Wednesday, May 24, 2023
Proposed Rule to Audit Rx Drugs Covered by Medicaid
Small & Rural Meeting: Addressing Workplace Violence
New Federal Funding for Rural Maternity Care
FDA Approves New Buprenorphine Treatment for OUD
HIV Infections Decline, Particularly Among Young People
Illinois COVID-19 Data
Briefly Noted
Proposed Rule to Audit Rx Drugs Covered by Medicaid
Yesterday, the U.S. Dept. of Health and Human Services (HHS), through the Centers for Medicare & Medicaid Services (CMS), issued a notice of proposed rulemaking (NPRM) intended to increase transparency on the cost of prescription drugs covered by Medicaid.
According to a CMS media statement, the rule would allow CMS to have more insight into what the most expensive drugs on the market today actually cost to manufacture and distribute. The proposed regulation would give CMS and states additional tools, like a drug price verification survey, to confirm drug prices and clarify why certain drug prices are expensive for Medicaid. CMS said this would help states better negotiate what the Medicaid program pays for high-cost drugs, allow state Medicaid agencies to operate their pharmacy programs more effectively and help more people get vital drug treatments.
Another proposed provision aims to enhance transparency into the costs of administering drug benefits in Medicaid-managed care plans, which cover approximately 80% of Medicaid beneficiaries in Illinois. Managed care plan pharmacy benefit managers (PBMs) often negotiate and administer the pharmacy benefit. CMS proposed that contracts between states, Medicaid-managed care plans, and third-party contractors, such as PBMs, should reflect transparent reporting of drug payment information among third-party contractors to help ensure that taxpayer dollars are actually going to pay for drugs and not increased profits.
The proposed rule also includes provisions to ensure states would receive the appropriate rebates to which they are entitled, since states receive a higher percentage of rebate dollars for brand-name drugs compared to generics. With increased transparency, states would be able to determine if manufacturers appropriately classified their covered outpatient drugs, and if they did not, give CMS the ability to take action to correct the misclassification.
Click here to view a CMS fact sheet on the proposal. To view the NPRM in its entirety, visit the Federal Register. CMS will accept public comment on the NPRM through July 25, 2023.
Small & Rural Meeting: Addressing Workplace Violence
Increasing incidents of workplace violence at hospitals during COVID-19 brought the issue—often regarded as part of the job—to the forefront with an urgency to find solutions. A panel discussion at this year's IHA Small & Rural Hospitals Annual Meeting will highlight successful efforts to implement strategies that protect healthcare professionals.
The session, “Keeping Our Staff Safe: A Discussion on Workplace Violence," will be moderated by Keneatha Johnson, MPH, IHA Senior Director of Safety and Emergency Preparedness, and will include panelists:
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Anthony A. Bucki, DNP, MSN, RN, Director of Emergency Services at Morris Hospital;
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Rachel Kelley, MHA, BSN, CHCM- HC, Chief Nursing Officer Vice President Patient Care Services at Horizon Health; and
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Keith G. McGlen, CPP, CHPA, Vice President of Security and Emergency Management at Carle Health.
As part of the June 28-29 meeting, “Milestones in Rural Health," the conversation will focus on best practices to safeguard staff from harm. Designed for CEOs, C-Suite leaders, department heads, board members and emerging leaders, the meeting will be held at the Bank of Springfield Center.
Join IHA President and CEO A.J. Wilhelmi for key insights on addressing workplace violence and other top issues, including financial stability, health equity and regulatory challenges. See our program webpage for information the complete agenda.
Register today.
Contact us with questions.
New Federal Funding for Rural Maternity Care
The Federal Office of Rural Health Policy announced that the Rural Maternity and Obstetrics Management Strategies Program (RMOMS) is now open on grants.gov. Click here for details, including eligibility criteria and application information. Applications will be accepted through July 7, 2023. A total of $2 million is anticipated to fund up to two health networks in this cooperative agreement program.
The purpose of the RMOMS program is to preserve access to and continuity of maternal and obstetrics care in rural communities that address the following RMOMS Focus Areas: 1) Rural Hospital Obstetric Service Aggregation; 2) Approaches to Risk Appropriate Care; and 3) Financial Sustainability.
A live technical assistance webinar is scheduled for May 31, 2023 from 1 p.m. – 2 p.m. CT to assist applicants in preparing their applications. Click here to join. The webinar will be recorded and playback information can be accessed at the RMOMS webpage.
FDA Approves New Buprenorphine Treatment for OUD
Yesterday, the U.S. Food and Drug Administration (FDA) approved Brixadi (buprenorphine) extended-release injection for subcutaneous use (under the skin) to treat moderate to severe opioid use disorder (OUD). Brixadi is available in two formulations, a weekly injection that can be used in patients who have started treatment with a single dose of a transmucosal buprenorphine product or who are already being treated with buprenorphine, and a monthly version for patients already being treated with buprenorphine.
According to the FDA, buprenorphine is a safe and effective medication for the treatment of OUD. The Substance Abuse and Mental Health Services Administration (SAMHSA) says patients receiving medication for their OUD cut their risk of death from all causes in half.
The safety and efficacy of Brixadi were evaluated in a behavioral pharmacology study assessing the ability of two weekly doses of Brixadi to block the subjective effects of opioids, and one randomized, double-blind, active-controlled clinical trial in 428 adults with a diagnosis of moderate-to-severe OUD. The FDA granted approval of Brixadi to Braeburn Inc.
HIV Infections Decline, Particularly Among Young People
Estimated annual new HIV infections were 12% lower in 2021 compared to 2017—dropping from about 36,500 infections to about 32,100, according to new Centers for Disease Control and Prevention (CDC) data published yesterday.
In a news release, the CDC says the decline was driven by a 34% decrease in new infections among 13 to 24-year-olds, mostly among gay and bisexual males. The CDC’s latest estimates show annual HIV infections have dropped from 9,300 in 2017 to 6,100 in 2021 among 13 to 24-year-olds.
Declines among young gay and bisexual males (who account for roughly 80% of new infections in this age group) drove the trend, falling from an estimated 7,400 infections to about 4,900 during the timeframe. CDC data suggests that improved reach of HIV testing, treatment, and pre-exposure prophylaxis (PrEP) has contributed to progress in HIV prevention among young gay and bisexual males.
Illinois COVID-19 Data
With the state of Illinois and the nation ending the Public Health Emergency (PHE) last week, the Illinois Dept. of Public Health (IDPH) announced it is shifting to a new cadence for data reporting and will release updates every other week. The next update will be May 26. IDPH will continue to report COVID-19 data on the weekly number of people admitted to hospitals from emergency departments, deaths and vaccinations, as well through the dashboard of the Illinois Wastewater Surveillance System.
Briefly Noted
In 2022, about one in five older adults experienced some cost-related barrier to medication adherence, a new JAMA Network Open report found. The report underscores prescription drug affordability is a pressing issue, as these costs impede patients’ care management and daily life.
People who experience pregnancy complications have higher lifetime stroke risk as compared to people with no pregnancy complications, according to a study published in the journal Stroke. Study authors said, “People who experience adverse pregnancy outcomes develop cerebrovascular disease at younger ages, with the earliest onset and greatest risk seen in those with multiple pregnancies affected by complications.”