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A new government report finds that data on the race and ethnicity of 

 is often inaccurate, hindering the program’s ability to assess 

 in access to and quality of care among its 66 million participants.

The report from the Department of Health and Human Services’ Office of the Inspector General (OIG) says that race and ethnicity data for beneficiaries identified as American Indian/Alaska Native, Asian/Pacific Islander or Hispanic is less accurate than for other groups.

“The Centers for Medicare & Medicaid Services has made advancing 

 a top priority,” the report states. “Ensuring that Medicare is able to assess disparities is key to this goal. The ability to assess health disparities hinges on the quality of the underlying race and ethnicity data.”

The OIG arrived at its findings by analyzing race and ethnicity data in Medicare’s enrollment database and comparing them to self-reported race and ethnicity data—considered the “gold standard” of such data—for about five million beneficiaries who’ve been in nursing homes. Medicare derives its enrollment data from data provided by the Social Security Administration (SSA) and applying the Research Triangle Institute algorithm to improve its accuracy.

The report finds two broad categories of errors in Medicare’s data. The first is individuals listed as part of a race or ethnicity with which they don’t identify on the nursing home assessment. That error applies to 28% of beneficiaries identified as Hispanic in the enrollment data, 46% of those identified as American Indian/Alaska Native and 17 percent of those identified as Asian/Pacific Islander.

Second is that the data don’t accurately depict the race and ethnicity with which beneficiaries in the groups do identify. Thirteen percent of beneficiaries who self-identified as Hispanic on the nursing home surveys are not so identified in the enrollment data. The same error occurs for 35% of those who self-identified as American Indian/Alaska Native on the nursing home assessment and 24% identifying as Asian/Pacific Islander.

The report notes that Medicare uses data on the race and ethnicity of beneficiaries to address issues such as disparities in the 

, access to care providers, and quality of services provided.

“However, inaccurate race and ethnicity data can raise concerns that efforts to address disparities …. would be targeted at the wrong beneficiaries,” according to the report. “Further, using inaccurate data to try to measure the effects of these efforts could produce misleading results.”

The OIG report offers several recommendations for improving the accuracy of Medicare’s data. Among them:

Transitioning away from the current practice of using SSA data and developing its own source of information

Incorporating existing data from the nursing home and other post-acute assessments into the enrollment data for current beneficiaries where available

Exploring other ways of collecting self-reported data from beneficiaries who don’t have post-acute care assessments by, for example, adding race/ethnicity questions to beneficiaries’ online accounts

Developing a process for making the race and ethnicity data it collects as standardized as possible and able to be incorporated into the enrollment database, and

Educating beneficiaries about CMS’s efforts to improve the quality of its race and ethnicity information

https://oig.hhs.gov/oei/reports/OEI-02-21-00100.pdf

This was originally posted on Medical Economics. 

Articles

Errors impede efforts to overcome disparities in health care access and outcomes

Report finds flaws in Medicare race, ethnicity data

Lawrence Eichenfield, MD, chief of pediatric and adolescent dermatology at Rady Children's Hospital-San Diego, professor of dermatology and pediatrics and vice-chair of the department of dermatology at UC San Diego School of Medicine, talks about some of the upcoming events at the annual Society for Pediatric Dermatology Conference, which is taking place this year in Indianapolis, Indiana.

Lawrence Eichenfield, MD, is excited about the upcoming Society for Pediatric Dermatology Conference in Indianapolis July 7-10, where he will be presenting the AAP Section on Dermatology Alvin Jacobs Award to Sheila Fallon Friedlander, MD

Ready, set, go: countdown to the Society for Pediatric Dermatology Conference

Ms. Hester is Content Specialist with Contemporary OB/GYN and Contemporary Pediatrics.

For patients living with complex conditions, therapeutic clinical outcome monitoring programs can help identify the need for clinical interventions and improve patient satisfaction, according to a poster presented by Alexandra B. Edinger, PharmD, of the University of Illinois Chicago, at the American Society of Health-System Pharmacists 2022 Summer Meetings and Exhibition in Phoenix, Arizona.

The poster highlighted the therapeutic outcome monitoring program for rheumatoid arthritis implemented at the UI Health Specialty Pharmacy Services, which included theRoutine Assessment of Patient Index 3 (RAPID-3) survey, which is a validated disease activity examined whether there was a link between the RAPID-2 survey scores and satisfaction with therapy.

The program was initiated on September 1, 2021. Any patient who began a new pharmacologic treatment that was FDA-approved for rheumatoid arthritis was given the RAPID-3 survey at baseline as well as 3 and 6 months after beginning the therapy. At those times, a technician would contact the patient and complete a monthly clinical assessment survey to look at missed doses, tolerability, recent hospital stays, and satisfaction with the new therapy, and then the patient was transferred to a University of Illinois Health Specialty Pharmacy Services pharmacist to complete the RAPID-3 survey.

Since the program’s inception, 17 eligible patients have been enrolled. At the start of treatment, the man weight RAPID-3 score for cohort was 5.9 (standard deviation [SD] = 1.56), which represents a high level of disease activity. By March 15, 2022, 7 patients had completed the 3-month RAPID-3 assessment, with 5 having a decrease in their score. The scores decreased by 1.5 points (SD = 0.61) on average and the mean satisfaction score was 6.2 out of 10 (SD = 1.7) for the specialty medication. For the other 2 patients, an increase in RAPID-3 score was found, which prompted a clinical intervention with an appropriate provider. These interventions led to a change in therapy and a dosage escalation.

Clinical outcome monitoring is a new way to manage the medication for patients who get specialty medications in health system pharmacy and it better identifies those who are in need of clinical intervention. Edinger did noted that data collection is ongoing and a full analysis is pending.

Edinger A. Evaluation of a therapeutic outcome monitoring program forpatients with rheumatoid arthritis. Presented at American Society of Hospital Pharmacists 2022 Summer Meeting; June 13, 2022; Phoenix, AZ.

Complex diseases can be difficult to manage for optimal outcomes. Monitoring programs of therapies can help with that management

Managing Complex Diseases with Therapeutic Monitoring Program

Rising insulin prices have sparked an examination by federal regulators who said they want to know how drug companies and pharmacy benefit managers are setting prices that patients can’t afford.

The Federal Trade Commission (FTC) on June 16 voted 5-0 to examine rebates and fees paid by drug manufacturers to pharmacy benefit managers (PBMs) and other intermediaries in exchange for disfavoring lowest cost drugs.

, comes a little more than a week after the FTC announced a new inquiry into the business practices of the six largest vertically integrated PBMs – CVS Caremark, Express Scripts Inc., OptumRx Inc., Humana Inc., Prime Therapeutics LLC, and MedImpact Healthcare Systems Inc.

 about the policy statement, the FTC summarized the situation: “Most consumers have health insurance that covers some part of their prescription medicine costs. These health plans, usually through prescription drug middlemen like pharmacy benefit managers, use ‘formularies’ to define which medicines they will cover. Drug companies use rebates to have their drugs placed on formularies or on preferred tiers of formularies to ensure those drugs are covered.

“These rebates are often conditioned on the drug staying in a preferred position on the formulary. Some rebates and fees are conditioned on the volume of sales of certain high list price prescription medicines. In addition to other factors, some have suggested that high rebates and fees to PBMs and other intermediaries may incentivize higher list prices for drugs and discourage coverage of the lowest-cost products.”

, FTC Chairwoman Lina M. Khan and Commissioners Noah Joshua Phillips, Rebecca Kelly Slaughter, Christine S. Wilson and Alvaro Bedoya all spoke about the effects of drug prices on patients.

In the last decade, drug prices in America have been soaring, even for medicines developed decades ago. The wholesale price of insulin nearly tripled between 2009 and 2017, increasing out-of-pocket costs for insured and uninsured patients alike, Khan said. Uninsured patients or those with high-deductible plans may pay $500 or more a month for insulin, she said.

In previous hearings, the commissioners have heard from people directly affected by high drug prices, Kahn said, recounting laws that give the FTC authority to stop unlawful business practices that lead to higher prices.

“Today's enforcement policy statement should put market participants on notice that these longstanding FTC statutory authorities may prohibit drug rebate practices, certain drug rebate practices, especially to the extent that these fees are paid to for close competition for more affordable generic and biosimilar alternatives,” Khan said. “I'm committed to ensuring that the FTC is bringing all of our tools to bear on unlawful business practices that may be resulting in Americans paying higher prices for medicines, and hope that my colleagues will agree.”

She credited the work of Slaughter, who has urged the Commission to examine the drug pricing systems.

Phillips said the policy statement is important, but the FTC and staff must direct their energies to results.

The commissioners heard moving testimony from those affected by insulin prices, Slaughter said, but a solution may not necessarily come quickly.

“While we need to be thorough on finding ways to tackle high insulin prices through enforcement, I want to be clear about expectations,” Slaughter said. “Expectations take time. It's important that staff have the time and space to follow the facts where they lead. The FTC can scour all the relevant documents and take hours of testimony, but at the end of the day, we need legal theories and sufficient evidence to support them.”

The FTC has examined prescription drug and health system mergers at least since 2002, Wilson said. “The rebate and fee issues in pharma and especially for insulin are clearly an area worthy of investigation,” she said, and FTC must protect competition and consumers.

The United States is the wealthiest country in the world, drug makers and middlemen make billions of dollars off of insulin, yet one in four Americans can’t afford it, Bedoya said.

“In a competitive market companies compete to lower their prices. It would appear that in the insulin market, companies compete to raise them,” Bedoya said, citing a study by the Senate Finance Committee that found drug companies gained revenue by raising prices.

The FTC meeting included time for public comments about the policy statement and other issues.

Speakers included Kristin Bass, chief policy and external affairs officer at the 

Pharmaceutical Care Management Association

It is in the interest of drug manufacturers and pharmacies, not consumers, for the FTC to target PBMs, which is the one industry using market forces to push the drug makers and pharmacies to lower costs for patients and health plan sponsors, Bass said.

She noted PBM formularies give patients strong incentives to use generic drugs, so 90% of all prescriptions are filled with generic drugs. For every dollar spend on PBM services, the PBMs deliver $10 in savings, Bass said.

The FTC is not the only government agency looking into drug makers and PBMs.

 filed last month by Arkansas Attorney General Leslie Rutledge against a number of pharmaceutical makers. The complaint alleged CVS Caremark, Express Scripts and OptumRx “collectively dominate the pricing system” for insulin drugs.

Those companies are, at the same time, the largest PBMs in the country and in Arkansas, the largest pharmacies in the country and within three of the largest insurance companies – CVS Caremark with Aetna, Express Scripts with Cigna and OptumRx with UnitedHealthcare.

The lawsuit alleges the drug makers and PBMs have created an “insulin pricing scheme” to “game the system,” making money by inflating consumer costs, with insulin prices not at all reflective of actual production costs.

The lawsuit seeks a ruling that the businesses violated the Arkansas Deceptive Trade Practices Act, along with restitution and damages.

Express Scripts Inc., the first company to respond, denied the allegations, and asked to move the case to federal court, according to 

Rising insulin prices have led department to examine the impetus behind setting prices that many patients can't afford.

 FTC to Examine Drug Makers, PBMs Due to Insulin Prices

Medicare Part D would have saved $3.6 billion if it purchased 77 generic 

 at prices charged by billionaire entrepreneur 

The findings “suggest that Medicare is overpaying for many generic drugs,” said the study, “Potential Medicare Part D Savings on Generic Drugs From the Mark Cuban Cost Plus Drug Company,” or MCCPDC, published June 21 in the 

, a journal of the American College of Physicians.

 suggested policy reforms that could make generic drugs more affordable.

“Although direct-to-consumer private companies like MCCPDC may offer savings for some patients on select drugs, policy reforms that improve price transparency, increase competition for high-cost generic drugs, prevent annual price increases, and limit pharmacy and distribution costs could increase affordability of essential generic medicines for all Americans,” said the study, led by corresponding author Hussain S. Lalani, MD, MPH, of Brigham and Women’s Hospital and Harvard Medical School in Boston.

The results “highlight inefficiencies in the existing generic pharmaceutical distribution and reimbursement system, which includes wholesalers, pharmacy benefit managers, pharmacies, and insurers,” the study said.

 that estimated the supply chain retains 64% of every dollar spent on generic drugs, compared with 25% of every dollar spend on brand-name drugs before rebates. Generic drugs have lower ingredient and manufacturing costs than brand-name drugs, so dispensing fees represent a greater share of the price.

The study noted MCCPDC sets prices at the cost of ingredients and manufacturing plus a 15% margin, a $3 dispensing fee, and a $5 shipping fee.

It did not mention the current economy with skyrocketiing 

, or the business goals of Cuban, the outspoken owner of the 

 NBA team and cohost of the ABC television show “Shark Tank.”

Cuban and MCCPDC cofounder Alex Oshmyansky started the company in 2016 with a “pledge to provide radical transparency in how we price our drugs,” according to its website.

“Our goal is that everyone should be able to afford their medicine. Everyone should know what it cost to make their medicine. Everyone should feel the price they paid for their medicine was fair,” the MCCPDC website said.

MCCPDC sells 109 generic medications. The study compared that company’s prices and Medicare Part D spent for 89 of those; it excluded 20 with multiple dosage forms, such as cream and ointment, because prices by ingredient were not comparable.

Researchers calculated prices in 2022 U.S. dollars, with use data based on 2020, the most recent Medicare data available.

Among the available savings for buying maximum quantities of drugs:

$1.9 billion for ingredients and manufacturing

$402 million for the 15% margin of the MCCPDC

Savings were greater when purchasing drugs in larger quantities to minimize fees. Even buying the minimum quantities of drugs, Medicare would have saved $1.7 billion on 42 of the 89 drugs. In that scenario, shipping would have cost $872 million and pharmacy fees would have cost $523 million, making up a higher percentage of the total spending.

The study included a chart with the top 10 generic drugs with the highest estimated savings, with drug name and dosage form; Medicare Part D vs MCCPDC prices per 90 count; estimated Medicare Part D spending; and estimated MCCPDC savings:

Esomeprazole, oral capsule; $160 vs $17; $327 million Medicare Part D spending; $293 million estimated savings

Rosuvastatin, oral tablet; $39 vs $19; $469 million Medicare Part D spending; $241 million estimated savings

Aripiprazole, oral tablet; $187 vs $22; $263 million Medicare Part D spending; $233 million estimated savings

Duloxetine, oral capsule; $39 vs $9; $295 million Medicare Part D spending; $226 million estimated savings

Losartan-hydrochlorothiazide, oral tablet; $62 vs $14; $208 million Medicare Part D spending; $160 million estimated savings

Ezetimibe, oral tablet; $59 vs $13; $198 million Medicare Part D spending; $153 million estimated savings

Memantine, oral tablet; $50 vs $13; $187 million Medicare Part D spending; $141 million estimated savings

Tizanidine, oral tablet; $35 vs $10; $194 million Medicare Part D spending; $141 million estimated savings

Colchicine, oral tablet; $381 vs $25; $140 million Medicare Part D spending; $131 million estimated savings

Bupropion, oral tablet, extended release; $56 vs $16; $183 million Medicare Part D spending; $131 million estimated savings

Originally published on our sister brand, 

Entrepreneur beats prices of supply chain wholesalers, PBMs, pharmacies, and insurers.

Medicare Could Save Billions Buying Generics through Mark Cuban Prescription Drug Company

The Society for Pediatric Dermatology was founded in 1975. As the only national organization in the United States specifically dedicated to the subspecialty of pediatric dermatology, its annual conference is something its 1400+ members look forward to each year. Meena Julapalli, MD, a board-certified pediatric dermatologist at Bluebird Dermatology in Houston, Texas, eagerly awaits this year's meeting, and talks about the sessions she is most looking forward to attending.

This was originally posted by our sister publication Contemporary Pediatrics.

Videos

Meena Julapalli, MD, notes the sessions she is most looking forward to at the Society for Pediatric Dermatology in Indianapolis, Indiana.

Meena Julapalli, MD, Gets Ready for the Society for Pediatric Dermatology Conference

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Each month, Dermatology Times® features a roundup of products trending in skin care. Find out what products are trending for the month of June.  

What's Trending in Skin Care: June 2022 

Lawrence Eichenfield, MD, chief of pediatric and adolescent dermatology at Rady Children's Hospital-San Diego and professor of dermatology and pediatrics and vice-chair of the department of dermatology at UC San Diego School of Medicine, discusses new treatments and therapies for pediatric atopic dermatitis. 

Pediatric Atopic Dermatitis: New Treatments and Therapies 

To stop inflation, former Treasury Secretary Larry Summers says high unemployment for an extended time period may be the only way to curb rising inflation.

Summers, whose comments were made at a speech in London and reported by 

, said the U.S. needs five years of unemployment above 5% to contain inflation, or two years of 7.5% unemployment, five years of 6% unemployment, or one year of 10% unemployment.

Unemployment is currently 3.6% according to the 

Typically, when inflation is high, unemployment is low, and Summers argument is that higher unemployment means less discretionary income going into the economy, thus lowering demand and reducing prices.

Current Treasury Secretary Janet Yellen says that overall consumer spending is strong, but that spending patterns are changing due to rising food and energy prices. She says that household savings that grew during the pandemic will help sustain spending.

The national saving rate is now around 6%, below pre-pandemic levels, after hitting 16.6% in 2020 and 12.7% in 2021.

Yellen told national news shows over the weekend that she expects the economy to slow after a period of very rapid growth, but to not hit recessionary levels.

 lose their inverse relationship — creating a period of high unemployment with high inflation — this creates what is known as stagflation. The last time this happened was in 1973. The fix was for the Fed to raise the federal funds rate to more than 20%, creating record unemployment rates, but also bringing inflation back to acceptable levels.

The Fed said last week that it would do whatever it takes to get prices under control, saying its commitment to reining inflation is “unconditional,” and added that stability is necessary to support a strong labor market.

 0.75% last week, the biggest increase since 1994 and indicated another large increase may happen in July. The Fed also downgraded its economic outlook, stating that the economy is now seen to have 1.7% growth with unemployment rising to 3.7% by the end of the year and rising to 4.1% through 2024.

Former Treasury Secretary Larry Summers said the U.S. needs a significant rise in unemployment to stave off more inflation

 High Unemployment May Be the Only Way to Stop Inflation

Dustin Portela, DO, a board-certified dermatologist and dermatologic surgeon at Treasure Valley Dermatology in Boise, Idaho.

Dustin Portela, DO, a board-certified dermatologist and dermatologic surgeon at Treasure Valley Dermatology in Boise, Idaho, talks about tinea versicolor.

Opinions expressed are that of Portela and do not express the views or opinions of Dermatology Times®.

In this week’s Pointers with Dr Portela, the 208SkinDoc talks what a “summer rash” is and prevention. 


Meena Julapalli, MD, Gets Ready for the Society for Pediatric Dermatology Conference

What's Trending in Skin Care: June 2022

Pediatric Atopic Dermatitis: New Treatments and Therapies

High Unemployment May Be the Only Way to Stop Inflation

Pointers with Dr Portela: Tinea Versicolor

Perspectives on Generalized Pustular Psoriasis