She works hard for the money.

The role (and payment) of pharmacists

Last week, Rep. Ron Kind (D-WI) introduced the Equitable Community Access to Pharmacist Services Act to ensure continued beneficiary access to essential pandemic and other healthcare services provided by pharmacists. The bill provides Medicare recognition of pharmacy provider status and Part B reimbursement for the following services:

These services are considered critical to ensuring access to treatment, particularly for Medicare patients who live in underserved areas during PHEs. 

Payment will be the lesser of the actual charges or 85% (or 100% if pursuant to a federal emergency authority clause) of the fee schedule. If a pharmacy is enrolled and being reimbursed as a mass immunizer, then separate payment to pharmacists is prohibited. 

For years, pharmacists have been asking to be recognized and paid as service providers. If approved, this may help move the needle to helping pharmacists be reimbursed for patient encounters and acknowledges the role pharmacists serve in the patient’s continuum of care.

Legislative bytes

Can’t buy me love but can buy an effective COVID treatment

On Monday, the Institute for Clinical and Economic Review (ICER) published its revised Evidence Report assessing the comparative clinical effectiveness and value of treatments for COVID-19. ICER assessed the following treatments: sotrovimab, molnupiravir, PAXLOVID (nirmatrelvir), and fluvoxamine. All studies were conducted in overlapping time frames; none were conducted while the Omicron variant was dominant. All 4 drugs were superior to placebo in reducing hospitalization related to acute infection. Compared to placebo, sotrovimab, molnupiravir, and PAXLOVID reduced the relative risk of hospitalization or death from any cause by 79%, 30%, and 88%, respectively. Compared to placebo, fluvoxamine reduced the relative risk of COVID-19–associated acute care by 32%. 

ICER found high certainty that the use of sotrovimab or PAXLOVID delivered at least a small net health benefit with moderate certainty of a small or substantial net health benefit compared to usual care (B+ rating). ICER found moderate certainty that the use of molnupiravir or fluvoxamine is either comparable to or has a small net health benefit compared to usual care (C+ rating). ICER’s findings showed the cost per quality-adjusted life-year (QALY) gained was $76,000 for sotrovimab, $61,000 for molnupiravir, $21,000 for PAXLOVID, and $8,000 for fluvoxamine. The cost-effectiveness of the 4 drugs would be more favorable should evidence become available showing these treatments reduce the respiratory support required among hospitalized individuals. Current prices are found to be reasonably aligned with patient benefits. 

Last Thursday, the Innovation and Value Initiative (IVI) and the Network for Excellence in Health Innovation (NEHI) co-hosted a webinar, “Next Steps Toward Patient Focus in Value Assessment and Payer Decision Making,” on the need to meaningfully engage patients and patient communities to prioritize the patient experience, define patient-centered impacts, and improve shared data measures and methods to help guide decision making. NEHI addressed 5 key principles of good patient-payer communication including: 1) trust, empathy, and transparency; 2) representativeness; 3) shared focus on evidence and a commitment to collaboration; 4) shared focus on total costs of patient care; and 5) timeliness. Health equity in value assessments was emphasized to achieve patient-centered healthcare. Syncing patient advocacy groups with payer decision makers before developing coverage policies was also discussed. The recorded webinar can be accessed here. 

Last Tuesday, Alira Health and Health Technology Assessment international (HTAi) announced their collaboration to develop a multi-stakeholder value assessment framework for robotic-assisted surgery and digital health technologies. The framework will provide best practices for assessing the value of robotic-assisted surgery, how to support the implementation of robotic-assisted surgery and digital health programs globally, and how to ensure the perspectives of patients and physicians are included in the quantification of value. 

If you need assistance with all things ICER or value-related, please contact Erika Wissinger.