperature.
If you are going to use ice to keep it cool, do not allow the insulin to freeze. Remember, do not use insulin that has been frozen.
Keep insulin away from heat and/or direct sunlight.

Oral Contraceptives

Tue, 13 Sep 2022 20:40:41 GMT

Oral Contraceptives, Emergency Contraceptives and Abortive Medications

There are important differences between oral contraceptives, emergency contraceptives, and abortive

medications. These agents act differently and have different regulations, but all have the same purpose of birth

control. The following article provides information on the three methods.

Oral contraceptives work by mimicking the natural hormones produced within the ovaries, which prevents the

ovulation process and the transportation of sperm. Oral contraceptives are available in two formulations: a

combination of estrogen and progesterone, or progesterone only. Most combined contraceptives (estrogen plus

progesterone) are taken daily for 21 to 24 days and include a week of placebo tablets. Placebo tablets contain

inactive ingredients that have no therapeutic effect on the body and are taken daily to increase adherence to

therapy. On the other hand, progesterone-only contraceptives are taken every day and do not include placebo

tablets. To be effective, one tablet is taken the first day of the menstrual cycle and must continue to be taken

every day at the same time. If the tablet is not started during the menstrual cycle, therapy must be combined with

another backup method of contraception for seven (7) days. However, if a dose is forgotten, it is recommended to

take two (2) tablets the next day. If a dose is missed for two (2) consecutive days, take two (2) doses of the oral

contraceptive as soon as possible, then continue with the daily dose as prescribed and use a backup method of

contraception for seven (7) days. If a dose is forgotten for two consecutive days and unprotected sex occurred

during the five (5) days prior to forgetting the dose, consider using emergency contraception. If oral contraceptives

are used correctly and consistently, they are an effective method of contraception. Currently, a prescription is

required to obtain oral contraceptives at the pharmacy. However, there is the possibility of an over the counter

(OTC) product that may be available in the future.

Emergency contraception is used after unprotected sex or when a contraceptive method fails. Its mechanism of

action is to prevent fertilization by altering the transport of the sperm and/or egg. This method is capable of

reducing the probability of pregnancy even when the act occurs close to the time of ovulation, which is when

conception can most likely occur. The most widely used emergency contraceptive is known as the morning-after-

pill. A common brand name is Plan B, which contains a hormone that prevents pregnancy before implantation

occurs. This tablet should be taken as a single dose within the first 72 hours of unprotected sex and is most

effective the sooner it is taken after the occurrence of unprotected sex.

Abortive medications are drugs that generate a pharmacological abortion for pregnant patients. The oral regimen

consists of a combination of drugs: mifepristone (Mifeprex) and misoprostol (Cytotec). First, the mifepristone

(Mifeprex) tablet is taken to prevent the growth and development of the pregnancy, with the misoprostol (Cytotec)

tablet taken within the first 48 hours of taking the mifepristone (Mifeprex). This medication generates cramps and

bleeding to empty the uterus. This regimen requires a doctor's prescription and will follow the regulations of each country/state regarding planned abortions.

These three methods of birth control involve different mechanisms of action, are used for specific situations, and

must be managed appropriately. To avoid or minimize the occurrence of serious adverse events, they must be

administered correctly. Therefore, it is recommended to always contact the nearest healthcare provider, doctor

and/or pharmacist.

References:

Casey, F. E. (2022, June 21). Anticoncepción de Urgencia - Salud Femenina. Manual Merck

versión para el público general. Retrieved July 8, 2022, from https://www.merckmanuals.com/es-pr/hogar/salud-

femenina/planificaci%C3%B3n-famili ar/anticoncepci%C3%B3n-de-urgencia?query=Anticonceptivos+orales

Casey, F. E. (2022, June 21). Anticonceptivos Orales - Ginecología y obstetricia. Manual Merck

versión para profesionales. Retrieved July 8, 2022, from

https://www.merckmanuals.com/es-pr/professional/ginecolog%C3%ADa-y-obstetricia/pla

nificaci%C3%B3n-familiar/anticonceptivos-orales

Lane, M. (n.d.). Unintended pregnancy in the United States - Guttmacher Institute. Unintended

Pregnancy in the US. Retrieved July 8, 2022, from https://www.guttmacher.org/sites/default/files/factsheet/fb-

unintended-pregnancy-us.pdf

Parenthood, P. (n.d.). The abortion pill: Get the facts about medication abortion. Planned

Parenthood. Retrieved July 8, 2022, from https://www.plannedparenthood.org/learn/abortion/the-abortion-pill

Psoriasis: Review of the management and treatment with first line topical therapies

Sat, 06 Aug 2022 00:08:46 GMT

Topical medications are those applied directly to the skin, such as creams, lotions, and ointments.

What is Psoriasis?

Psoriasis is an autoimmune skin disease characterized by rapidly growing skin cells and the appearance of plaques with red and scaly lesions on the skin. It is estimated that this chronic condition affects 3.2% of the US population and not only affects the appearance of the skin, it can also predispose to the development of other diseases.

If you have mild-to-moderate psoriasis, your doctor will most likely start you on some of the following topical treatments: steroids, calcineurin inhibitors, vitamin D analogs, or retinoids.

What is a topical treatment? Topical medications are those applied directly to the skin, such as creams, lotions, and ointments. These are considered first-line therapy to treat mild-to-moderate psoriasis. One of the advantages of using topical drug therapy is that they have fewer side effects than other alternatives, such as oral and injectable medications. Your doctor will choose the most suitable treatment based on the severity and location of the lesions, as well as other factors such as age, pregnancy status and others. In this article you will find information about the first-line therapy options available to treat psoriasis.

What can I do for my Psoriasis?

Since psoriasis is unique for each individual, and drugs work differently on different patients, it can be a challenge to manage. Finding the most effective therapy can be a process of trial and error, and can often be frustrating. Therefore, the most important thing you can do is stay informed about what alternatives are available and consult with your doctor or pharmacist regularly.

References:

Elmets, C. A., Korman, N. J., Prater, E. F., Wong, E. B., Rupani, R. N., Kivelevitch, D., Armstrong, A. W., Connor, C., Cordoro, K. M., Davis, D. M. R., Elewski, B. E., Gelfand, J. M., Gordon, K. B., Gottlieb, A. B., Kaplan, D. H., Kavanaugh, A., Kiselica, M., Kroshinsky, D., Lebwohl, M., … Menter, A. (2021). Joint AAD–NPF guidelines of care for the management and treatment of psoriasis with topical therapy and alternative medicine modalities for psoriasis severity measures. Journal of the American Academy of Dermatology , 84 (2), 432–470. https://doi.org/10.1016/j.jaad.2020.07.087

Mayo Foundation for Medical Education and Research. (2022, June 4). Psoriasis . Mayo Clinic. Retrieved July 13, 2022, from https://www.mayoclinic.org/diseases-conditions/psoriasis/diagnosis-treatment/drc-20355845

WebMD. (n.d.). Topical creams & lotions to treat psoriasis . WebMD. Retrieved July 13, 2022, from https://www.webmd.com/skin-problems-and-treatments/psoriasis/topical-treatments-psoriasis

First-Line Options for Mild-Moderate Psoriasis:

Treatment Options for Rheumatoid Arthritis

Fri, 05 Aug 2022 23:20:39 GMT

There are dozens of medicines for rheumatoid arthritis.

What are the treatments for rheumatoid arthritis?

There are dozens of medicines for rheumatoid arthritis. The right one for you will depend on:

The severity of your symptoms
The number of affected joints
How your disease has changed over time
The side effects experienced from prescribed medications
What your X-rays look like
Your blood test results

In general, the treatment options include the following medications:

"Nonsteroidal anti-inflammatory drugs," also known as "NSAIDs"
Steroids
"Disease-modifying anti-rheumatic drugs," also known as "DMARDs". These medications can be divided between biologic or non-biologic.
Biologic DMARDs: Products obtained from natural sources (either human, animal, or microorganism) and may be produced by biotechnology methods and other cutting-edge technologies.
Non-biologic DMARDs: Chemically formed products made by combining specific chemical ingredients in an ordered process.

Patients experiencing severe pain that does not improve with the medications listed above will sometimes be prescribed opioid pain medication. However, this is not usually necessary. Also, unlike the other medications used for rheumatoid arthritis, opioids do not help with inflammation or joint damage.

References:

https://www.arthritis.org/health-wellness/about-arthritis/understanding-arthritis/what-is-arthritis
https://ard.bmj.com/content/79/6/685
https://www.rheumatology.org/Practice-Quality/Clinical-Support/Clinical-Practice-Guidelines/Rheumatoid-Arthritis

HEADACHES

Sun, 10 Jul 2022 18:56:22 GMT

Types of Headaches

Headaches can be debilitating and are one of the most common neurological complaints among patients. If a headache has an unknown cause, it is called a primary headache. However, if the headache is caused by an underlying condition it is called a secondary headache. Most patients that experience headaches have primary headaches and can be further divided into:

Tension-type headaches,
Migraine headaches, or
Cluster headaches

There are other primary headaches, but the ones mentioned above are the most experienced. Even though some symptoms overlap between the types of headache, there are some symptoms that are characteristic.

See below for the key characteristics of primary headaches:

TENSION-TYPE

Involves both sides of the head
Pressure or squeezing around the head
Comes and goes, relatively dull
No specific duration

MIGRAINE

Generally one-sided
Throbbing
Nausea and/or vomiting
Might cause sensitivity to light/ sound
Can last between 4 to 72 hours

CLUSTER

Always one-sided
Burning or stabbing sensation behind the eye or around the temple
Begins quickly and intensifies in minutes
Can last between 30 minutes to 3 hours

Treatment Types

Treatment options will depend on the type of headache. For example, over-the-counter medications like acetaminophen or naproxen might be helpful at relieving the pain. If you are experiencing frequent and severe headaches, visit your primary care provider and explain the symptoms and frequency. This will help prevent taking too many OTC medications, which can ironically lead to another type of headache (medication-overuse headache). Frequency, duration, and severity of the headache will determine further treatment plans by your provider.

If your primary care provider has determined that you should receive prescribed medication , there are two categories of treatment available:

Acute treatment : a medication used to relieve the pain of a headache immediately.
Preventive treatment : a medication taken regularly for headaches.

Lifestyle Changes

Some adjustments to your daily life might help in reducing the frequency of headaches:

Quit smoking, if applicable
Reduce daily intake of alcohol
Avoid or decrease caffeine intake
Sleep and eat on regular schedules
Exercise regularly
Use relaxation techniques
Keep a headache diary to help you identify your headache triggers

References:

https://www.amjmed.com/article/S0002-9343(17)30932-4/fulltext

https://pubmed.ncbi.nlm.nih.gov/29322494/

https://pubmed.ncbi.nlm.nih.gov/24784123/

https://medlineplus.gov/ency/article/003024.htm#:~:text=A%20headache%20is%20pain%20or,and%20sometimes%20by%20taking%20medicines

HIV Pre-Exposure Prophylaxis (PrEP)

Sun, 10 Jul 2022 18:31:27 GMT

HIV Pre-Exposure Prophylaxis (PrEP)

Human immunodeficiency virus (HIV), which can progress to acquired immunodeficiency syndrome (AIDS), targets the immune system and reduces a healthy patient’s ability to fight off many infections. In the United States there are an estimated 1.2 million people infected with HIV. HIV pre-exposure prophylaxis (PrEP) is defined as a combination of drugs to help prevent the transmission of HIV in people at risk of developing this condition. The first treatment for PrEP, Truvada, was approved in 2012. Since then, two additional options have been approved by the FDA. In 2020, about 25% of the 1.2 million people for whom PrEP is recommended were prescribed a PrEP drug, compared to only about 3% in 2015.

During the initial HIV infection, over the course of about 4 weeks, patients will present with symptoms of fever, sore throat, rash, joint pain, diarrhea, weight loss, and headache, similar to a common cold. However, some patients may not show any symptoms at all. Approximately 13% of HIV-positive patients do not know they have HIV and need to be tested.

It is good to note that everyone between the ages of 13 and 64 should get tested for HIV at least once. However, there are high-risk behaviors that may require an individual to get more frequent testing. People engaging in high-risk behaviors for HIV should be tested every 3-6 months. These high-risk behaviors include: inconsistent condom use, sex with HIV positive persons, shared needles or injectable drugs, or have been diagnosed with another sexually transmitted disease. If you engage in any of these activities, talk with your healthcare provider to see if pre-exposure prophylaxis (PrEP) may be right for you.

PrEP treatments are covered by most insurance plans at no charge to the patient. If there are still coverage issues, there are federal and state programs to help you afford PrEP.

PrEP reduces the risk of getting HIV from sex by about 99% when taken as prescribed. PrEP reaches maximum protection for receptive anal sex at about 7 days and receptive vaginal sex at about 21 days of daily use.

Currently, there are oral therapies for PrEP called Truvada and Descovy which are taken once-daily. However, in December 2021, a new injectable therapy called Apretude was approved by the U.S. Food and Drug Administration (FDA). In the clinical studies, Apretude was shown to be just as effective as other therapies in the prevention of HIV with minimal side-effects.

Even though there are medications to help reduce your risk of HIV, condoms are paramount to further reducing your risk of HIV and sexually transmitted diseases. Please speak with your healthcare provider about taking PrEP and about what options may work best for you.

References

https://www.cdc.gov/nchhstp/newsroom/fact-sheets/hiv/PrEP-for-hiv-prevention-in-the-US-factsheet.html#:~:text=Notable%20gains%20have%20been%20made,only%20about%203%25%20in%202015

https://pubmed.ncbi.nlm.nih.gov/27192360

https://www.hiv.gov/hiv-basics/overview/data-and-trends/statistics

https://www.cdc.gov/hiv/pdf/risk/prep/cdc-hiv-prep-guidelines-2021.pdf

https://www.cdc.gov/hiv/basics/prep/prep-effectiveness.html

https://www.fda.gov/news-events/press-announcements/fda-approves-first-injectable-treatment-hiv-pre-exposure-prevention

ORAL ANTIVIRALS – COVID 19

Sun, 10 Jul 2022 17:58:44 GMT

Oral Antivirals - COVID 19

The development of newer therapeutic alternatives provides additional tools for the prompt and appropriate management of COVID-19 infections. Two oral antivirals have received an Emergency Use Authorization (EUA) by the Food and Drugs Administration (FDA) for the treatment of mild-to-moderate COVID-19 infections. The purpose of the EUA for these treatments is to quickly manage the disease to limit the risk of progression to severe infection, which could result in complications that include hospitalization and death.

Information on these drugs is presented below:

Indication

Both are for the treatment of mild-to-moderate COVID-19 in patients with positive results to COVID-19 viral testing, and who are at high risk of progression to severe disease, including hospitalization and death:

PAXLOVID

(nirmatrelvir & ritonavir)

Population: Age 12 years or older, weight 40 kg (88 pounds) or more

Dosage: 300 mg of nirmatrelvir (two tablets) and 100 mg of ritonavir (one tablet)

Administration Frequency: Twice daily

Dosage Form: Tablets

Treatment Duration: 5 days

Possible Adverse Effects: Altered taste, diarrhea, hypertension, and muscle pain

Special Considerations: Dosage should be adjusted in renally compromised patients. This therapy interacts with some medications taken for other conditions.

LAGEVRIO

(molnupiravir)

Population: Age: 18 years or older

Dosage: 800 mg of molnupiravir (four capsules)

Administration Frequency: Twice daily

Dosage Form: Capsules

Treatment Duration: 5 days

Possible Adverse Effects: Diarrhea, nausea, dizziness, rash and itchy skin.

Special Considerations: Not recommended for patients that are pregnant or that could become pregnant.

Lactation should be stopped while on treatment and 4 days after the last dose was taken.

Limitations for both medications:

Not authorized for use:

In patients already hospitalized for severe COVID-19 infection

As a preventive measure, either before or after exposure

For more than 5 days of treatment

To facilitate the selection of the most appropriate treatment, it is important to provide the physician a complete list of medications currently taken. Additionally, these treatments should be started in the first 5 days after symptoms onset to maximize their effectiveness. These treatments are already available and require a medical prescription.

Press Release - May 3rd 2022

webmaster@procarerx.com (Matthew Shockley) — Tue, 03 May 2022 23:04:51 GMT

MC-RX BECOMES PRIMARY PHARMACY BENEFITS MANAGEMENT ORGANIZATION IN PROCARE FAMILY OF COMPANIES

MC-Rx Realigns all PBM Services Under the MC-Rx Brand to Best Serve Customers

April 28 ^th , 2022, Caguas, Puerto Rico – MC-Rx announced today that it will now be the primary Pharmacy Benefits Management (PBM) organization within the ProCare family of businesses. ProCare Pharmacy Benefit Manager, Inc. headquartered in Gainesville, GA acquired the Puerto Rican based MC-Rx, (formally known as MC-21) in 2018. Since that time, the PBM services have been transitioned over to the MC-Rx brand. MC-Rx is solely focused on Prescription Benefits Management serving clients in all 50 states and Puerto Rico.

URAC accredited MC-Rx operates as a third-party administrator of prescription drug programs for commercial health plans, self-insured employer plans, Medicare & Medicaid programs, among others. MC-Rx is responsible for creating cost-effective healthcare by offering clinical utilization management programs, offering more affordable pharmacy channels, negotiating discounts with drug manufacturers and retail drugstores, and encouraging the use of low cost generics and affordable brands. MC-Rx manages the processing and paying of prescription drug claims, leveraging ProCare Rx’s pharmacy claims processing technology.

“We believe uniting Prescription Benefit Management under the MC-Rx brand allows us to provide the most focused, high-quality services to our client partners,” said MC-Rx President Marileny Lugo, R.Ph. “Our company has built strong and long-lasting relationships with pharmacies, physicians, associations, government entities, and top industry leaders. We are a PBM that encompasses knowledge, experience, technology, and a proven record of excellence in client-geared solutions. Uniting all of the PBM services under the MC-Rx brand allows us to provide the most value to our clients,” Lugo continued. MC-Rx has demonstrated its commitment to innovation, efficiency, and excellence, and to guaranteeing an optimal level of client satisfaction and ongoing savings in the management of pharmacy benefits.

About MC-Rx Powered by ProCare Rx
MC-Rx is a full-service Pharmacy Benefits Management (PBM) company. MC-Rx is a third-party administrator of prescription drug programs for commercial health plans, Medicaid & Medicare/PACE programs, dynamic health systems, private label PBMs, 340B & workers compensation administrators, cash discount card sponsors, complex TPAs, employer groups, unions, hospices, and many other client types. MC-Rx offers clinically appropriate utilization management programs focused on safety and clinical outcomes. Our knowledge of the market has been crucial for the successful development, implementation, and administration of PBM services and programs for our clients and their members. We serve more than 13 million lives, and our staff is a reputable group of specialized professionals in the areas of health, information systems, process management, and clinical, technical, and administrative services. MC-Rx utilizes the proprietary technology of parent company ProCare Rx for processing and paying prescription drug claims.

What is a Biosimilar?

Wed, 30 Mar 2022 17:27:39 GMT

Biosimilars

To understand what a biosimilar is, we must first understand what biological products are: 

Biological products (also known as reference products or original biologic) are a diverse group of drugs that are made up of large molecules such as protein, sugar, and other complex substances and are approved by the Food and Drug Administration (FDA) to diagnose, prevent, treat, or cure diseases. Some examples of a biological medication include: 

Insulin glargine (Lantus®): used to treat type 1 and 2 diabetes 

Adalimumab (Humira®): used to treat rheumatoid arthritis, Crohn’s disease, and other autoimmune diseases.

Since biological products contain large complex molecules, these cannot easily be replicated as regular medications. When a new biological product that’s similar to the original biologic becomes available on the market, it is referred to as a biosimilar. 

Biosimilar is also a biological medication approved by the FDA that is highly similar to the original biological product. Their minor differences are not clinically significant and they are equally safe, effective, and as pure as the original biologic products. In other words, a biosimilar product is to generic medication as an original biological product is to brand medication. The main difference is that generic medications are the exact copies of the brand drug, whereas biosimilars contain minor differences compared to the original biologic product. Some examples of a biosimilars are: (Original Biologic Product Biosimilar)

• Neulasta® (pegfilgrastim)  Fluphila® (pegfilgrastim-jmdb), Ziextenzo® (pegfilgrastim-bmez)

• Neupogen® (filgrastim)  Nivestym® (filgrastim-aafi), Zarxio® (filgrastim-sndz)

Important Key Points: Besides being equally safe and as effective as the original biologic products, biosimilars have more advantages as they generally carry less copay from plan insurance and provide a greater amount of savings compared to original biologics. In fact, it is estimated that biosimilars are 30% cheaper than biologic products.

Even though one original biologic product may have multiple biosimilars, it is important to mention that they cannot be switched as regular medications unless the switch is approved by the FDA. It’s crucial that doctors specify the exact biosimilar or reference product they want to prescribe, and that the pharmacy dispenses the exact medication. The main reason is that for a biosimilar to be interchanged with its original biological product, it must meet additional requirements established by the FDA.

Interchangeable Biosimilar: A biosimilar that meets the additional requirements and can be interchanged with the original biological product. These interchangeable biosimilars can be switched with their original biological product and vice versa without consulting the healthcare professional who originally wrote the prescription. This means that if a doctor prescribes a biologic product that is not available in the pharmacy, the pharmacist may substitute with its biosimilar without the doctor’s approval as long as the substitution is approved by the FDA. As of now, the only FDA-approved interchangeable biological drugs that are commercially available are:

Insulin glargine-yfgn (Semglee®) and insulin glargine (Lantus®): Both are safe and effective and are used to treat diabetes. Insulin glargine-yfgn (Semglee®) can be switched with Lantus® and vice versa since it complies with the additional requirements established by the FDA, and has the approval to do so. However, it is not interchangeable with other biosimilars such as Basaglar® (also insulin glargine) or any other insulin, as the switch is not approved by the FDA.

References

• About Biosimilars and Interchangeable Products. (2022). Retrieved 7 March 2022, from https://www.fda.gov/drugs/biosimilars/biosimilar-and-interchangeable-products

• Golden L. Peters, M. (2022). Naming of Biological Products. Retrieved 7 March 2022, from https://www.uspharmacist.com/article/naming-of-biological-products

• Goldman, D., & Philipson, T. (2021). Biosimilars Competition Helps Patients More Than Generic Competition. USC Schaeffer. Retrieved 11 March 2022, from https://healthpolicy.usc.edu/ article/biosimilars-competition-helps-patients-more-than-generic-competition/

• How do Drugs and Biologics Differ? - BIO. (2022). Retrieved 7 March 2022, from https://archive.bio.org/articles/how-do-drugs-and-biologics-differ

Heart Failure and Common Drug Treatments

Wed, 09 Mar 2022 16:46:19 GMT

What is heart failure?

Heart failure occurs when the heart is not able to supply sufficient oxygen-rich blood to the body because of the impaired ability of the heart to either fill or eject blood.

What Causes Heart Failure?

In the U.S., most cases are due to damage from a heart attack or from long-standing uncontrolled hypertension. Heart failure is commonly classified by what caused it as:

• Ischemic heart failure: caused by decreased blood supply, such as from a myocardial infarction (commonly known as a heart attack).

• Non-ischemic heart failure: caused by long-standing uncontrolled hypertension.

• Other less common cases include: valvular disease, excessive alcohol intake, or illicit drug use.

There are two main types of heart failure. They are defined based on whether the “ejection fraction” (which indicates how well the left ventricle is able to pump) is reduced or preserved:

• In heart failure with reduced ejection fraction, the heart is too weak. When the heart pumps, it doesn’t squeeze normally. • Also called systolic heart failure

• In heart failure with preserved ejection fraction, the heart is too stiff. When the heart pumps, it doesn’t relax and refill with blood normally. • Also called diastolic heart failure

Which are the most common heart failure symptoms?

• Shortness of breath - which might require you to cut back on your normal activities and/or sleep with several pillows to elevate your head

• Feeling tired or fatigued quickly

• Weakness, particularly of the legs, when exercising

• Lightheadedness or dizziness

• Rapid heart rate, even while resting

• Swelling in the lower legs and feet (edema) or in the abdomen (ascites)

• Unintentional weight loss (in severe heart failure)

How can we treat heart failure?

Currently there are many drug treatments that are used to treat heart failure and other cardiovascular diseases. Most of these treatments reduce your risk of having a heart attack, control high blood pressure, lower cholesterol, or improve cardiac output. The goal is to relieve symptoms; reduce the chances that you will develop complications; and slow, stop, or reverse the progression of the underlying process.

When making the decision with your healthcare provider to begin a new treatment, review your insurance plan formulary to verify the drug treatment is covered. Sometimes drug treatments can be subjected to different containment strategies in order to confirm their proper use. Contact your insurance provider if you have any doubt on the coverage of a drug therapy.

References:

1. 2017 ACC/AHA/HFSA Focused Update of the 2013 ACCF/AHA Guideline for the Management of Heart Failure: A Report of the American College of Cardiology/American Heart Association Task Force on Clinical Practice Guidelines and the Heart Failure Society of America

2. 2016 ACC/AHA/HFSA Focused Update on New Pharmacological Therapy for Heart Failure: An Update of the 2013 ACCF/AHA Guideline for the Management of Heart Failure: A Report of the American College of Cardiology/American Heart Association Task Force on Clinical Practice Guidelines and the Heart Failure Society of America

Testing Covid 19 with OTC

Wed, 23 Feb 2022 16:16:04 GMT

Test is easy and important to help reduce the virus.

Testing is critically important to help reduce the spread of the virus that causes COVID-19. If you have symptoms or have had a known exposure to someone with suspected or confirmed COVID-19, you should be tested, regardless of your vaccination status. You may also consider self-testing to screen for COVID-19 immediately before an activity to see if you are positive for COVID-19.

• Self-tests can be taken anywhere, are easy to use, and produce rapid results.

• You can use self-tests regardless of vaccination status or presence of symptoms.

• A negative self-test result means that the test did not detect the virus and you may not be infected. Repeating the test within a few days, with at least 24 hours between tests, will increase the confidence that you are not infected.

• A positive self-test result means that the test detected the virus, and you are very likely to have an infection and should stay home or isolate for 10 days, wear a mask if you could have contact with others, and avoid indoor gatherings to reduce the risk of spreading disease to someone else.

Testing Covid 19 with OTC Test is easy and important to help reduce the virus

COVID-19 self-tests (also referred to as home tests or over-the-counter OTC tests) along with vaccination, masking, and physical distancing, protect you and others by reducing the chances of spreading COVID-19.

OTC COVID-19 Tests Emergency Use Authorization (EUA)

Key Points Generally, OTC COVID-19 Tests EUAs present the following intended use, storage, and stability information. For specific questions regarding the product that you are using, please refer to the product’s information printed on the box.

How to Use a Self-Test

Follow the manufacturer’s instructions exactly, and perform the steps in the order they are listed. The manufacturer may also provide other resources, such as quick reference guides or instructional videos, to help you perform the test correctly. Talk to a healthcare provider if you have questions about the test or your results. You can also refer to CDC’s videos on “How to Use a Self-Test” and “How to Interpret Self-Test Results”.

1. Store all test components according to the manufacturer’s instructions until they are ready for use.

2. Check the expiration date. Do not use expired tests or test components that are damaged or appear discolored.

3. Clean the counter top, table, or other surfaces where you will perform the test.

4. Open test devices or other test components ONLY when you are ready to start the testing process.

5. Have a timer ready because you will need to keep track of time to interpret test results. These tests are for individuals that present symptoms within the past 7 days, or individuals who are suspected to have COVID-19 with or without symptoms. These individuals should be tested twice over the course of three days, with no more than 48 hours between tests. Store kit between 35.6-86°F (2-30°C). Ensure all test components are at room temperature before use. Tests are generally stable until the expiration date marked on the outer packaging and containers. COVID-19 Antigen Self-Test

6. Read test results only at the time specified in the manufacturer’s instructions. A result read before or after the specified time frame may be incorrect.

7. Do NOT reuse test devices or other components. After you have the results, place the specimen collection swab or tube and test in the trash, clean all surfaces that the specimen may have touched, and wash your hands.

Interpretation of Results

No test is perfect. There is always a chance that a test will return a false result. Because of this, even if you receive a negative result, you should keep practicing preventive measures, such as distancing, washing hands, and wearing masks, to reduce the risk of spreading COVID-19. If you are sick, you should stay home and isolate yourself from others, even if you receive a negative test result. Talk with your health care provider to determine if you should be retested or for advice on managing your symptoms. MC-Rx will continue to monitor announcements for OTC COVID-19 Tests as new information becomes available. For more details, please refer to CDC’s Website.

References

https://www.cdc.gov/coronavirus/2019-ncov/testing/self-testing.html#how-test https://www.cdc.gov/coronavirus/2019-ncov/testing/self-testing.html https://www.fda.gov/medical-devices/coronavirus-disease-2019-covid-19-emergency-use authorizations-medical-devices/in-vitro-diagnostics-euas-antigen-diagnostic-tests-sars-cov https://www.cdc.gov/coronavirus/2019-ncov/testing/self-testing.html#how-test https://www.cdc.gov/coronavirus/2019-ncov/testing/self-testing.html#interpret

What is arthritis?

Wed, 19 Jan 2022 16:42:58 GMT

Arthritis

Arthritis is the swelling and tenderness of one or more of your joints. The main symptoms of arthritis are joint pain and stiffness, which typically worsen with age. In addition, patients can present inflammation, redness and lack of movement. The most common types of arthritis are osteoarthritis (OA) and rheumatoid arthritis (RA).

A reduction in the normal amount of this cartilage tissue causes some forms of arthritis. Normal wear and tear causes OA, the most common type of arthritis. An infection or injury to the joints can exacerbate this natural breakdown of cartilage tissue. Your risk of developing OA may be higher if you have a family history of the disease.

RA, is an autoimmune disorder. It occurs when your body’s immune system attacks the tissues of the body. These attacks affect the cartilage and the joints. RA can eventually lead to the destruction of both bone and cartilage inside the joint.

The most common signs and symptoms of arthritis affect the joints. Symptoms can appear and disappear; can be mild, moderate or severe. Severe arthritis can result in chronic pain, incapacity to realize daily living activities and difficulty walking or using stairs. It is important to know that even if some changes are visible commonly the damage can only be seen through a radiography. Less common types of arthritis can also affect the heart, eyes, skin, and kidneys.

Another type of arthritis is psoriatic arthritis , a form of arthritis that affects some people that have psoriasis. Sometimes the problems in the arteries appear before the skin findings that characterize psoriasis. These arthritic problems can arise in any artery of the body including fingers, column and intensity can vary from low to severe. People that suffer from psoriatic arthritis can have periods of high disease activity and some periods of remission. Currently there isn’t a cure for psoriatic arthritis this is why current treatment focuses on controlling symptoms and preventing damage to the articulations.

What are the risk factors for developing arthritis?

Family history: Some types of arthritis run in families, so you may be more likely to develop arthritis if your parents or siblings have the disorder. Your genes can make you more susceptible to environmental factors that may trigger arthritis.
Age : The risk of many types of arthritis including osteoarthritis, rheumatoid arthritis and gout increases with age.
Sex: Women are more likely than men to develop rheumatoid arthritis, while most of the people who have gout, another type of arthritis, are men.
Previous joint injury: People who have injured a joint, perhaps while playing a sport, are more likely to eventually develop arthritis in that joint.
Obesity: Carrying excess pounds puts stress on joints, particularly your knees, hips and spine. People with obesity have a higher risk of developing arthritis.

What are the possible treatments for arthritis?

In terms of treatment, the main goal is to reduce the amount of pain you are experiencing and prevent further joint damage. Some people find heating pads and ice packs relaxing. Others use assistive mobility devices, such as canes or walkers, to help relieve pressure on sore joints. Arthritis treatments can help reduce inflammation in your joints, relieve pain, prevent or delay joint damage, reduce disability, and allow you to be as active as possible.

It is also important to improve the function of your joints. Your doctor can prescribe a combination of treatment methods to achieve the best results.

Medical treatments:

Pain relievers, such as hydrocodone or acetaminophen, are effective in controlling pain, but they do not help decrease inflammation.
Nonsteroidal anti-inflammatory drugs, such as ibuprofen and salicylates, help control pain and inflammation. Salicylates can thin the blood, so they should be used with great caution with additional blood-thinning medications. Avoid it if you are allergic to aspirin.
Menthol or capsaicin creams block the transmission of pain signals from the joints.
Immunosuppressants such as prednisone and cortisone can help reduce the inflammation.

How can my lifestyle help me control arthritis?

Losing weight or maintaining a healthy weight: This reduces the risk of developing OA and can reduce symptoms if you already have it. A diet high in antioxidants, such as fresh fruits, vegetables, and herbs is recommended and can help reduce inflammation. Other foods that reduce inflammation are fish and nuts. For people who are overweight or obese, losing weight reduces pressure on the joints, particularly weight-bearing joints like the hips and knees. Losing 10 to 12 pounds can reduce pain and improve function for people with arthritis. Avoid eating fried foods, processed foods, dairy products, and a high intake of meat
Exercise : Staying active will keep your joints flexible. Swimming, walking, or biking are often a good form of exercise for people with arthritis because they don't put pressure on the joints. These forms of exercise are usually recommended by doctors for arthritis patients. It is recommended that you exercise for 30-40 minutes most days of the week. Staying active is important, but you also need to make sure you rest when you need to and avoid overexerting yourself.

References:

Diabetes Awareness

Tue, 16 Nov 2021 16:35:17 GMT

Understanding Diabetes

What is Diabetes?

Diabetes is a chronic health condition that affects how your body turns food into energy. Most of the food we eat is

broken down into sugar which causes our organ called the “pancreas” to release insulin. Insulin is a substance produced

naturally and is needed to help move sugar from the blood into other parts of the body, like your legs, to help you walk.

Insulin is the key to letting sugar into your body.

If you have diabetes, your body either doesn’t make enough insulin or can’t use insulin. When there isn’t enough insulin

or cells stop responding to insulin, too much sugar stays in your blood which causes damage to your body. Over time, that can cause serious health problems, such as vision loss, heart disease, and kidney disease. Initially, none of these health problems may have symptoms.

Types of Diabetes

There are three main types of diabetes: type 1, type 2, and gestational diabetes (diabetes while pregnant).

o Type 1 Diabetes: Thought to be caused by an autoimmune reaction (the body attacks itself) that stops your body from making insulin. Approximately 5-10% of the people who have diabetes have type 1. It’s usually diagnosed in children, teens, and young adults. For type 1 diabetes, patients need to take insulin every day.

o Type 2 Diabetes: The body doesn’t use insulin well and can’t keep blood sugar at normal levels. About 90-95% of people with diabetes have type 2. It develops over many years and is usually diagnosed in adults. Type 2 diabetes can be prevented or delayed with healthy lifestyle changes, such as losing weight, eating healthy food, and being active.

o Gestational Diabetes: Develops in pregnant women who have never had diabetes. If a patient has gestational

diabetes, the baby could be at higher risk for health problems.

Gestational diabetes usually goes away after your baby is born but increases your risk for type 2 diabetes later

in life. The baby is more likely to have obesity as a child or teen and more likely to develop type 2 diabetes later

in life.

Breast Cancer Prevention

Wed, 13 Oct 2021 18:36:21 GMT

Breast Cancer Prevention

What is Breast Cancer?

Breast cancer is a disease in which malignant (cancer) cells form in the breast tissues. A breast is made up of three main parts: lobules, ducts, and connective tissue. The lobules are the glands that produce milk. The ducts are tubes that carry milk to the nipple. The connective tissue (which consists of fibrous and fatty tissue) surrounds and holds everything together. Most breast cancers begin in the ducts or lobules.

The most common types are invasive ductal carcinoma and invasive lobular carcinoma, which can spread or metastasize to other parts of the body. Ductal carcinoma in situ, is also a type of breast cancer that has not spread to other tissues of the breast.

Which are the risk factors for breast cancer?

Older age
Obesity
Drinking alcohol
Personal history of breast cancer or benign (non-cancer) breast disease
Inherited risk of breast cancer
Dense breast - Having breast tissue that is dense on a mammogram
Exposure of breast tissue to estrogen made in the body - Being exposed to estrogen over a long time may increase the risk of breast cancer. Estrogen levels are highest during the years a woman is menstruating. Other factors the increased estrogen levels:

o Early menstruation

o Starting menopause at a later age

o Older age at first birth or never having given birth

Taking hormone therapy for symptoms of menopause, such as estrogen and progesterone, which may be given to replace the estrogen no longer made by the ovaries in postmenopausal women or women who have had their ovaries removed.
Radiation therapy to the breast or chest – increased risk can be seen up to ten years after treatment.

o The risk of breast cancer depends on the radiation dose and the age at which it is given.

o The risk is highest if radiation treatment is used during puberty when breasts are forming.

o Radiation therapy to treat cancer in one breast does not appear to increase cancer risk in the other breast.

How can we prevent breast cancer?

Decreasing the length of time a woman's breast tissue is exposed to estrogen may help prevent breast cancer:

o Early pregnancy and breastfeeding (if possible) result in lower estrogen levels

Keep a healthy weight and exercise regularly. Women who exercise four or more hours a week have a lower risk of breast cancer. Most healthy adults should aim for at least 150 minutes a week of moderate aerobic activity or 75 minutes of vigorous aerobic exercise weekly, plus strength training at least twice a week.
Don't drink alcohol or limit alcohol intake to less than one drink a day
Don't smoke
Avoid exposure to radiation and environmental pollution
Taking selective estrogen receptor modulators, such as raloxifen and tamoxifen, (which act like estrogen on some tissues in the body, but block the effect of estrogen on other tissues) may lower the risk in pre- and post-menopausal women at higher risk.

o With either drug, the reduced risk lasts for several years or longer after treatment is stopped.

o Side effects include blood clots in the lungs and legs and hot flashes. It is essential to talk with your doctor about the risks and benefits of starting one of these drugs.

Use of aromatase inhibitors (anastrozole, letrozole) and inactivators (exemestane) lower the risk of both recurrence and new breast cancers in women who have a history of breast cancer.

References:

National Cancer Institute: www.cancer.gov
Mayo Clinic: www.mayoclinic.org
Centers for Disease Control and Prevention: www.cdc.gov/cancer
Medline Plus: www.medlineplus.gov

Migraine Prevention

Mon, 13 Sep 2021 12:07:00 GMT

Migraine Prevention

What is Migraine?

Migraine is a type of headache that can cause severe throbbing pain or pulsing sensation. It usually presents on one side of the head and may be accompanied by nausea, vomiting, and extreme sensitivity to light and sound. When a person suffers from a migraine attack, it can last several hours to days, and the pain could be so severe that it can interfere with the person’s daily activity. Sometimes, a visual disturbance called aura may present itself before or during a migraine attack. If the person presents aura, they may experience blurry vision, flashes of light, or blind spots.

Migraine is the 3rd most prevalent illness in the world. It is most common among people ages 18 – 44. Nearly 18% of women, 6% of men, and 10% of children suffer from migraines in the USA. Population prevalence studies report migraine prevalence rates from 2.6% to 21.7%, for an average of 12%. The most recent statistical analysis said that 15.4% and 15.5% of adults in the USA suffered from severe headaches or migraines in 2015 and 2016, respectively.

Migraine symptoms and triggers:

If you suffer from migraine, you may experience the following symptoms:

Pain in one side of the head (unilateral)
Nausea and Vomiting
Throbbing pain or pulsation
Light and sound sensitivity
Confusion
Irritability
Visual Disturbances

Triggers that may initiate or worsen migraine include:

Hormonal Changes
Alcohol
Coffee
Stress
Strong Smells (smoke, perfume, gasoline)
Changes in Weather
Meal skipping
Some medications (oral contraceptives and vasodilators)

What are the risk factors for migraines?

Major risk factors for migraines are gender, age, and genetics. Women are three times more likely to experience migraine attacks than men, and people ages 18-44 are more at risk of experiencing migraines than people under 18 and over 44. This does not, however, mean that children or older people cannot suffer from a migraine attack.

How can migraine be prevented?

The following strategies may prevent migraine attacks:

Establishing a healthy sleeping pattern (7-8 hours)
Avoiding triggers such as consuming alcohol and coffee
Practicing relaxation techniques
Avoiding hunger and low blood sugar levels
Making dietary restrictions
Practicing stress management

Maintaining adherence of prescription medications for migraine management

can also help prevent migraine attacks.

Prescription oral medications such as Propranolol, Topiramate, and/or Amitriptyline can be used as the first choice to prevent migraine attacks. Naproxen, which is available without a prescription, can also be used for prevention. Injectable agents, such as Botulinum toxin A, have been proven safe and effective for preventing migraines. Triptans and ergotamine derivatives are migraine-specific medications used to manage acute migraine attacks. Examples of triptans and ergotamine derivatives include Sumatriptan and Frovatriptan, and Ergotamine Tartrate and Dihydroergotamine, respectively.

References:

Migraine Research Foundation: https://migraineresearchfoundation.org/about-migraine/migraine-facts/
Mayo Clinic: https://www.mayoclinic.org/diseases-conditions/migraine-headache/symptoms-causes/syc-20360201
WebMD: https://www.webmd.com/migraines-headaches/migraines-causes

How to prevent an opioid overdose?

Thu, 02 Sep 2021 15:59:02 GMT

How to prevent an opioid overdose?

Knowledge that can save a life:

Prescription opioids (like hydrocodone, oxycodone, and morphine) and illicit opioids (like heroin and illegally made fentanyl) are powerful drugs that have a risk of a potentially fatal overdose. An opioid overdose occurs when too much of the drug acts on the brain and interrupts the natural impulse of the body to breath. Anyone who uses opioids can experience an overdose, but certain factors may increase this risk like:

Combining opioids with alcohol or certain other drugs such as benzodiazepines (e.g. Xanax, Valium)
Taking high daily doses of prescription opioids
Taking more opioids than prescribed
Taking illicit or illegal opioids, like heroin or illicitly-manufactured fentanyl
Certain medical conditions, such as sleep apnea, or reduced kidney or liver function
Age greater than 65 years old

Signs and symptoms of an opioid overdose:

During an overdose, breathing can be dangerously slowed or stopped, causing brain damage or death. It’s important to recognize the signs and act fast. Signs include:

Small, constricted “pinpoint pupils”
Falling asleep or loss of consciousness
Slow, shallow breathing
Choking or gurgling sounds
Limp body
Pale, blue, or cold skin

What to do if you think someone is overdosing:

Call 911 immediately
Administer naloxone, if available
Try to keep the person awake and breathing
Lay the person on their side to prevent choking
Stay with them until emergency workers arrive

Ask your doctor or pharmacist about naloxone –

This is a medication that can rapidly reverse the effects of an opioid overdose.

Myths and Facts about COVID-19 Vaccines

Thu, 26 Aug 2021 15:00:17 GMT

Myths and Facts about COVID-19 Vaccines

Everybody has the responsibility to provide correct and accurate information.

In this modern era, it is crucial to question sources of information. Reliable sources for health-related topics include the Centers for Disease Control and Prevention (CDC), Food and Drug Administration (FDA), and World Health Organization (WHO). Other useful references for people with scientific knowledge or curiosity include The Journal of the American Medical Association (JAMA) and The New England Journal of Medicine (NEJM).

COVID-19 is today's hottest topic. Incorrect information or myths about COVID-19 are common. Below are examples of myths about COVID-19 vaccines.

Myth #1: Receiving a COVID-19 vaccine will cause my body to become magnetic.

False, receiving a vaccine against COVID-19 will not cause you to become magnetic. COVID-19 vaccines are metal-free. After reports of people putting metal objects on their skin after getting the vaccine, this myth arises from social media.

Myth #2: COVID-19 vaccines cause infertility.

False, there is no evidence that COVID-19 or any other vaccine causes infertility. This myth arose from social media when people stated that mRNA vaccines target the same spike protein in placental development.

Myth #3: COVID-19 vaccines track people with a microchip.

False, none of the components of any vaccine are used to track an individual. This myth came from social media when false claims were made against a company. The company has products (syringes) with a microchip used to scan the vaccine's origin, expiration date, etc.

Myth #4: COVID-19 vaccines alter DNA (genetic material).

False, none of the COVID-19 vaccines enter the cell's nucleus (which contains the DNA). These vaccines give instructions to the cell to start producing proteins, later to be recognized by the immune system. This myth arises due to biological processes being complex and easily misunderstood.

Myth #5: Receiving a COVID-19 vaccine will give me COVID-19.

False, none of the COVID-19 vaccines contain the virus. This myth arises from other vaccines that use the virus, which can be inactivated/dead (vaccines like Hepatitis A, flu, polio, and rabies). Other vaccines use the live-attenuated virus (chickenpox, smallpox, measles, mumps, and others).

Myth #6: Receiving a COVID-19 vaccine will cause a positive result on a viral test.

False, none of the COVID-19 vaccines will positively result in the tests used to determine current infection. However, after receiving a vaccine, we develop antibodies. The presence of antibodies will lead to a positive result for an antibody test (used to indicate the previous infection and to test immunity).

Myth #7: If I get COVID-19, I don't need a vaccine.

False, even if you are infected, you can still get re-infected. Evidence suggests a benefit in getting vaccinated after being infected with COVID-19. The body does generate certain immunity after being infected. However, this type of immunity is not long lasting.

Myth #8: The side effects of COVID-19 vaccines are common.

COVID-19 vaccines may cause the following expected side effects: pain in/around the area of injection, body aches, headaches, or fever. These are signs that the vaccine is working to stimulate your immune system and be treated with over-the-counter drugs (acetaminophen). Infrequent and fatal side effects have been reported. For example, the FDA has recently included a warning for Janssen's COVID-19 vaccine about Guillain-Barre Syndrome (GBS). GBS is a rare disorder in which your body's immune system attacks your nerves. After 12.5 million vaccines have already been administered, only 100 cases have been reported, that's about 0.0008%, with only one mortality. To put things in context, aspirin can cause a severe adverse drug reaction called Drug Reaction with Eosinophilia and Systemic Symptom (DRESS). This can occur in 0.01 – 0.1% and has a mortality rate of up to 10% among people that develop DRESS.

Myth #9: COVID-19 vaccine research was rushed and cannot be trusted.

False, there are many reasons why the COVID-19 vaccines were developed so fast:

● The technology used for Pfizer/BioNTech and Moderna, called mRNA vaccines, was in development since 1990, and this allowed for rapid vaccine development.

● The coronavirus group existed before the 2019 pandemic, and its genetic sequence was already known. A strain of coronavirus was first isolated in humans in 1965, and 3 species cause severe symptoms:

o Severe acute respiratory syndrome coronavirus (SARS-CoV, 2003)

o The Middle East respiratory syndrome-related coronavirus (MERS-CoV, 2012)

o Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2, 2019)

● China quickly isolated and shared genetic information. Scientists started working on vaccines. These vaccines are approved under emergency use authorization (EUA). They are under constant surveillance. For example, after six reported cases of blood clots related to Janssen's COVID-19 vaccine, the FDA recommended pausing vaccination. After a safety review, the pause was lifted.

● The vaccine developers didn't skip proper testing. Steps were carried out on an overlapping schedule to gather data faster (Operation Warp Speed).

IMPORTANT: If you have questions about COVID-19, seek information from an expert. Do not repeat false information and always be respectful.

References:

1. https://www.cdc.gov/coronavirus/2019-ncov/vaccines/facts.html

2. https://www.hopkinsmedicine.org/health/conditions-and-diseases/coronavirus/covid-19-vaccines-myth-versus-fact

3. https://www.defense.gov/Explore/Spotlight/Coronavirus/Operation-Warp-Speed/

TRANSPARENCY AND OPENNESS - A MUST

Wed, 11 Nov 2020 15:11:50 GMT

Transparency and Openness – A Must in the Murky World of Drug Pricing

A NOTE FROM THE CEO

Wed, 11 Nov 2020 15:09:18 GMT

HOW DOES MC-RX CHALLENGE THE WELL-ESTABLISHED PBMS IN THIS COMPETITIVE MARKET?

Our company's growth is driven by our technology, direct contracts, and over 20 years’ of experience in pharmacy benefit management, combined with the agility and ability to develop, market, and deliver innovative programs against much larger, well-funded competitors.

As the industry rapidly rolled up through mergers and acquisitions, the small- and medium-sized self-insured employers and health plans became second-class citizens to those larger competitors. We chose to go directly to those customers to offer contracts, services, and technology equivalent to or better than those offered by the larger PBMs. Based upon our lean infrastructure and collaborative client approach, we are able to provide this offering customized to client requirements at a reduced price to allow them to control their costs and the healthcare outcomes with no hidden costs and absolutely no “shell games”.

"Small health plans currently contracted with one of the large PBMs may find themselves effectively working with, and selling against, their larger competitors, as the PBM may be owned by a large insurance company or drug store chain. Why would anyone want to contract with a competitor for one or more core services when they have a better, faster, cheaper, and customizable option provided by an independent partner with no conflicts of interest?" asked Roger Burgess, Chairman of MC-Rx.

“Another significant value that MC-Rx provides to our customers is the superior quality of our services compared to other solutions,” Burgess added, “Everything that we do is targeted to provide the client with what they need to create and manage plan designs focused on saving money and improving the health of their members. Since we own all the contracts and the technology, we can always customize the platform to a client’s individual needs.”

When a client contracts with MC-Rx, they can be assured that all plans are 100% tested against existing claims before the new plans go into production. Some competitors may only do spot-claim type testing versus the comprehensive regression testing we perform against all recent claims, which allows our clients to know the overall cost and member disruption impact before going into production.

Transitioning to a new platform is stressful, and this level of extensive testing creates peace of mind, as well as providing an advanced claim level confirmation of cost savings.

WHAT ARE SOME OF THE BIG CHALLENGES MC-RX IS FACING?

Brokers and consultants sometimes consider it "safer or easier" to recommend that their clients purchase the services from one of the big PBMs instead of digging into more customized service offerings designed specifically for the client that may also generate additional cost savings. We have worked with hundreds of these intermediaries to show them the opportunities that MC-Rx can offer them for their clients.

Additionally, we see larger insurers that are contracting with self-insured payers as their Administrative Services Organization (ASO), either blocking them from carving out pharmacy benefits or raising the administrative fees to dissuade the plan sponsor from making a change. As justification, they maintain that they can manage members better when the data is integrated. In most cases, their pharmacy data and their medical data are in two separate systems and all “integrations” happen after the fact, not in real-time. We share data openly with brokers, ASOs and Third Party Administrators (TPAs), and we can provide the data, in compliance with all regulatory requirements, in near real-time.

As we work with brokers and TPAs, we show them and the plan sponsors that these moves should flag the hidden profit margins those larger insurers may retain from the pharmacy side of the employee medical plan equation. We have several case studies showing that mid-sized employer groups were able to transition from a fully insured arrangement to a self-insured arrangement, realizing over 30% in annual cost savings from the pharmacy spend alone.

WHAT ARE THE BIG OPPORTUNITIES YOU SEE IN THE MARKETPLACE?

Prescription drug spending in the U.S. is in the hundreds of billions of dollars and continues to grow as our population ages and new drugs enter the market. MC-Rx’s innovative clinical and member service offerings, customizable networks, direct contracts, and extensive experience allow us to be responsive to our clients' needs: to help them solve problems, optimize their drug lists and pharmacy network, and identify ways to help them manage their costs and their members’ health outcomes.

As one of the few truly independent PBMs left in the marketplace today that own their own direct contracts, clinical services, and technology and currently serves millions of members, MC-Rx should be a clear choice.

About MC-Rx: ProCare Pharmacy Benefit Manager Inc. acquired MC-21, LLC in 2018 and created MC-Rx by combining the two Pharmacy Benefit Managers (PBM). Each of the PBMs have over 20 years’ experience serving Employers, Medicare Health Plans, Medicaid Health Plans, City, County, and State Government organizations, Unions, Workers Comp intermediaries, and other payers of prescription drug benefits. For more information about MC-Rx products and services, please contact PublicRelation@mc-rx.com or sales@mc-rx.com.

TOP COVID 19 SUMMIT

Wed, 11 Nov 2020 15:08:16 GMT

In this time of uncertainty, Steve Treff and Barbara Rambo “sit down” with Karla Jo Helms, CEO of JoTo PR, to bring some clarity of the essential functions of a PBM, and introduce the steps MC-Rx is taking to ensure those affected by this crisis do not lose their ability to access the medications they need at a reasonable price. This discussion is part of a larger panel discussion regarding the current hurdles the country is facing due to the pandemic. You can link to both the PBM transcript AND the entire panel discussion below:

Entire panel: https://lnkd.in/dDxkrp4

MC-Rx segment: https://lnkd.in/dbnJT5J

ProCare Rx Acquires MC-21

Wed, 11 Nov 2020 15:06:46 GMT

MC-21 Merges with ProCare’s Pharmacy Benefit Manager

Atlanta, Georgia

May 7, 2018

ProCare, a leading independent national PBM founded almost 30 years ago and headquartered in Gainesville, Georgia, has joined forces with MC-21 LLC, the market-leading Pharmacy Benefit Manager in Puerto Rico, founded in 1998. The intention is to broaden service offerings and strengthen key capabilities.

This new chapter for ProCare was formalized on April 30, 2018.

“Our PBM clients and the members they serve require continuous innovation, especially around value-based reimbursement models and the role pharmacies can play in improving health outcomes and lowering total healthcare costs. We believe MC- 21 Corporation, with Rosa Hernandez, MC-21’s President since the company’s inception, is a great addition to our team, and the experience she brings with regard to innovation in these value–based models, in particular, will help us to continue to serve our clients’ needs while also developing and delivering more innovative solutions and offerings”, ProCare’s Chairman Roger Burgess said.

Rosa Hernández continued, “MC-21 clients will gain immediate access to an expanded array of services, programs, and technological tools – innovative and proprietary – as well as increased efficiency and flexibility in the processing of prescriptions, value-based contracting, and business intelligence services, among others.” Hernandez added, “There will be no disruption in the award-winning service levels currently enjoyed by MC-21’s clients”.

A key to this union is the common vision that both companies share in providing efficient and cost–effective services tailored to clients’ needs. The business focus of both companies will continue to concentrate on heath insurance plans, managed care, self-insured employer groups, government employees, unions, public health organizations, hospices, and workers compensation plans.

The combined company will be well positioned to address the rapid and continuous changes both in the commercial and subsidized healthcare industry in the United States and Puerto Rico. With this union, the combined company will manage more than 174 million prescriptions per year for over 8 million patients.

Roger Burgess concluded, “The combination of ProCare and MC-21 is highly focused on better serving the Medicare and Medicaid MCO market by driving down costs and gaining shares in these fast growing markets as the government’s role will continue to increase in the coming years driven by the growth in the number of Medicare lives”.

For more information about the ProCare companies, please contact:

Barbara Rambo, ProCare Rx CFO /678-248-3101

For more information about MC-21, please contact:

Rosa Hernández Amalbert, MC-21 Marketing Director / 787-286-6032 Ext. 3168

ProCare PBM and MC-21 join forces

Wed, 11 Nov 2020 15:05:14 GMT

New name, same tradition of excellence. Same dedication to better health. Same commitment to quality, reliability, and care.

Miramar, FL – May 16, 2019 – ProCare PBM and MC-21 combine to form MC-Rx. The combination of ProCare PBM and MC-21, both URAC-accredited for pharmacy benefit management services, makes MC-Rx one of the top privately-owned pharmacy benefit management companies in the US and Puerto Rico. Together they have over 50 years’ experience, four major locations, two state-of-the-art 24/7 data and customer support centers, three software research and development centers, and more than 550 employees. By virtue of this combination, MC-Rx will have clients in all 50 states, Puerto Rico, St. Thomas, and the U.S. Virgin Islands.

Roger Burgess, Founder, Chairman, & CEO said, "We believe that operating our pharmacy benefit management services as MC-Rx in all of our markets will allow us to better serve customers, be more efficient, and create and build one trusted brand. MC-Rx will draw on our strengths and unlock the power of a single brand."

About MC-Rx

MC-Rx is a Pharmacy Benefit Manager (PBM) that provides state-of-the art, client–focused solutions with a comprehensive portfolio of services and capabilities.

MC-Rx provides better, faster, cheaper and customized pharmacy benefit services and solutions. They partner with clients by understanding and actively responding to their needs so they can manage their business and pharmacy program the way they want to.

Andrea Baker, Marketing Director

800-377-1037

sales@mc-rx.com

Openness in Drug Pricing at the Forefront of MC-Rx Mission

Wed, 11 Nov 2020 15:03:46 GMT

In the world of pharmaceutical pricing, distrust and misinformation are rampant. Independent PBMs ProCare PBM and MC-21 recently combined, setting a new standard for transparency and openness in prescription drug pricing.

GAINESVILLE, GA, Aug. 5, 2019 -- The merger of MC-21 and ProCare PBM to form independent pharmacy benefit manager MC-Rx creates a new standard for transparency and openness in prescription drug pricing.

MC-Rx is a competitive and service-focused pharmacy benefit manager (PBM) option for businesses and insurers in the U.S. and Puerto Rico.

"MC-Rx clients have the ability to review and audit our contracts to ensure that the price we pay the pharmacy on their behalf is exactly the same price that is billed on their invoice," said LaMar Williams, executive vice president of MC-Rx. "Additionally, after each claim has been reconciled, we populate the same data in both the –pharmacy reimbursement field as provided in the billed amount to the client. This approach allows our clients to see that what we have reimbursed for their members' pharmacy claims exactly matches what we have billed."

Lowering healthcare costs is an important issue for most Americans, but the causes of high prescription drug prices are largely misunderstood.

PBMs absorb misplaced blame for drug costs in the court of public opinion. According to a study by the TPA network, many consumers view PBMs as a "black box," meaning "they know what they should do but they don't know if and how they do it" [1]. Open systems and processes as deployed by MC-Rx allow clients to not only know what the PBM should be doing but easily confirm the "ifs" and the "hows".

In January, the U.S. Department of Health and Human Services (HHS) issued a proposal to ban rebates paid by drug makers to PBMs[2]. There has been widespread concern about where the rebate money ends up. Although the rebates are supposed to be passed onto PBMs' client beneficiaries through lower premiums or out of pocket costs, they could instead be partially pocketed by the PBM themselves. Thus, even though the Trump administration abandoned this bill in early July, public skepticism about PBMs remains[3].

The HHS proposal further positioned PBMs at the forefront of the complex, multifaceted issue of prescription drug pricing. In reality, PBMs are the middlemen between drug manufacturers and pharmacies, helping to reduce prescription drug costs by:

Offering home delivery for medications;

Facilitating and creating a network of pharmacies that carry affordable and generic medications;

Communicating with drug manufacturers to negotiate rebates that secure lower prices, and;

Managing the high costs associated with specialty medications[4].

Despite these efforts by PBMs to reduce prescription drug costs, the HHS proposal included passing rebates onto consumers directly at the point of sale. After further evaluation by the Trump administration, the proposal was dropped, due in part to the statistical prediction that it could increase Medicare spending by $200 billion[5].

"A core tenet in our philosophy is lowest net cost, so we are in full agreement with the mandate to control drug spending, but also agree with the decision to seek avenues other than the recently announced drug rebate rule," Williams said. "The rule and timeline as proposed would have found many PBM's and their claims processing system vendors ill-prepared to accommodate the impact of the change. Public education and outreach to the industry leading to legislative reforms are vital and MC-Rx stands poised to be on the leading edge of advancement for these initiatives."

About MC-Rx

MC-Rx, a full-service pharmacy benefit manager (PBM) with corporate offices in Gainesville, Ga. and Caguas, Puerto Rico, focuses on transparency, best-in-class service and offering clients the "lowest net cost." MC-Rx was formed by combining two Utilization Review Accreditation Commission (URAC) certified world-class PBMs: ProCare Pharmacy Benefit Manager and MC-21. The newly formed ProCare company provides innovative computer software systems and services to various sectors of the healthcare industry. Together they have more than a half-century of industry experience, four major locations, two state-of-the-art 24/7 data and customer support centers, three software research and development centers, and more than 550 employees. By virtue of this combination, MC-Rx will have clients in all 50 states, Puerto Rico and the U.S. Virgin Islands. MC-Rx includes two affiliated mail-order and specialty pharmacies, ProCare PharmacyCare, and is one of only four PBM providers that own all of their component systems. For more information, visit http://www.mc-rx.com.

Nicholas, Richard L. "Everything You Always Wanted to Know about Pharmacy Benefit Managers." https://www.aprx.org

"Trump Administration Proposes to Lower Drug Costs by Targeting Backdoor Rebates and Encouraging Direct Discounts to Patients." Hhs.gov, 31 Jan. 2019, http://www.hhs.gov.

Lovelace, Berkeley. "Senate Panel Wants to Bring Back Drug Proposal Loved by Big Pharma in New White House-Backed Bill." CNBC.com, 25 July 2019, http://www.cnbc.com.

"What Is a PBM?" http://www.pcmanet.org, http://www.pcmanet.org/our-industry/.

Sullivan, Peter. "White House Withdraws Controversial Rule to Eliminate Drug Rebates." http://www.thehill.com, 11 July 2019

Open Pricing in the PBM Industry – Do You Know What’s Behind the Scenes?

Wed, 11 Nov 2020 15:02:04 GMT

HOMEPBM SOLUTIONSRESOURCES

MEMBER PHARMACIES

HomeOpen Pricing in the PBM Industry – Do You Know What’s Behind the Scenes?

IN THE NEWS

OPEN PRICING IN THE PBM INDUSTRY – DO YOU KNOW WHAT’S BEHIND THE SCENES?

John Gerzema, CEO of The Harris Poll, a leading public opinion, market research, corporate, brand, and reputation strategy firm1, said, "Transparency, honesty, kindness, good stewardship, even humor, work in businesses at all times."

Although dishonesty, misuse, and fraud are on the minds of many Americans when it comes to politics, in recent years, the pharmacy benefit management (PBM) industry has come under intense scrutiny to become more transparent, also. As pressures mount to effectively manage the cost of prescription drugs, plan sponsors have begun asking questions in an attempt to better understand the inner workings of PBMs, their revenue streams, and fee structures.

Sometimes contract confusion comes from the “spread model,” where the pharmacy is charged one price for a prescription, the plan sponsor is charged a higher price for the same product, and the PBM keeps the difference.

Although there is nothing inherently wrong with the spread model (that is the typical American model, i.e. shopping at a grocery store, retail store, etc.), the plan sponsor is charged a higher price for the same product and the actual spread/margin can seem excessive.

Unlike the spread model, MC-Rx uses a “pass-through” or open pricing model, which bills the client the same amount paid to the pharmacy and charges clients a disclosed and fixed fee per member/per month, or a per-claim administrative fee2. Having an open pricing model guarantees that plan sponsors are never in the dark about their contract and are free to audit it at any time.

More than half of employers feel that PBM contracts are complicated and mainly benefit the PBM at the expense of the employer3. By being open on all fronts, it is MC-Rx’s goal to put our clients’ minds at ease by making ourselves open to shine some light on our contracts.

References

1 https://www.johngerzema.com/john-gerzema

2Hemphill TA. The "Troubles" with Pharmacy Benefit Managers. Regulation. 2017:14-17. https://object.cato.org/sites/cato.org/files/serials/files/regulation/2017/3/regulation-v40n1-5.pdf. Accessed April 3, 2018.

3Kuehner-Hebert K. What do employers think of prescription drug benefits? BenefitsPRO. https://www.benefitspro.com/2017/10/25/what-do-employers-think-of-prescription-drug-benef/?slreturn=20180327085914. Published October 25, 2017. Accessed April 27, 2018.

PBM Urges Security and Convenience with Prescription Data

Wed, 11 Nov 2020 15:00:26 GMT

Amazon has entered the pharmacy sphere with its acquisition of PillPack and all signs point to positive impacts on the industry.

However, some experts have shared concerns regarding high-profile missteps. MC-Rx, a leading pharmacy benefit manager (PBM), says while the future looks promising, security must be synonymous with convenience.

GAINESVILLE, Ga., Sept. 5, 2019 -- In 2018, online retail giant Amazon set out to conquer the consumer-facing experience with its acquisition of PillPack, an online retail pharmacy. However, some pharmaceutical experts and investors have recently expressed concerns regarding their patient data management. MC-Rx, one of the top privately-owned pharmacy benefit management companies in the US and Puerto Rico, says Amazon entering the marketplace can be a positive free-market boost to increase competition and hence outcomes for patients, but consumers beware as Protected Health Information is not just another online service.

Case in point: PillPack may be forced to halt soon due to their recent battle with Surescripts, an electronic-prescription company. PillPack contracts with medical data aggregation platform ReMy, which in turn pulls its data from Surescripts (Surescripts > ReMy > PillPack). Surescripts terminated their agreement with ReMy last month, citing that ReMy was giving patient information to Amazon fraudulently. The matter has been turned over to the FBI for further investigation, but this whirlwind of activity is certainly prompting caution.[1]

"Protecting Patient Health Information is a vital aspect of our business," said LaMar Williams, Executive Vice President of MC-Rx.

MC-Rx is no stranger to high-tech security with medical records. Powered by ProCare Rx, another industry leader in innovative pharmacy management technology, MC-Rx operates its own internally developed and maintained claims processing adjudication engine. Every member prescription is evaluated electronically within the same integrated platform in real-time, whether filled by their own mail order/specialty pharmacy or within their extensive retail pharmacy network. Their technology allows prescription claims to be processed in seconds, providing improved clinical outcomes while at the same time delivering significant cost savings.

PillPack's patient data store was revealed to be vulnerable to sophisticated hackers who can gain access to Big Tech's clouds.[2] Israeli cybersecurity firm NSO Group, who was responsible for developing the "Pegasus" malware used to compromise WhatsApp in May 2019, may pose a significant threat to PillPack.[3] Sources with access to NSO Group's new product presentation have revealed that it has developed capabilities to scrape data from the cloud, and potentially lift all of an individual's data as stored by tech giants such as Facebook, Google, Amazon and Microsoft.[4]

Amazon is reportedly "[continuing] to investigate and monitor the issue," and has found no evidence of a breach from this source thus far.[5]

"This is where consumers should really read the terms of service before agreeing to submit their personal [health] information," said Williams. "This may not be convenient, but in the long run it is crucial."

Questions to ask are:

Look for third-party administrators that could have access to patient data-who are they, what is their role?

Are they URAC accredited for mail order services? (URAC helps promote health care quality through the accreditation of organizations involved in medical care services.)

Are multiple quality checks performed by licensed professional pharmacists for every prescription?

Is there a barcoded shipping and manifesting system that provides reliable and fast, delivery-including the ability to track every order and assure its confidentiality?

"While we applaud Amazon's foray into the prescription market in the efforts to improve convenience and affordability for consumers-it's vital all industry leaders work together to establish and maintain the best security protocols for consumers," said Williams.

MC-Rx's only data security focus, as a PBM, is on security of patient healthcare data. In order to succeed in this market that must be the number one priority above convenience.

About MC-Rx

MC-Rx is a full-service Pharmacy Benefit Manager (PBM) with corporate offices in Gainesville, Georgia and Caguas, Puerto Rico, with focuses on transparency, best-in-class service, and offering clients "lowest net cost." MC-Rx was formed by combining two URAC certified world class PBM's - ProCare Pharmacy Benefit Manager and mc-21. The ProCare companies were founded in 1988 with the vision of providing innovative computer software systems and services to various sectors of the healthcare industry. ProCare processed their first pharmacy claim in 1994 using their proprietary, internally developed and managed systems, and expanded in 1998 to full-service pharmacy benefit management through the acquisition of NextGen PBM. Today, the ProCare companies also includes two affiliated mail-order and specialty pharmacies, ProCare PharmacyCare, and are one of only four PBM providers that own all of their component systems. MC-Rx now provides comprehensive, industry-leading service to clients in Puerto Rico and the U.S. Visit http://www.mc-rx.com/

1) Bloomberg News. "Surescripts Cuts off Vendor Linked to Amazon Unit, Citing Misuse." Health Data Management, Health Data Management, 2 Aug. 2019,

2) Srivastava, Mehul. "Israeli Group's Spyware 'Offers Keys to Big Tech's Cloud'." Financial Times, Financial Times, 19 July 2019, http://www.ft.com/content/95b91412-a946-11e9-b6ee-3cdf3174eb89.

3) Hamilton, Isobel Asher. "The Israeli Firm behind Software Used to Hack WhatsApp Reportedly Boasted That It Could Scrape Data from Amazon, Apple, Facebook, Google, and Microsoft Cloud Servers." Business Insider, Business Insider, 19 July 2019, http://www.businessinsider.com/nso-boasted-it-can-hack-apple-google-amazon-cloud-servers-2019-7.

4) Kanter, Jake. "WhatsApp Was Hacked and Attackers Installed Spyware on People's Phones." Business Insider, Business Insider, 14 May 2019, http://www.businessinsider.com/whatsapp-hacked-attackers-installed-spyware-2019-5?r=US&IR=T.

5) Srivastava, Mehul. "Israeli Group's Spyware 'Offers Keys to Big Tech's Cloud'." Financial Times, Financial Times, 19 July 2019, http://www.ft.com/content/95b91412-a946-11e9-b6ee-3cdf3174eb89.

6) "Capital One hack suspect may have breached more than 30 organizations." CBS News. August 142019, http://www.cbsnews.com/news/capital-one-data-breach-suspect-paige-a-thompson-may-have-hacked-more-than-30-other-organizations/

MC-RX URGES INDUSTRY ACCOUNTABILITY FOR PBMS WITH JOTO PR

Wed, 11 Nov 2020 14:58:38 GMT

Drug prices are a heated topic in American society and in the Federal government. Pharmacy Benefit Managers (PBMs) usually take the blame for rising drug costs with rebate practices. MC-Rx, a full-service PBM, is urging others in the industry to be held accountable for their rebate practices.

Tampa Bay, FLA. (PRWeb) September 25, 2019

It’s no secret that PBMs are considered culpable for high drug prices in the court of public opinion. As of late last month, 47 states had filed a collective 275 bills to address rising drug costs—nearly half of these bills pertained to PBMs [1]. Republicans and Democrats do agree on the need to lower these exorbitant costs; the conflict arises when it comes to logistics. With all the controversy swirling in the industry, MC-Rx Executive Vice President LaMar Williams is calling for all fellow PBMs to be accountable for their rebate practices and product placement on their formularies.

Rebate and formulary malpractices contribute immensely to the negative public opinion of PBMs. As the middlemen between drug manufacturers and pharmacies, PBMs negotiate prices with drug manufacturers. Those manufacturers want their product on as many formularies as possible, so they include rebates that PBMs can either partially pocket or pass-through to their clients, the plan sponsors. This former tactic can encourage negotiations that are more in favor of yielding greater rebate profit than the lowest net cost for consumers.

MC-Rx’s approach to formulary and rebate management follows the lowest net cost methodology. They develop their preferred drug list based upon medications with the best efficacy and lowest total of acquisition cost, less available rebates. Their Pharmacy and Therapeutics Committee reviews and determines which drugs are the most therapeutically sound and cost effective.

“We allow our customers to see all components of their pharmacy claim data. They are able to view what was paid to the pharmacy and what we billed to their plan. Customers with rebate pass-through arrangements can elect to receive a similar level of detail,” said Williams. “We are open and completely auditable. Open access is the key to real transparency.”

Williams recognized the need to bring a strong, clear voice to the murky issue when his company signed with JoTo PR in June. MC-Rx wanted to bring clarity and set a standard for the PBM industry. “Communication efforts are vital in disseminating accurate information to the industry, our pharmacy customers, lawmakers, and ultimately, the consumers who are most positively-affected by lowered drug prices,” continued Williams.

Karla Jo Helms, CEO of JoTo PR, recognizes the value of MC-Rx’s purpose and need to lead the way in revamping the rising drug costs. “Major players in various industries tend to overuse the word “transparency” without really considering the definition or expectations attached to it,” Helms said. “MC-Rx takes this to the next level with accountability—by holding themselves accountable and open for their practices to their clients.”

MC-Rx is a full-service Pharmacy Benefit Manager with corporate offices in Gainesville, Georgia and Caguas, Puerto Rico, focusing on true openness leveraging real transparency, best-in-class service, and offering clients “lowest net cost.” The company was formed by combining two URAC-accredited, world class PBM’s (ProCare Pharmacy Benefit Manager and MC-21) and provides comprehensive, industry-leading service to clients in Puerto Rico and the U.S.

JoTo PR has a track record of innovative PR services that demonstrates their ability in gaining consistent news traction within the media for national and international organizations—helping provide front-line information about industry disruptions and technological solutions aimed at making markets better for consumers. The firm is a trailblazer in the PR industry, blending traditional PR expertise with digital media algorithms to harness the advantages of the current PR landscape. JoTo PR specializes in the healthcare, finance, and technology sectors, but they have worked for a variety of industries and non-profits, using a proprietary process to consistently identify, communicate, and distribute the latest news most valuable to journalists’ readers, viewers, and listenership.

About JoTo PR DisruptorsTM:

After doing marketing research on a cross-section majority of 5,000 CEOs of fast-growth trajectory companies and finding out exactly how they use PR, how they measure it, and how they want the PR industry to be different, PR veteran and innovator Karla Jo Helms created JoTo PR and established its entire business model on those research findings. Astute in recognizing industry changes since its launch in 2009, JoTo PR’s team utilizes newly established patterns to create timely PR campaigns comprising both traditional and the latest proven media methods. This unique skill enables JoTo PR to continue to increase the market share and improve return on investment (ROI) for their clients, year after year, beating usual industry standards. Based in Tampa Bay, Florida, JoTo PR is an established international public relations agency. Today, all of JoTo PR’s processes are streamlined PR services that have become the hallmark of the JoTo PR name. For more information, visit JoTo PR online at http://www.jotopr.com.

About Karla Jo Helms:

Karla Jo Helms is the Chief Evangelist and Anti-PR Strategist for JoTo PR.

Karla Jo learned firsthand how unforgiving businesses can be when millions of dollars are on the line—and how the control of public opinion often determines whether one company is happily chosen or another is brutally rejected.

Being an alumna of crisis management, Karla Jo has worked with litigation attorneys, private investigators, and the media to help restore companies of goodwill back into the good graces of public opinion. Karla Jo operates on the tenant of getting it right the first time, not relying on second chances, and doing what it takes to excel.

Karla Jo has patterned her agency on the perfect balance of crisis management, entrepreneurial insight, and proven public relations experience. Helms speaks globally on public relations, how the PR industry itself has lost its way, and how, in the right hands, corporations can harness the power of PR to drive markets and impact market perception.

1. Mills, Shamane. “States Continue To Tackle Rising Drug Costs.” Wisconsin Public Radio, 11 Sept. 2019

THE BLACK BOX OF DRUG PRICING HAS BEEN OPENED; PBM MC-RX URGES ACCOUNTABILITY

Wed, 11 Nov 2020 14:57:05 GMT

Several states have passed drug price transparency laws that require drug makers to report the reasons behind dramatic price increases. More states will follow. These laws represent an important first step in shining a light on why drug prices are rapidly rising. MC-Rx, a PBM advocating for change, argues the need not just for transparency, but accountability in the often secretive flow of funds from the pharmaceutical manufacturer to the ultimate consumer.

Gainesville, GA. (PRWeb) December 10, 2019

As drug prices continue to rise at a significant rate, hindering efforts to restrain overall healthcare costs, lawmakers and industry insiders are calling for major changes to the industry’s pricing formularies and payment strategies. The action comes as the practices of drug makers, insurance companies, and particularly Pharmacy Benefit Managers (PBMs) have come under scrutiny following government studies revealing little to no transparency in the areas of pricing and reimbursement schemes [1]. “Transparency isn’t enough,” said LaMar Williams, Executive Vice President of MC-Rx. “There has to be accountability. We allow our customers to see all components of their pharmacy claim data. Our clients can see the details of every claim processed, including the patient copay, amount billed to their plan, and the ultimate pharmacy payment. They can opt to receive pass-through pricing at the same rates as are paid to the pharmacy. We are open, honest, and completely auditable. Open access is the key, and we call on all PBMs to operate in the same way.”

The new transparency laws, which are in effect in Vermont, Nevada, California, and Oregon, provide states the ability to collect common elements about drug pricing, such as data concerning both brand name and generic drugs; drug prices and percentage increases over time; production costs, including manufacturing and marketing; sales revenue and profit; and money spent on patient assistance programs. Their purpose is to provide lawmakers and consumers visibility into the process by which pricing is calculated [2].

Williams believes complete accountability is the most effective way for PBMs to ensure they remain commercially viable and true to their mission, which is to work with pharmacies and insurers to find ways to lower drug costs for consumers while improving the healthcare delivery system – a mission he believes has been forgotten at many larger PBMs. This makes it harder for everyone.

“Strong, independent, (privately-owned) PBMs provide value to the pharmaceutical industry and to patients. In an age of vertical integration and mergers, it’s important that clients, insurers, and payers have options and that competition doesn’t disappear,” he said.

Lawmakers in Maryland agree. They passed price-gouging legislation that authorizes its attorney general to instruct the circuit court to fine drug manufacturers that raise the price of generic drugs by 50 percent or more within 12 months – and subsequently return funds to patients and payers. The pharmaceutical industry is contesting the law in court, but similar legislation is being considered in multiple other states [3].

Physicians support the legislation, as well as improved transparency and accountability around PBMs. A report issued by the American College of Physicians highlighted “the need for reliable, timely, and relevant information on prescription drug pricing for physicians and patients [4].”

According to experts, the role PBMs play in reducing healthcare costs has increased in scope in recent years, at the same time that government and consumer confidence in their operations has decreased.

“We believe in accountability, so we put our money where our mouth is, and we encourage all the PBMs out there to do the same,” said Williams. “That should be the industry standard.”

About MC-Rx

MC-Rx is a full-service Pharmacy Benefit Manager (PBM) with corporate offices in Gainesville, Georgia and Caguas, Puerto Rico, which focuses on transparency, best-in-class service, and offering clients “lowest net cost.” MC-Rx was formed by combining two URAC-accredited, world class PBM’s - ProCare Pharmacy Benefit Manager and mc-21. The ProCare companies were founded in 1988 with the vision of providing innovative computer software systems and services to various sectors of the healthcare industry. ProCare processed their first pharmacy claim in 1994 using their proprietary, internally developed and managed systems, and expanded in 1998 to full-service pharmacy benefit management through the acquisition of NextGen PBM. Today, the ProCare companies also include two affiliated mail order and specialty pharmacies, ProCare PharmacyCare, and are one of only four PBM providers that own all of their component systems. MC-Rx now provides comprehensive, industry-leading service to clients in Puerto Rico and the U.S. Visit http://www.mc-rx.com/.

1. “GAO Highlights,” Government Accounting Office, July 2019

2.“California’s new transparency laws show staggering rise in wholesale drug prices,” Los Angeles Times, October 11, 2019

3. “Maryland Passes Nation’s First Prescription Drug Affordability Board Legislation,” National Academy for State Health Policy April 15, 2019

4. Policy Recommendations for Pharmacy Benefit Managers to Stem the Escalating Costs of Prescription Drugs: A Position Paper from the American College of Physicians,” Annals of Internal Medicine, November 12, 2019

CDC ORDERS RULES RELAXED FOR HOME DELIVERY PHARMACY MEDICATION DURING THE CORONAVIRUS PANDEMIC

Wed, 11 Nov 2020 14:52:08 GMT

With adults 60 years and older most at risk during the pandemic, and 85% of this demographic in the U.S relying on prescriptions, maintaining access to medication is vital.(1)(2) Compared to in-store pharmaceutical visits, obtaining medication from established mail order all but eliminates the risk of exposure and helps reduce the threat of prescription stockpiling panic by ensuring regularly scheduled deliveries. MC-Rx and its affiliated home delivery pharmacies are committed to meeting that demand.

(Gainesville, GA) March 30, 2020—Using home delivery pharmacies to obtain prescription medications is an immediate step those who are most at risk can take to protect themselves from the COVID-19 virus, according to MC-Rx, a national Pharmacy Benefit Manager (PBM). MC-Rx announces that, effective immediately, it has enhanced several aspects of its services to the company’s clients and their members to ensure medication availability. These protocols aim to adhere to current social-distancing procedures and quarantine actions while reducing the risks of both medication inaccessibility and prescription hoarding.

Details of the MC-Rx announcement include:

MC-Rx will support clients who are seeking to enact emergency procedures for prescriptions by allowing early refills of maintenance medications or other changes in plan design rules.

The MC-Rx affiliated Pharmacy Support Center will remain available 24/7 and can assist in finding available medications should any shortages occur.

MC-Rx will make 30-day prescriptions available at the 30-day retail price with no additional shipping fees in addition to the normal 90-day supply coverage.

Client support staff and clinical pharmacists will remain available for phone calls and emails from 9 AM to 6 PM Eastern Time, Monday through Friday.

The company’s wholly owned and internally managed data centers, which can be remotely administered by its IT staff, will continue to operate without interruption.

“MC-Rx is here to support our clients and their employees during these difficult times. We will work even harder to maintain your confidence as well as keep you informed of any changes,” pledged Steven Treff, President and COO of MCH.

The American Pharmacists Association (APA) recently called for health insurers and PBMs to implement flexibility into their operating protocols. (3) Specifically, the APA expressed concern about long in-store waits for medicine while pharmacists “address administrative barriers." APA also stated its support for the Center for Disease Control’s (CDC) recent instruction to Medicare Advantage and Part D plans to, among several changes, relax the restriction on home or mail delivery options for prescription drugs.

Few PBMs can offer such extensive depth in coordinating home delivery medication fulfillment, best prices, and medication compliance for its patients—with such skills vital considering the current pandemic. MC-Rx rises to this challenge with two commonly owned pharmacies that can ensure timely nationwide home delivery of critical medications. According to the CDC, just under half of the population has one or more prescriptions. (4) If all prescription holders switched to home delivery, it would support both the current federal and state mandates for social isolation.

Reports of requested increases in 30-day prescriptions to 90-days are rising. However, there is the concern that if this trend continues, it could cause medication shortages. Refills over normal patterns are recommended by the CDC only for “primarily high-risk patients, such as those with comorbidities,” according to a trade source.(5) MC-Rx reminds plan sponsors and their members that they can rely on the well-established mail-order pharmacy fulfillment network already in place in the U.S.

About MC-Rx

MC-Rx is a full-service Pharmacy Benefits Manager (PBM) with corporate offices in Gainesville, Georgia and Caguas, Puerto Rico, focusing on transparency and best-in-class service, and offering clients “lowest net cost.” MC-Rx’s retail network includes more than 65,000 national, regional, and local pharmacies. MC-Rx was formed by combining two URAC certified world-class PBM’s—ProCare PBM and MC-21. The ProCare companies were founded in 1988 with the vision of providing innovative computer software systems and services to various sectors of the healthcare industry. ProCare processed its first pharmacy claim in 1994 using proprietary, internally developed and managed systems and expanded in 1998 to full-service pharmacy benefit management through the acquisition of NextGen PBM. Today, the ProCare companies also include two affiliated mail-order and specialty pharmacies and are one of only five PBM providers that have built and own all of their component systems. MC-Rx now provides comprehensive, industry-leading service to clients in Puerto Rico and the U.S. For more information, visit www.mc-rx.com.

Andrew, Scottie. “Worried about Coronavirus? If Your Loved One Is over 60, Read This.” CNN, Cable News Network, 13 Mar. 2020, cnn.com/2020/03/12/health/what-60-older-need-to-know-coronavirus-wellness-trnd/index.html.

“Products - Data Briefs - Number 332 - February 2019.” Centers for Disease Control and Prevention, Centers for Disease Control and Prevention, 19 Mar. 2019, cdc.gov/nchs/products/databriefs/db334.htm.

“APhA Urges Insurers, PBMs to Immediately Remove Barriers on Prescription Drug Refills for Coronavirus Preparedness.” Home, 13 Mar. 2020, pharmacist.com/press-release/apha-urges-insurers-pbms-immediately-remove-barriers-prescription-drug-refills.

McCook, Alison. “COVID-19: Stockpiling Refills May Strain the System.” IDSE, 11 Mar. 2020, idse.net/Policy--Public-Health/Article/03-20/COVID-19-Stockpiling-Refills-May-Strain-the-System/57583.

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AS SUPPLY CHAIN UNRAVELS AMIDST COVID-19, PBM’S FEAR MEDICATION SHORTAGES ARE NEXT

Wed, 11 Nov 2020 14:34:36 GMT

The effects of COVID-19 will linger long after life has returned to normal, as pharmaceutical industry experts are raising concerns that disruptions to the supply chain could lead to medication shortages. Pharmacy benefit manager, MC-Rx, stresses the importance of implementing changes to the supply chain to alleviate potential drug shortages.

(Gainesville, GA) May 12, 2020—As COVID-19 began to spread across the world, U.S. consumers left store shelves all but barren in rushing to stock up on essentials while—at the same time—the supply chain was still struggling to catch up with demand. It did not take long until ventilators, personal protective equipment (PPE), and other lifesaving medical resources were also in short supply. The World Health Organization estimates that manufacturing of PPE alone must increase by 40% worldwide in order to meet current and future demands.(1) According to a tenured veteran of the pharmacy benefit manager (PBM) industry and president of one of MC-Rx’s lines of business, Steve Treff, industry experts and society alike worry that the next wave of supply chain shortages could target prescription medications.

“Pharmacies typically operate as a ‘just-in-time’ inventory business,” Treff says. “This means they rely on continual shipments of drugs to fill their on-demand pharmacy orders. A disruption anywhere among the supply chain could pose severe threats.”

According to experts at John Hopkins University, the prescription drug supply chain is vulnerable even without a pandemic looming, as the industry is so dependent on international suppliers like China—a key provider of the raw materials used to make prescription drugs—and India, which is a major producer of generic drugs.(2) As early as February, the FDA had already reported the first drug shortage caused by the COVID-19 outbreak.(3) On top of pharmaceutical industry experts, society is plagued by fears of how the international supply chain will affect medications—with 30% of Americans concerned about drug shortages.(4) The novel coronavirus has brought to light weaknesses in this supply chain process, and now it is up to industry experts to examine those vulnerabilities, execute necessary changes, and prepare for how to move forward.

Limitations on refills were lifted as part of many state governors’ emergency orders to help ensure patients maintained access to critical medications resulting pharmacies seeing increases in patients requesting to extend 30-day prescriptions to 90 days.(5) Even though stakeholders said they had been able to meet these requests (as of early April), many predict it to only be “a matter of time” before the supply chain begins to crumble under panic-induced pressures.(6)

One precaution MC-Rx put into practice very early on during the crisis to ensure its 6+ million members in the U.S. and Puerto Rico would be able to get necessary medications was to closely monitor such requests. “We decided to provide our clients’ members with a month’s supply of their prescription out of our mail service pharmacies instead of three months so that there would be enough supply in stock for everyone over time,” Treff says. “Prescriptions were refilled in a timely manner to alleviate member concerns and this also helped control the finances of our clients to make sure they weren't getting hit with higher bills during the financial downturn. Nearly two months in, we judge this strategy to be successful in helping our clients financially, ensuring our patients received their medications, allowed for patient outreach compliance programs, and reduced our risk of drug shortages.”

Other measures have and continue to be implemented in efforts to limit the damage to the supply chain. Social distancing and shelter-in-place guidelines have led to more mail medication deliveries, with many companies—like MC-Rx—even offering free shipping. And while the trucking sector has been hit particularly hard due to a lack of drivers caused by the closures of critical entities like DMVs and driver training schools, innovation is paving the way for new delivery options—such as with drones set to transport prescription medications to over 135,000 residents home to the largest retirement community in the U.S.(7) But there are still many improvements to be made in order to plan for both the now and future implications of supply chain interruptions.

“There are many different complex components to the pharmaceutical supply chain,” Treff says, “and when one of them is disrupted, it has repercussions for the rest. But the federal government, state pharmacy organizations, pharmacy chains, and pharmacy benefit management companies are taking steps to make sure that people will be able to get the medication they need in the future. So far, drug shortages in the most common critical disease states—diabetes, high blood pressure, COPD and asthma—have not been reported although might have occurred at individual pharmacies.”

About MC-Rx

MC-Rx is a full-service pharmacy benefit manager (PBM), with corporate offices in Gainesville, Georgia and Caguas, Puerto Rico, focusing on transparency, best-in-class service, and offering clients “lowest net cost” pricing. MC-Rx was formed by combining two URAC-certified, world class PBMs—ProCare Pharmacy Benefit Manager and mc-21. The ProCare companies were founded in 1988 with the vision of providing innovative computer software systems and services to various sectors of the healthcare industry. ProCare processed their first pharmacy claim in 1994 using their proprietary, internally developed and managed systems, and expanded in 1998 to full-service pharmacy benefit management through the acquisition of NextGen PBM. Today, the ProCare companies also include two affiliated mail-order and specialty pharmacies, ProCare PharmacyCare, and are one of only four PBM providers that own all of their component systems. MC-Rx now provides comprehensive, industry-leading service to clients in Puerto Rico and the U.S. For more information, visit www.mc-rx.com.

Chaib, Fadela. “Shortage of personal protective equipment endangering health workers worldwide” World Health Organization Newsroom, Marcy 3, 2020, who.int/news-room/detail/03-03-2020-shortage-of-personal-protective-equipment-endangering-health-workers-worldwide

Volkin, Samuel. “How has COVID-19 impacted supply chains around the world?” John Hopkins University HUB, April 6, 2020, hub.jhu.edu/2020/04/06/goker-aydin-global-supply-chain/

Hahn, Stephen M., M.D. “Coronavirus (COVID-10) Supply Chain Update” FDA Statement, February 27,2020, fda.gov/news-events/press-announcements/coronavirus-covid-19-supply-chain-update

Blank, Christine. “Survey: Americans Worried About COVID-19 Drug Shortages.” Drug Topics, 30 Apr. 2020, drugtopics.com/latest/survey-americans-worried-about-covid-19-drug-shortages.

COVID-19: Information from the States (April 27 2020). Natnal Alliance of State Pharmacy Associations. https://naspa.us/resource/covid-19-information-from-the-states/.

McCook, Alison. “COVID-19: 90-Day Refills May Strain Supply Chain.” Specialty Pharmacy Continuum, 8 Apr. 2020, specialtypharmacycontinuum.com/Covid-19/Article/04-20/COVID-19-90-Day-Refills-May-Strain-Supply-Chain/57779.

Scripps National. “UPS, CVS Will Use Drones to Deliver Medication to Nation's Largest Retirement Community.” WPIX, 28 Apr. 2020, pix11.com/news/national/coronavirus/ups-cvs-will-use-drones-to-deliver-medication-to-nations-largest-retirement-community.

PREVIOUSLY VILIFIED, BIG PHARMA STEPS UP IN COVID-19 FIGHT

Thu, 15 Oct 2020 19:53:47 GMT

Big Pharma’s reputation has taken quite the hit in recent years. But during the COVID-19 pandemic, pharmacy benefit manager MC-Rx notes that pharmaceutical companies are leading the fight to find a vaccine and save American lives.

(Gainesville, GA) June 9, 2020—It is no secret Americans are generally distrustful of the pharmaceutical industry. However, with the outbreak of COVID-19, many look to Big Pharma to find effective methods of combating the virus. MC-Rx—a full-service pharmacy benefit manager (PBM)—suggests it’s worth noting that, despite their reputation, drug manufacturers have truly stepped up when it comes to vaccine development and research into other therapies that could help patients survive. “There are no less than 100 different manufacturers in the game racing to develop a viable vaccine, some already working through or having completed human trials,” says Steve Treff, tenured veteran of the pharmacy benefit manager industry and president of one of MC-Rx’s lines of business.

Stories from all across the industry show just how far Big Pharma is willing to go to help protect American lives. Gilead, the company that developed the antiviral drug remdesivir, has already pledged 1.5 million doses of the drug at no cost to COVID-19 patients.(1) Other companies—such as Johnson and Johnson, Pfizer, and AbbVie—have donated over a combined $125 million for COVID-19 disaster relief.(1) Astra Zeneca has partnered with Oxford BioMedica to develop and market vaccines, potentially by the end of the year(4). Even the U.S. Department of Health and Human Services is partnering with pharma companies to expand drug manufacturing for needed medications during the global pandemic.(2)

All this is occurring despite the wealth of misinformation coming from mainstream media sources and other so-called “experts,” like those on social media platforms. Treff reminds consumers that amidst COVID-19, “Take what you read at face value as development of vaccine candidates continues to progress at “warp speed”. We all want a vaccine as soon as possible, but knowing how that vaccine will work with people taking insulin, heart medications, and using inhalers is critical to patient safety.”

While there is no joint committee of industry experts currently overseeing development, it is not stopping pharmaceutical companies from working together to boost the industry’s response. Several companies, such as Novartis, Pfizer, Sanofi, and Merck are collaborating by sharing their proprietary compound libraries.(3) When promising compounds are identified, these companies then move those products through the different phases of clinical testing. All share the same goal: to find a vaccine or other treatment that works best for everyone, not just for one patient at a time.

Treff says, “While pointing fingers over skyrocketing drug prices has long been a topic of bitter discussion and division in the industry, this is a rare time where manufacturers seem to be working to find a cure rather than continuing to increase prices on critical medications..”

About MC-Rx:

MC-Rx is a full-service pharmacy benefit manager (PBM) with corporate offices in Gainesville, Georgia and Caguas, Puerto Rico, focusing on transparency, best-in-class service, and offering clients “lowest net cost.” MC-Rx was formed by combining two URAC- accredited, world class PBM’s - ProCare Pharmacy Benefit Manager and mc-21. The ProCare companies were founded in 1988 with the vision of providing innovative computer software systems and services to various sectors of the healthcare industry.

ProCare processed their first pharmacy claim in 1994 using their proprietary, internally developed and managed systems, and expanded in 1998 to full-service pharmacy benefit management through the acquisition of NextGen PBM. Today, the ProCare companies also include two affiliated mail-order and specialty pharmacies, ProCare PharmacyCare, and are one of only four PBM providers that own all of their component systems. MC-Rx now provides comprehensive, industry-leading service to clients in Puerto Rico and the U.S. For more information, visit www.mc-rx.com.

LaMattina, John, et al. “Big Pharma Could Boost Its Reputation with Its Covid-19 Response.” STAT, 29 Apr. 2020, statnews.com/2020/04/30/big-pharma-improve-reputation-covid-19-response/.

S. Department of Health and Human Services. “HHS, Industry Partners Expand U.S.-Based Pharmaceutical Manufacturing for COVID-19 Response.” HHS.gov, US Department of Health and Human Services, 19 May 2020, hhs.gov/about/news/2020/05/19/hhs-industry-partners-expand-us-based-pharmaceutical-manufacturing-covid-19-response.html.

Taylor, Nick Paul. “Big Pharma Companies Join Forces for Fightback against COVID-19.” FierceBiotech, 27 Mar. 2020, fiercebiotech.com/biotech/big-pharma-companies-join-forces-for-fightback-against-covid-19.

https://www.fiercepharma.com/manufacturing/astrazeneca-oxford-biomedica-agree-to-1-year-tie-up-to-produce-covid-19-vaccine

###

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INDEPENDENT PBM CLIENTS LOWER DRUG PRICES BY 37% IN FIRST YEAR

Thu, 15 Oct 2020 19:53:47 GMT

PR Newswire February 11, 2020

The turbulent landscape has fingers pointed in all directions; however, one Pharmacy Benefit Manager (PBM), MC-RX remains diligent is controlling costs and delivering a fresh perspective in otherwise murky waters.

GAINESVILLE, Ga., Feb. 11, 2020 /PRNewswire-PRWeb/ -- Skyrocketing prescription drug prices are enough to make you sick. Just when you thought Big Pharma prices could not get any higher, 471 medications increased an average of 5.1% in the first few days of 2020.

Politicians, lawmakers, and advocates have all stated, "Enough is enough" and vow to prompt legislature to lower drug prices "now." S. 2543, the Prescription Drug Pricing Reduction Act of 2019 (PDPRA), is a bill that proposes reductions in Medicare reinsurance payments from 80% to 20% over a three-year period. This does, however, increase insurers' shares of cost responsibility from 15% to 60%. So, what are the actual savings?

This increase in insurer responsibility has forced more Prescription Benefit Managers to take a closer look. "Consumers are fed up with high prescription drug prices," says LaMar Williams, MC-Rx Executive Vice President. "They should choose a privately held healthcare technology company as an authority on the continuing debate over drug pricing, not another Big Pharma multinational corporation. With a combined 50 years of experience, MC-Rx provides the best, lowest cost PBM system and services available with demonstrated savings of up to 37% in its first year among its network of over 70,000 pharmacies."

"Furthermore," he continues, "Unlike most other PBMs, MC-Rx is one of a very small number of PBM's that owns and operates its own system. This enables great flexibility in benefit plan design and system coding to create a reduced-cost model, which translates to lower prescription drug prices. Above all, we offer independence, transparency, openness, and accountability so plan sponsors may provide better health, every day."

Big Pharma vs. One PBM

Political outrage is running high against Big Pharma drug prices and their "broken promise" to lower or offer generics at a discount.(1) Both major political parties have promised to lower drug prices, only to rise yet again this past January.(2) Even if out-of-pocket costs for Medicare Part D beneficiaries become law in 2020 though S. 2543 (PDPRA), there is still a high annual out-of-pocket spending cap of $3,100 starting in 2022.(3)

A recent study confirmed that "…PBMs are able to obtain lower prices because of their specialized knowledge, negotiation ability, and volume of covered lives, giving them substantial leverage over pharmacies and pharmaceutical companies…" but the ongoing finger-pointing continues to result in an apparent inertia to move any initiatives forward.(4) How long will it take to accomplish any of these goals in today's volatile healthcare environment?

The Solution is a PBM Independent of Outside Influence

"MC-Rx provides faster, more cost-effective services and solutions customized to its clients' needs," adds Williams. "As an independent and transparent PBM with over 70,000 pharmacies in its network, clients' drug spending has been kept below the national growth rates for the past ten years in a row. That speaks volumes about our low drug pricing and how we hold Big Pharma accountable."

One client said it best: "We decided that we needed to make dramatic changes in our pharmacy benefits, and our PBM really wasn't helping us. When we implemented, we used all of MC-Rx's savings tools, and without much disruption at all to our Union members, we saved 37% on our total drug spend and our members saved about 24% on their copays in the first year." ~Trust Fund Administrator

"The bottom line is that MC-Rx is focused on being the best Pharmacy Benefit Manager in the business. We have the most flexible, technologically superior, integrated systems for prescription benefit administration. With our state-of-the-art online solutions, growing network of pharmacies, mail order pharmacy, and ProCare HospiceCare, our customers are able to measure and manage their businesses in real-time, all the time, anywhere."

About MC-Rx

MC-Rx is a full-service Pharmacy Benefit Manager (PBM), with corporate offices in Gainesville, Georgia and Caguas, Puerto Rico, focusing on transparency, best-in-class service, and offering clients "lowest net cost" pricing. MC-Rx was formed by combining two URAC-certified, world class PBMs - ProCare Pharmacy Benefit Manager and mc-21. The ProCare companies were founded in 1988 with the vision of providing innovative computer software systems and services to various sectors of the healthcare industry. ProCare processed their first pharmacy claim in 1994 using their proprietary, internally developed and managed systems, and expanded in 1998 to full-service pharmacy benefit management through the acquisition of NextGen PBM. Today, the ProCare companies also include two affiliated mail-order and specialty pharmacies, ProCare PharmacyCare, and are one of only four PBM providers that own all of their component systems. MC-Rx now provides comprehensive, industry-leading service to clients in Puerto Rico and the U.S.

Brannon, Ike (Jack Kemp Foundation) and Tony LoSasso (DePaul University). INSIGHT: Constraining Pharmacy Benefit Managers Will Not Reduce Drug Prices (January 6 2020). Bloomberg Law – Big Law Business. biglawbusiness.com/insight-constraining-pharmacy-benefit-managers-will-not-reduce-drug-prices.

2. Rowland, Christopher, "Under fire over high prices, Eli Lilly promised cheaper insulin in 2019. The result has some senators steamed", Washington Post, December 29, 2019, washingtonpost.com/business/economy/under-fire-over-high-prices-eli-lilly-promised-cheaper-insulin-in-2019-the-result-has-some-senators-steamed/2019/12/26/6c440b44-204e-11ea-86f3-3b5019d451db_story.html.

3. Luhby, Tami, "Democrats and Republicans promised to lower drug prices. Instead they've gone up again," CNN, January 5, 2020, cnn.com/2020/01/05/politics/2020-drug-price-increases/index.html.

4. Cohen, Joshua, "Prescription Drug Pricing Reduction Act may become law in 2020", Forbes, December 15, 2019, forbes.com/sites/joshuacohen/2019/12/15/prescription-drug-pricing-reduction-act-may-become-law-in-2020/#7e10e08d5537.

NATIONAL COLLABORATION NEEDED TO COMBAT OPIOID EPIDEMIC

Thu, 15 Oct 2020 19:53:47 GMT

National collaboration among public and private companies and governmental agencies is needed to manage, prevent and curb new and chronic existing opioid use, states pharmacy benefit manager MC-Rx.

Gainesville, GA [October 1, 2019] – Many pharmacy benefit managers (PBMs) are working with employers to curb and prevent the abuse of prescription opioids with data-driven safety management programs. To more effectively combat and prevent new and chronic opioid abuse, a holistic approach with collaboration among insurers, PBMs, governmental agencies and others is needed, says LaMar Williams, executive vice president of the PBM MC-Rx.

Many PBMs and insurers are actively addressing workplace opioid use and abuse in an attempt to reduce continued negative impact. A 2018 survey of 2,000 U.S. workers and 500 human resources professionals by The Hartford, a property and casualty insurer, found that 65 percent of companies report detrimental financial impact associated with opioid use by their employees1, and the U.S. Centers for Disease Control and Prevention estimates that the total cost of opioid misuse and abuse is almost $80 billion a year, including employee healthcare, lost productivity and workplace injury.4 The National Business Group on Health has urged employers to communicate with PBMs to detect unusual patterns of employee opioid use and help protect employees from opioid dependence by structuring custom benefit plan designs to limit access to minimum necessary treatment regime and dosage.2 About half of U.S. businesses are using a prescription drug monitoring program and/or their PBM to reduce claims involving opioids.3

“PBMs have a major and necessary role to play in addressing the epidemic,” Williams said. “Since almost 100percent of every opioid prescription that is processed under insurance will adjudicate on a PBM system, we have a unique and vital piece of the puzzle that enables us to engage with these claims in real-time. The PBM database is the only data repository that can provide a real-time perspective on legal opioid prescription activity, as the individual may obtain prescriptions from multiple physicians and attempt to fill at different pharmacies. Our role should not only be supporting the effort to curb dependence, but also facilitating effective efforts with the end goal of creating a way to get out of this crisis through prevention mechanisms.”

However, there is not yet national collaboration among all stakeholders, in part due to lack of interoperability of data management systems as well as privacy regulations, Williams said.

In 2016, the Centers for Disease Control and Prevention (CDC) released the Guideline for Prescribing Opioids for Chronic Pain, the first national standard for opioid safety management for primary care providers who account for half of all opioid prescriptions annually.5

“Outcomes from this guideline have helped prevent many patients from escalation to opioids by concentrating on optimizing alternative therapy, such as NSAIDs,” Williams said. “We know that one size does not fit all, and that’s why the CDC standard is a guideline, not a protocol. We try to work as a team with physicians and pharmacists to allow them to treat patients to the best of their ability."

Gainesville, Ga.-based MC-Rx works with employers by:

Evaluating potential risk based on population and current utilization, which may include Drug Utilization Review (DUR) warnings.

Administering Morphine Milligram Equivalent (MME) dosing protocols with seven-day initial fill limits for patients with acute pain needs, such as post-surgery.

For chronic existing opioid users, MC-Rx generally follows the CDC guideline that requires:

Attestations from the medical provider to bypass the CDC’s MME dosing protocol, including clinical specifications of chronic conditions, such as cancer and sickle cell.

Medical providers to review state databases to determine patients’ history of opioid use.

Some chronic existing opioid users to receive drug screens, state prescription drug monitoring programs (PDMP) review, and the dissemination of naloxone, an emergency antidote to treat acute opioid poisoning.

“Established chronic pain patients need to be carefully managed as a team effort,” Williams said. “PBMs are in alignment with physicians and other providers in the belief that no one should endure pain, if possible. However, this needs to be done in a meticulous and measured way.”

About MC-Rx

MC-Rx, a full-service pharmacy benefit manager (PBM) with corporate offices in Gainesville, Georgia and Caguas, Puerto Rico, focuses on transparency, best-in-class service, and offering clients the “lowest net cost.” MC-Rx was formed by combining two Utilization Review Accreditation Commission (URAC)-certified, world-class PBMs: ProCare Pharmacy Benefit Manager and MC-21. The newly formed ProCare companies provide innovative computer software systems and services to various sectors of the healthcare industry. Together they have more than a half-century of industry experience, four major locations, two state-of-the-art, 24/7 data and customer support centers, three software research and development centers, and more than 550 employees. By virtue of this combination, MC-Rx will have clients in all 50 states, Puerto Rico, and the U.S. Virgin Islands. MC-Rx includes two affiliated mail-order and specialty pharmacies, ProCare PharmacyCare, and is one of only four PBM providers that own all of their component systems. For more information, visit http://www.mc-rx.com.

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