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Michelle Powell 5909

News Roundup

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Model cuts 5-year CVD event risk for Medicare patients

Results from a new study in JAMA found that the Million Hearts Model, which paid participating health care organizations to assess and reduce patients’ CVD risk, decreased myocardial infarction and stroke rates for Medicare fee-for-service beneficiaries aged 40 to 79 years at high or medium risk for these events.

The Million Hearts Model, part of the broader Million Hearts initiative, is co-led by CDC and CMS and aims to prevent one million heart attacks and strokes over 5 years.

According to the study findings, the Million Hearts Cardiovascular Disease Risk Reduction Model reduced the probability of a first-time myocardial infarction or stroke over 5 years by 0.3%, and the probability of a first-time CVD event or CVD death by 0.4% for study participants when compared with the general population.

Researchers said the results support guideline recommendations for CV risk assessment.

In the trial, which ran from 2017 to 2021, patients with no previous myocardial infarctions or stroke and with high or medium CVD risk were enrolled from U.S.-based primary care and specialty practices, health centers, and hospital-based outpatient clinics. Organizations were assigned to a model intervention group or standard care control group. Of 516 organizations, 342 entered patients into the study population.

CVD-related Medicare spending in the intervention and control groups was similar, suggesting that paying for the intervention did not result in higher costs overall.

Using a novel longitudinal risk calculator, researchers noted that the model was unique in paying for overall CVD risk reduction rather than tying performance-based payments to control of individual risk factors.

The researchers said that the findings have implications for value-based payment policy.

“Systematic reviews show that value-based payment initiatives, both overall and for CVD care, have improved care processes, but few improved long-term outcomes. This randomized pragmatic trial suggests that paying for risk assessment and reduction could improve outcomes of public health importance. However, high rates of model nonparticipation demonstrate the importance of calibrating payments to effort and reducing burden of data sharing,” the researchers wrote. ■


Pharmacies in Georgia gearing up to sell medical cannabis

Georgia is set to become the first state to allow independent pharmacies to sell medical cannabis. In early October 2023, the Georgia Board of Pharmacy began accepting over 120 applications from pharmacies who agreed to provide cannabis from one of the state’s two licensed production companies.

Georgia’s 2019 cannabis law allows independent pharmacists across Georgia to dispense cannabis oil to patients, without association of an approved producer. Georgia’s legislature passed a bill in 2019 setting up a licensing process for companies to grow cannabis indoors under close supervision, convert the plant to oil, and sell the product to patients with a doctor’s prescription if the companies are in a registry run by the Georgia Department of Public Health.

Patients will be able to buy cannabis oil at Georgia pharmacies if they show a state-issued low THC oil registry card and identification.

THC is the principal psychoactive compound of cannabis. Low THC oil can contain no more than 5% THC.

There are over 400 independent pharmacies in Georgia. Cannabis products are not being sold in chain community pharmacies. ■


DEA extends telehealth authorities for controlled substances through 2024

DEA will continue to allow providers to use telemedicine to prescribe certain controlled substances through the end of 2024.

DEA said the temporary authorization is designed “to ensure a smooth transition for patients and practitioners that have come to rely on the availability of telemedicine for controlled medication prescriptions, as well as allowing adequate time for providers to come into compliance with any new standards or safeguards.”

Controlled substances covered by the rule, which DEA released during the COVID-19 public health emergency, include stimulant medications for ADHD, anxiety, and OUD.

In May 2023, just before the expiration of the public health emergency, DEA said it would temporarily extend the telehealth flexibilities through November 11, 2023.

In September 2023, DEA hosted a listening session to hear from health care practitioners, experts, advocates, and patients who called on the agency to extend the more lenient rules and create a special registration pathway for remote prescribing. APhA took part in the listening session.

DEA said it hopes to draft new regulations by fall 2024.

The agency also announced a forthcoming proposed rule on telehealth prescribing of controlled substances, including buprenorphine, that will be released before the temporary rule expires on November 11, 2024. ■


Analysis finds e-prescribing by pharmacists on the rise, filling gaps in care

A new report from Surescripts finds that more pharmacists are electronically prescribing medications as they assist with managing chronic diseases for patients.

According to the report’s data, the number of prescribers in the Surescripts’ network who were not conventional primary care providers rose by 12.1% on average annually between 2018 to 2022, while the number of clinicians who frequently provide primary care grew by less than 1%.

Surescripts found that the number of overall e-prescriptions submitted by pharmacists increased by 47% between 2019 and 2022, in particular for drugs that treat chronic conditions. Electronic prescriptions for diabetes, high BP, and high cholesterol rose by 3.6% during that time frame, while the number of e-prescriptions in those categories submitted by conventional primary care providers fell by 3.5% on average each year.

“As gaps in primary care grow wider, pharmacists have become essential care providers—especially for patients with chronic conditions,” said Frank Harvey, Surescripts CEO, in a press statement. “Health care has an opportunity to catch up by bringing policy and payment structures in line with how patients are accessing primary care and truly empowering pharmacists to deliver care at the top of their education and training and as part of a collaborative care team.”

Additionally, Surescripts noted that a recent survey found 89% of prescribers and 97% of pharmacists support the increased use of team-based care. That survey found that 41% of prescribers believe it is essential for pharmacists to be able to issue prescriptions. ■


Metformin could be beneficial for gestational diabetes

The use of metformin among pregnant women with gestational diabetes was associated with enhanced glycemic control and reduced gestational weight gain, according to a randomized, placebo-controlled study published in JAMA.

The trial was conducted from June 2017 to September 2022 at two sites in Ireland, comprising 510 women with gestational diabetes.

The patients were randomly assigned to receive either a placebo or metformin with a maximum dose of 2,500 mg. Researchers at the University of Galway in Ireland found that the trial’s primary outcome—a composite of insulin initiation or a fasting glucose of 5.1 mmol/L or higher at gestation weeks 32 or 38—did not differ notably between the two groups.

However, the women who used metformin were significantly less likely to require insulin and had considerably lower fasting blood glucose levels at weeks 32 and 38, the researchers found. There was a nonsignificant increase in babies that are small for their gestational age among the expectant parents using metformin. The researchers plan to follow up with mother and infant to see if those diagnosed as small for gestational age turn out to have an increase in BMI and weight as they grow into adolescents. ■


Telehealth can increase likelihood of remaining in OUD treatment

Initiating buprenorphine for OUD via telehealth enhanced patients’ likelihood of staying in treatment longer compared with starting treatment in a nontelehealth setting, according to new research in JAMA Network Open.

The study was based on Medicaid data from 2019 to 2020 in Kentucky and Ohio. The researchers found that in Kentucky, 48% of those who started buprenorphine treatment through telehealth remained in treatment for 90 continuous days compared with 44% of those who started treatment in nontelehealth settings.

In Ohio, 32% of those who used telehealth to start buprenorphine remained in treatment for 90 continuous days compared with 28% of those who started treatment in nontelehealth settings.

The research was part of the HEALing Communities Study, the largest ever addiction prevention and treatment implementation study and backed by the National Institute on Drug Abuse (NIDA) in partnership with the Substance Abuse and Mental Health Services Administration and NIH’s Helping to End Addiction Long-term Initiative.

“This study suggests that telehealth may increase treatment access and retention, strengthening the evidence that receiving addiction care through telehealth is to be safe and beneficial, and that it should be made available to those who need it,” said Nora Volkow, MD, NIDA director, in a news release.

The study findings also indicated that receiving buprenorphine treatment through telehealth was not linked to a higher risk of nonfatal overdose. This finding suggests that patients were not adversely affected by having increased access to buprenorphine treatment through telemedicine.  ■



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