Smug looks awful on me so it is a good thing I did a terrible job picking my brackets. I need to set a reminder to create 2 brackets next year –one on how I actually think things will go and one on a more whim basis (colors, mascots, which school I think my kids would like best.) I only went whim this year…  

Called It. Per Dr. Oz’s testimony, looks like Medicare Advantage is going to be on the hot seat. And Most Favored Nation might not be dead. We live in a sound bite world and these are both easy to explain in 10 seconds or less.

It is not Altruism. This week Optum, a pharmacy benefit manager (PBM) owned by United Healthcare, announced they were getting rid of annual prior authorization requirements for 80 drugs. The reason? No longer necessary to clinically review these drugs. On one hand, this is great for patients taking these drugs. No one is taking a drug for cystic fibrosis for fun. But, if it made financial sense to do prior authorization, I must believe they would keep doing it. It is just that now probably almost all the requests are approved so why bother paying for the process to continue?

Optum also announced that they are moving toward changing the way that community pharmacies are to a cost-based payment model. Right now, generally pharmacies are underwater on branded products and forced to balance that with profit on generic products. Yes, you read that correctly. This press release at least acknowledges this weirdness and says that it will work toward fixing it. Again, not unselfish. More high-cost drugs, more Medicare negotiated drugs, etc. and pharmacies will close. Plus, PBMs have been under a lot of scrutiny so it is better to self-correct a little than be legislated to change.

Staying the Course. Looks like the Trump Administration picked up where the Biden Administration left off on 340B and not allowing pharmaceutical companies to pay through a rebate rather than discount product. The Administration wants an “ask for permission, not forgiveness” approach so the door is open for changes in the future.

Bright Spots. Researchers are taking steps forward on delaying (maybe preventing) Alzheimer’s symptoms. I also loved this paper on the use of therapy dogs in pediatric emergency rooms. I ended up down a rabbit hole of learning about therapy dogs and thinking about plans. My current dog thinks I am a traitor.