Pharmaceutical Commerce - November/December 2016 - 17


Brand Communications
safety or efficacy of the brand medication
could potentially be very beneficial."
The 'dual eligible' conundrum
Today, the vast majority of patients in
nursing homes and other LTC settings are
"dual eligible" patients, meaning they are
enrolled in both Medicaid and Medicare.
Typically, Medicare acts as the primary payer
for a range of services; Medicaid provides
cost-sharing assistance and may pay for
services that are limited or not covered
under Medicare.
"The long stay is covered under Medicare
Part D, and each Part D plan has its own
formulary that is well outside of the nursing
home's control," says The Access Group's
Stefanacci. "Medicare Part A provides drug
coverage during the subacute/short stays
(Medicare pays a per diem to the nursing
home that includes all medications). "As
a result, skilled nursing facilities develop
their own formulary drugs prescribed under
Part A." This complicates the picture when
it comes to drug companies trying to ensure
access to its products across all of the many
competing formulary types.
One issue to watch is the changing status
of the so-called "protected classes" that
were identified when Medicare Part D was
initiated. Today, all Medicare Part D plans
are required to include therapy options
in these six categories-antineoplastics,
anticonvulsants, antiretrov irals,
antipsychotics, antidepressants and
immunosuppressants. "Part D Legislation
designated these protected classes to ensure
that Medicare patients would have access to
these life-saving therapies," says Stefanacci
of The Access Group. "Recently CMS has
been given permission to eliminate some
of these requirements, and this could limit

patient access to some medications that
are already heavily utilized by patients in
LTC facilities." Specifically, the Medicare
Payment Advisory Commission (MedPAC)
recently recommended eliminating two
protected drug classes-antidepressants and
transplant medications.
LTC readmission
At all types of LTC facilities, the pressure
is on to reduce hospitalization, and for shortterm stay patients, to reduce readmission to
the skilled nursing or rehab center. An oftencited Henry J. Kaiser Family Foundation
study shows reducing hospitalizations and
emergency room visits by 25% among
Medicare beneficiaries living in LTC facilities
could have reduced $2.1 billion in healthcare
costs in 2011 alone.* These savings come

Kimberly Binaso,
Managed Healthcare
Associates

Frank Grosso,
ASCP

from the high cost of acute care, and the
potential for medication errors and hospitalacquired infections that can occur during
a hospital stay, particularly among the
frail-elderly, says Stefanacci. Similar studies
have suggested that a 33% reduction in
potentially avoidable hospitalizations would
save Medicare more than $1 billion annually.
*http://kff.org/health-costs/report/medicare-spendingand-use-of-medical-services/

As a result, LTC facilities continue to
face mandates from the CMS to reduce
hospitalizations and readmissions to skillednursing and rehab facilities. CMS estimates
that roughly 45% of hospitalizations among
Medicare/Medicaid enrollees receiving
either Medicare skilled nursing facility
services or Medicaid nursing facility services
could have been avoided, saving billions of
dollars in healthcare expenditures.
Today, "targeting those LTC facilities that
are discharging the most patients to home
(such data are available on the CMS website)
should be a strategic business focus for those
providing therapies for chronic conditions
such as heart disease, diabetes, COPD and
others," says ASCP's Grosso. "Today a typical
short-stay nursing home with 100 beds
may have an average length of stay of 20

John Doyle,
Quintiles

Stephen Hendrickson,
AmeriSource Bergen

days. Such turnover means that 150 patients
per month are being discharged to home.
Compared with longer-stay LTC setting,
these facilities are producing a larger target
patient population who may benefit from
the strategic adherence factors, outcomes
data, and safety and clinical advantages that
the branded drug may be able to provide at
home-in other words, that the drug should
not be judged on its price alone."

"To reduce costs and improve the patient
experience and outcomes, CMS is calling
for efforts to coordinate care earlier in an
effort to avoid hospitalization earlier, or if
hospitalization is necessary, there should
be a better transfer of information for an
improved patient care plan in an effort
to reduce adverse events," adds Doyle
of QuintilesIMS. The right medications
can play a big role here in reducing
hospitalization and readmission.
A case in point that Doyle cites is
Entresto, the branded ACE inhibitor from
Novartis. He says that the drug has been
proven to reduce congestive heart failure
(CHF)-related hospitalization. "LTC
facilities are very much focused on which
drugs could help to avoid or reduce the
length of stay-and such clinical advantages
may help to address cost differentials over
generic alternatives," he says.
"Under current and proposed Medicare
rules, nursing homes and hospitals will
continue to be financially penalized for
excessive hospital readmissions," says
Grosso of ASCP. "So it begs the question
for them: 'Should we put the patient on
the higher-cost therapy (that may prevent
readmission), or should we save money in
the short term on generics but then face
penalties later?'" As the debate continues
over whether it's more prudent to opt for
the lowest-cost drug, or to pay the higher
cost of a branded therapy with data that
supports reduction of overall episode-ofcare costs, says Grosso, "It's more important
today than ever before that pharmaceutical
manufacturers and healthcare providers
work collaboratively to focus on the
patient's episode of care and consider the
most cost-effective drug therapy rather than
the lowest-cost drug."

Putting drug administration
in patient's hands
Branded as MedStation, the device gives active guidance
to seniors
Many people who interact directly with an elderly person know that they often
carry various kinds of daily or weekly pill dispensers with them-by one measure, an
elderly person typically is consuming a handful of prescriptions or OTC products daily,
and often more. Now, an inventor from Texas, Vincent Mauk, is offering a feature-laden
version of these dispensers, and one specifically attuned to elderly living on their own or
in assisted living, whereby a nurse or other caregiver can program the device with simple
usage instructions and data-collection measures.
"I developed this to help my mother, who had difficulty keeping track of which pills to
take, and when," he says. Even remembering that a dosage has been taken can be a problem
for some. The case features various slots for daily dosages, a simple datalogging device for
keying in instructions color-coded to time of day and day of week, and a writing pad for
recording pill consumption. A visual alarm can also be programmed to act as a reminder
that a dosage is due. Interactivity via a Bluetooth connection is being planned for a next
version.
Mauk's company, Silver Magnolia Medical Products, has patents on the design, and has
undergone an FDA review. He is having discussions with the medical managers of assisted
living facilities, and is looking for a retailer to put it on community pharmacy shelves. It can
also be purchased directly, for $145, from www.HomeMedStation.com.

Credit: Silver Magnolia

November | December 2016 Visit our website at www.PharmaceuticalCommerce.com 17


http://kff.org/health-costs/report/medicare-spending-and-use-of-medical-services/ http://www.HomeMedStation.com http://pharmaceuticalcommerce.com/

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