CedoHealth’s Post

🔍 **Insight into Semaglutide's Impact on U.S. Health Costs and Access** A recent analysis reveals that over 136 million American adults could potentially benefit from semaglutide, the GLP-1 drug marketed as Ozempic for diabetes and Wegovy for weight management. Beyond these uses, semaglutide may also aid in preventing heart disease. Despite the promising health benefits, the costs—approximately $1,000 per month—pose significant financial barriers. Currently, insurance coverage predominantly supports its use for type 2 diabetes. With 2023 net sales reaching $13.8 billion, semaglutide's pricing remains under scrutiny. While pharmaceutical firms emphasize the role of pharmacy benefit managers (PBMs) in cost decisions, economic accessibility remains a critical issue, with less than half of eligible patients receiving coverage through Medicare or Medicaid. As healthcare professionals and policymakers navigate these challenges, prioritizing affordability and broadening coverage could enhance health outcomes and access for millions. #Healthcare #Pharmaceuticals #Semaglutide #AccessToCare #InnovationInMedicine

Good morning & happy Monday. Funny story: All the experts agree that #MART (aka #SMART) therapy is the preferred treatment for #asthma. But here's what will happen to you if your doctor orders it: 1) Your pharmacy will tell you it's not covered, 2) You will go back and forth with your doctors office based on the pharmacists information and 3) Eventually realize the prescription is perfectly valid and medically on point, but your insurance company refuses to cover it because it's not "FDA approved" and therefore considered off label. FDA won't do anything because they require pharmaceutical companies to conduct multimillion dollar studies for each new indication, even for medications used for decades with unanimous support from the medical community. 4) Your insurance company won't budge, because their systems are built to reject anything off label. 5) The eventual solution? Your doctor will prescribe your inhaler one way, for the purpose of insurance approval, but tell you to take it differently, for maximal clinical benefit. Seriously? Yes #administrativecruelty

November is Diabetes Awareness Month. Although "Diabetes Awareness" is focused on individuals who are living with or at risk of developing diabetes, why don't we switch things up in this corner with some prescribing tips & tricks for the prescribers involved in the care of patients with diabetes?😜 ------ #Fact: While certain types of insulin are structurally similar with similar effectiveness, they're NOT considered interchangeable. For example, Basaglar 100u/ml is not interchangeable with Lantus 100u/ml. #Fact: The use of a brand name on a prescription for certain types of insulin indicates that the prescriber has a preference for that brand of insulin. I know this is not the intention for most prescribers. #PrescribingPearls: - avoid using the brand names on prescriptions. Prescribe with the drug name and concentration e.g Insulin Glargine 100u/ml instead of "Basaglar" or "Lantus." -if the prescriber's system automatically populates the brand name, it may be beneficial to add a note saying that it's "ok to substitute for the preferred brand." Here are the winning reasons to consider these pearls 👇🏾 ✨️zero administrative burden for the prescriber & team -> sanity, saved! ✨️clear + simple indication of the intended drug therapy -> hello team work! ✨️obvious clue that patient's access to the insulin therapy was considered -> the drug cost & availability may be a barrier that the patient may not yet be aware of during their encounter with the prescriber. 🎯 Remember that a written prescription for a medication means nothing if the patient can't access the medication! ------ Got more tips to share? let's see it in the comment! For now, try implementing these pearls and be sure to let me know how it goes. Cheers to being efficient and saving sanity together! *📸 The attached picture is a real prescription for Insulin Glargine 100u/ml that took 3 tries and 8 days to get it right. #PatientCare #TeamBasedCare #Community #Pharmacy #Consultant #PharmD #MD #NP #PA #PatientAdvocate

No one should have to pay 10x more for the same weight-loss medications ... That's why we submitted an official statement to the congressional record at this morning’s Senate hearing with three specific recommendations to help end the obesity epidemic. That's why we launched a petition requesting policymakers not to allow the only affordable GLP-1s to be forced off the market without fair brand-name pricing. And that's why we ran a full-page ad on the back cover of today's Wall Street Journal encouraging the Senate Committee to focus on two key questions. The removal of Wegovy and Zepbound from the FDA drug shortage list will also remove the only affordable GLP-1 medications from the US market, forcing large numbers of citizens to discontinue vital treatments or else face a large price hike. Noom calls for caution to avoid such harm. Our proposal is as simple as it is modest ... We ask pharmaceutical companies for data to show how they will meet the demand of these potentially millions of citizens, allow a lengthy grace period so that folks do not lose access to their obesity and diabetes medications overnight, and base the length of the grace period on achieving fair US pricing—as measured by the global price of the SAME medications. For the last year, our program prescribed only brand-name meds. We've seen firsthand how many folks can't access the medications because of the high U.S. pricing. These high prices discourage health plans from covering the med, restricting access. We've seen even those fortunate enough to have good insurance to also not be able to access the medication because of the short supply. We prescribe brand-name meds to patients who can access them and affordably-priced medications produced via 503B FDA-regulated outsourcing facilities to those who cannot. We ask for affordable choices and fair pricing for obesity and diabetes medications.

https://lnkd.in/gtTvQTmr 𝐀 𝐆𝐮𝐢𝐝𝐞 𝐭𝐨 𝐆𝐞𝐭𝐭𝐢𝐧𝐠 𝐏𝐫𝐢𝐨𝐫 𝐀𝐮𝐭𝐡𝐨𝐫𝐢𝐳𝐚𝐭𝐢𝐨𝐧 𝐟𝐨𝐫 𝐀𝐦𝐥𝐨𝐝𝐢𝐩𝐢𝐧𝐞 𝐎𝐥𝐦𝐞𝐬𝐚𝐫𝐭𝐚𝐧 𝐓𝐚𝐛𝐥𝐞𝐭𝐬 𝐟𝐨𝐫 𝐇𝐲𝐩𝐞𝐫𝐭𝐞𝐧𝐬𝐢𝐨𝐧 𝐈𝐧𝐬𝐮𝐫𝐚𝐧𝐜𝐞 𝐂𝐨𝐦𝐩𝐚𝐧𝐲 𝐚𝐧𝐝 𝐌𝐞𝐝𝐢𝐜𝐚𝐭𝐢𝐨𝐧 𝐎𝐯𝐞𝐫𝐯𝐢𝐞𝐰: When you’re dealing with high blood pressure that’s tough to manage, finding the right medication can feel like a challenge. For many patients, Amlodipine Olmesartan is the answer—a combination medication that’s specifically designed to help bring blood pressure down effectively, particularly for those with essential hypertension who haven’t had much success with other treatments. However, because Amlodipine Olmesartan is a combination drug that’s often prescribed after other medications fail, Medicare generally requires a prior authorization (PA) before covering it. This PA requirement is Medicare’s way of ensuring that Amlodipine Olmesartan is the best and most medically necessary option for the patient’s situation. In this case, we’re looking at Amlodipine Olmesartan 10-20mg, a powerful combination of a calcium channel blocker (Amlodipine) and an angiotensin II receptor blocker (Olmesartan), each working in its own way to lower blood pressure. The goal of this PA was to show Medicare that this medication was essential, especially after a prior treatment with a single-agent drug (furosemide) didn’t give the patient the blood pressure control they needed. Here’s a step-by-step look at how this PA request was completed, and what you’ll need to know if you’re handling a similar situation. 𝐊𝐞𝐲 𝐓𝐚𝐤𝐞𝐚𝐰𝐚𝐲𝐬: 𝐂𝐥𝐞𝐚𝐫 𝐃𝐨𝐜𝐮𝐦𝐞𝐧𝐭𝐚𝐭𝐢𝐨𝐧 𝐨𝐟 𝐏𝐫𝐞𝐯𝐢𝐨𝐮𝐬 𝐓𝐫𝐞𝐚𝐭𝐦𝐞𝐧𝐭𝐬: Medicare wants to see that other medications have been tried and haven’t been effective. Detailed documentation of prior treatment failures, like furosemide in this case, is essential. 𝐂𝐨𝐦𝐩𝐫𝐞𝐡𝐞𝐧𝐬𝐢𝐯𝐞 𝐏𝐚𝐭𝐢𝐞𝐧𝐭 𝐚𝐧𝐝 𝐏𝐫𝐨𝐯𝐢𝐝𝐞𝐫 𝐃𝐞𝐭𝐚𝐢𝐥𝐬: Accuracy in filling out patient demographics and provider information helps avoid delays. 𝐒𝐮𝐩𝐩𝐨𝐫𝐭𝐢𝐧𝐠 𝐃𝐨𝐜𝐮𝐦𝐞𝐧𝐭𝐚𝐭𝐢𝐨𝐧: Blood pressure logs, treatment histories, and a summary of the positive response to Amlodipine Olmesartan can help make the case stronger. 𝐒𝐭𝐞𝐩-𝐛𝐲-𝐒𝐭𝐞𝐩 𝐏𝐫𝐨𝐜𝐞𝐬𝐬 𝐟𝐨𝐫 𝐎𝐛𝐭𝐚𝐢𝐧𝐢𝐧𝐠 𝐏𝐫𝐢𝐨𝐫 𝐀𝐮𝐭𝐡𝐨𝐫𝐢𝐳𝐚𝐭𝐢𝐨𝐧.... 𝐅𝐨𝐫 𝐌𝐨𝐫𝐞 𝐈𝐧𝐟𝐨𝐫𝐦𝐚𝐭𝐢𝐨𝐧: https://lnkd.in/gtTvQTmr

TELUS Health | TELUS Santé will now reimburse its employees for certain medication costs only if the prescriptions are filled through the company's own #Virtual #pharmacy. This rule applies to two categories of medications: maintenance drugs, which are regularly used to manage conditions such as asthma or diabetes, and specialty drugs, which are prescribed for treating complex or severe illnesses like #cancer or #Crohn's #Disease. Preferred Pharmacy Networks (#PPNs) are a common practice among many of Canada's leading insurers. For instance, Sun Life's PPN includes pharmacies like Express Scripts Canada Pharmacy, InnomarPharmacy, and BioScript Pharmacy, and its use is optional for Sun Life's staff. What do you think? https://lnkd.in/giDWhai8

GSK's recent decision to cap out-of-pocket costs for essential asthma and COPD medications signals a positive shift toward affordable respiratory care - making vital treatments more accessible to patients.     A study utilising National Health Interview Survey data (2013-2020) revealed that 1 in 6 US adults with asthma face cost-related medication non-adherence.1 This potentially dangerous practice includes skipping doses, taking less medication, or delaying prescription refills. Easier prescription refill processes could boost patient compliance and lead to improved asthma and COPD management.    At Adherium, we’re committed to empowering patients to take control of their respiratory health.     This news creates opportunities to better serve patients by combining our connected devices with affordable treatment options, which means better outcomes for those who need it most. This combination is poised to significantly reduce hospital admissions, emergency room visits, and mortality rates, while simultaneously improving the management of biologics. Ultimately, this leads to an elevated quality of life for patients.    Read GSK’s announcement 👉 https://lnkd.in/gg6Ybw88    $ADR #Adherium #asthma #COPD #inhaler #healthcare #medtech #respiratoryhealth  

Today, we are proud to announce HCA Healthcare collected 21,137 pounds of unused or expired medications during our sixth annual “Crush the Crisis” national prescription drug take back day. This surpasses last year’s totals and is the most we have ever collected during the annual event. In total, HCA Healthcare has now collected more than 88,600 pounds of medication since launching “Crush the Crisis” as an enterprise initiative in 2019. “I am amazed by the results of this year’s Crush the Crisis,” said Dr. Randy Fagin, chief medical officer of HCA Healthcare’s National Group. “Our colleagues showed up for their communities to help remove unneeded medication before it could fall into the wrong hands. This record-breaking year is a testament to how HCA Healthcare cares for the communities we serve.” HCA Healthcare facilities across the country partnered with local law enforcement to help communities safely and anonymously dispose of unused or expired medication. An estimated 14.5 million doses of medication were collected at more than 125 collection sites. HCA Healthcare’s “Crush the Crisis” events were held in alignment with the Drug Enforcement Administration’s (DEA) National Prescription Drug Take Back Day, which collected 629,953 pounds of medication. ➡ Learn more about HCA Healthcare’s initiatives to help reduce prescription drug misuse and transform pain management: https://bit.ly/3AQyTmu. #HealthierTomorrows #CrushTheCrisis

Today, as part of a Senate hearing examining the high cost of obesity medications, we’re submitting an official statement to the congressional record urging lawmakers to ensure affordable and fair pricing for GLP-1 meds for all Americans. In tandem, our latest Wall Street Journal ad highlights the pressing need for equitable access to these life-changing treatments. Join us in advocating for sustainable solutions by signing our petition. ✍️ https://lnkd.in/e_B_ZvJi

FDA-approved approved #Leqembi is the latest medication for #Alzheimers treatment. This pricey drug is covered by #Medicare—but the cost sharing amount for beneficiaries can be high. As #MedicareOpenEnrollment continues, learn how Leqembi works, who can get it, and what people with Medicare can expect to pay out of pocket.👇 #AlzheimersAwarenessMonth https://lnkd.in/eF2TH8ue