For the policy wonk that has everything. I give you the 2025 Notice of Benefit and Payment Parameters.
Everything you wanted to know about DIR but were afraid to ask. Direct remuneration (DIR) doesn’t exactly roll off the tongue but it is a big part of the behind the scenes reimbursement of pharmacies. DIR are fees tied to performance metrics between pharmacies and pharmacy benefit managers (PBMs). These fees have gone from $9 million to $12.6 BILLION between 2010 and 2021. As of January, DIR is supposed to be calculated at the time of dispense. This was intended to be good news rather than PBMs clawing back fees months later. But, you guessed it, PBMs didn’t take the news lying down. KFF has a great article giving you the ins and outs.
Things I wish we did better at – caregiving. The New York Times and KFF both did articles about long term care and caregiving and how the United States is just not great at it. We don’t support caregivers and a lot of the time we just don’t have the resources out there to provide for patients. I think for every situation it feels like caregivers are the first people to go through the situation and there is no roadmap. They feel alone. But don’t just take it from me. NYT
KFF does a nice job explaining how we could do better with descriptions of long term care from around the world and a comparison of long term care spending. We spend way less, then again, we spend way more in other healthcare areas.
You get a weight loss product and you get a weight loss product. The American Medical Association encouraged payers to provide evidence-based obesity treatments without exclusions. Not likely to happen (yet) but given the overall health impact of being obese, also very possible as we move toward additional products and higher rebates in the therapeutic class. A few years from now, I think we’ll see a very different landscape.
Strawberry Short Take. A recent study found that is it possible that strawberry supplements can reduce cognitive decline and depressive symptoms.
Right Angles, Right Approach. For anyone that has had that middle-aged conversation of surgery or not on a torn anterior cruciate ligament (ACL), a recent study suggests that keeping it in a brace at 90 degree angle and rehab might be the way to go. Yes, this story is self-serving – a way to keep the story front and center for this upcoming ski season.