A Blog by AMCP CEO Susan A. Cantrell, RPh, CAE


 

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Prior Authorizations Play Crucial Role in Ensuring Appropriate Medication Use 

 
 

May 1, 2019 

Prior authorization (PA) is a crucial but often-misunderstood utilization management tool in the pharmacy benefit space. The bad rap that PAs have received recently, I believe, comes from either misinformation about the process or glitches in specific systems that can easily be corrected.

AMCP represents thousands of pharmacists and other health care professionals who design and implement pharmacy benefits for millions of Americans. PA is an essential part the equation.

Every day our members design and implement PAs that help optimize patient outcomes by encouraging the use of therapies that have established evidence of efficacy and safety, and provide the highest value. PAs help reduce waste, error and unnecessary medication use and costs.

One example is PAs for powerful painkillers. Today’s addiction crisis has been fueled in part by inappropriate and over-prescribing of opioids and other medications with addictive properties. PA programs involving opioids provide an additional level of safeguard to ensure the patient receives the appropriate medication for his or her condition, while avoiding unnecessary risks.

Another common example of PA is for the drug Botox. The medicine is used to treat muscular disorders, but it also can be used for cosmetic purposes (e.g., eliminate wrinkles). If a health plan does not cover cosmetic products or procedures, a PA would ensure that Botox is covered only when it’s used for appropriate medical indications.

Prior authorizations are not designed to save money to the detriment of patient care. Costs are considered only after safety and efficacy are first considered to determine appropriate clinical use.

While we strongly believe in this utilization management tool, we know that more can be done to improve the PA process. On this front, AMCP has taken a lead role in supporting the National Council for Prescription Drug Programs SCRIPT standard-based electronic prior authorization (ePA). This standard improves the patient and prescriber experience by providing real-time responses to PA processes.

In addition, we are continually assessing best practices. The AMCP Professional Practice Committee recently published “Prior Authorization and Utilization Management Concepts in Managed Care Pharmacy” in AMCP’s Journal of Managed Care & Specialty Pharmacy

Nine specific concepts the committee developed for effective PA practices focus on: (1) patient safety and appropriate medication use, (2) clinical decision making, (3) evidence-based review criteria, (4) automated decision support, (5) transparency and advanced notice, (6) emergency access, (7) provider collaboration, (8) need for timeliness and avoiding disruptions in therapy, and (9) cost-effectiveness and value. I encourage you to read this important document.

I am proud to say that members take AMCP’s vision seriously: “Optimizing medicines. Improving lives.” And I also note that we too are patients and caregivers, and we agree that everyone deserves timely and efficient access to appropriate therapy. That is our commitment with PA programs.

 

Cantrell: 'Now more than ever, our leadership, perspective and voice are essential'  

 
 

 April 5, 2019 

AMCP CEO Susan A. Cantrell, RPh, CAE addressed the AMCP Annual Meeting 2019 General Session on March 26, laying out how AMCP is prepared to meet the challenges of today’s complex health care system. The following is a lightly edited transcript of that address 

We face a time of tremendous change and uncertainty in health care. The advent of gene editing and digital therapies are game changers. New health care business models are emerging, and we’re on the brink of myriad policy changes that could dramatically change the future of our profession. Mergers are creating new health care organizations that will operate in different ways to deliver care and medication therapy. Read more

 

Managed Care Pharmacy Is Part of the Solution  

 
 
 

 March 1, 2019 

It’s a truism that the U.S. health care system is complex and expensive. Everyone from patients, payers and politicians agree that costs are too high and care delivery is difficult to navigate. We do too. But sometimes in the heated debate over how to improve the system, fingers are pointed and targets identified without understanding the full ramifications of proposed solutions. Read more.

 
 

HHS’s Rebate Negotiations Proposal Leaves Unanswered Questions  

 
 
 

February 6, 2019 

When doing major renovations on a house one must take care not to remove foundational support beams, or the entire building could come crashing down. That image struck me as we read the Jan. 31 announcement by Health and Human Services Department (HHS) to eliminate negotiated rebates for pharmaceuticals in Medicare Part D and managed Medicaid programs. Under the HHS proposed rule, negotiated rebates would no longer qualify for safe harbor protection under the Anti-Kickback Statute, a move that would disrupt a foundational practice of our profession. Read more.

 

Applications for Value: The Digital Therapeutics Revolution 

 
 
 

January 11, 2019 

[Susan Cantrell (second from left) was a panelist at a Jan. 9, 2019, session of the Digital Medicine and Medtech Showcase at the Biotech Showcase in San Francisco, California]  

Managed care pharmacy has a wide array of tools and practices that help ensure patients have access to needed medications while controlling rising costs. These include P&T committees, tiered formularies, step therapies and utilization management programs, which are all tried and true. But nothing says these tools can’t be used beyond the biopharmaceutical realm. Read more

    

JMCP Launches New Feature Focused on Advancing Value in Health Care  

 

Jan. 9, 2019 

As publisher of AMCP’s Journal of Managed Care & Specialty Pharmacy (JMCP), I am pleased to announce the launch of a new article series called Perspectives on Value. This new feature gets to the very heart of AMCP’s focus on advancing value in health care. Perspectives on Value will consist of a summary of a recent evidence report written by the Institute for Clinical and Economic Review (ICER), along with commentary authored by a key stakeholder. ICER is an independent, nonpartisan organization that provides comprehensive clinical and cost-effectiveness analyses of treatments, tests and procedures. Read more.

    

New CMS Report Demonstrates Cost-Effectiveness of MTM Programs in Medicare Part D  

 

December 19, 2018 

It’s not necessarily polite to say, “I told you so”… but it can feel satisfying. A new report from the Centers for Medicare & Medicaid Services (CMS) confirms our long-held position that providing flexibility in the delivery of medication therapy management (MTM) services not only is good for patients, but also provides significant cost savings. Read more.

    

A Season to Be Thankful!  

 

 

November 21, 2018 

With Thanksgiving upon us, and the holiday season fast approaching, now is a perfect time to reflect on the good fortune that we in the AMCP family enjoy. I am personally thankful on many levels. Read more.

 

    

Cantrell Addresses AMCP Nexus 2018 General Session  

 

   

October 23, 2018 

It is a great honor to welcome everyone to Orlando and AMCP Nexus 2018. This large gathering is a testament to the vitality of our profession and the strength of AMCP. It’s also a reflection of this pivotal moment in our country’s history. Read more. 

 

    

Emerging Trends Update: The Patient’s Paramount Place   

 

 

September 28, 2018 

As managed care pharmacy professionals, we work to improve the lives of millions of people. But we also must never forget that behind these large numbers are individual patients. That’s why the AMCP Foundation’s latest bridge report on its initial Emerging Trends research rings so true. The article, “The Patient’s Paramount Place: Emphasis on Empowerment, Engagement, Experience,” raises many important points on how patient empowerment is crucial to the success of health care today. The underlying conclusion is that empowered patients may be more adherent to treatment, and their engaged role can contribute to an improved health care system. Read more.

 

    

Addressing Increasing Costs and Spending on Pharmaceuticals Requires Multipronged Approach  

 

Aug. 30, 2018 

A new article in Health Affairs (http://bit.ly/2BQlgo9) highlights the challenges that many health plans and payers face as spending on pharmaceuticals continues to rise. The report, which looked at total health care spending at Harvard Pilgrim Health Care (HPHC) from 2011 and 2016, found that spending on pharmaceuticals had increased to a full 25% of all dollars spent. Read more.

    

AMCP is Leading Efforts to Find New Benefit and Payment Models to Address High-Cost Medications

 

Aug. 13, 2018 

By now, it’s virtually an article of faith that the costs of pharmaceuticals are too high (and, by-the-way, so are costs of hospitalizations, MRIs, ambulance rides and many other health care interventions). But because so many people rely on and purchase medications every day, they feel the bite of pharmaceutical costs more acutely. Last year's headlines from a bad actor who raised the price of a lifesaving drug by more than 5,000 percent added to the impression that costs are out of control. Read more.

    

Focus on Prevention Pays Off

 

July 25, 2018 

“An ounce of prevention is worth a pound of cure” — Benjamin Franklin

This truism lies at the heart of much of what managed care pharmacy does. AMCP members and their organizations have long championed the use of preventive-care services to achieve better health outcomes and lower overall health care costs. To wit, it’s better to ensure a heart patient takes his medicines regularly than to treat him in the emergency room with a heart attack. Read more

 
 

Summertime, and AMCP is Busy!

 

July 4, 2018 

Summer is in full swing! It’s time to enjoy a good barbecue, go to the beach, soak up the sun, and dine with friends at your favorite sidewalk cafe. At AMCP, it’s also a time to engage with the Academy’s volunteer leadership, as well as a diverse array of health care stakeholders...who said pharmacists ever slow down when the weather gets hot? In July, we have two important events planned. Read more.

  

Biosimilars Will Foster Competition and Lower Costs

 

June 1, 2018 

The White House made news last month with its blueprint to lower drug prices. But it's also important to note that biosimilars will play a crucial role in fostering competition and lowering costs. Biosimilars are the topic of my latest op-ed, "How to Foster Competition While Cutting Drug Costs," published last month in Morning Consult. 


  

Welcome Remarks at General Session of AMCP Annual Meeting 2018 in Boston

 
 

May 2, 2018 

Hello! Welcome to Boston and the Academy of Managed Care Pharmacy’s Annual Meeting!  

It is my pleasure to stand here before you at this pivotal moment in the history of our country’s health care system. As we just saw, the way we deliver care is undergoing a sweeping transformation by forces that require new thinking and innovation. Glance at any news outlet today and you’ll see story after story on the trends buffeting health care. Read more

  

Not All Scientific Journals Are Created Equal: Beware of Predatory Publishers

 

April 4, 2018 

Usually I delete emails like the one I received recently, but this one got me thinking. It was addressed to one of my predecessors, and invited her to publish a paper in a journal on patient care and nursing. The message said, “We believe that your invaluable experience and insights as a scholar in the area will be enlightening to our readers.”

Well, the former CEO of the Academy did indeed have “invaluable experience,” just not in the areas of patient care or nursing, at least to my knowledge. Read more.

  

AMCP Legislative Days Focuses on Passage of PIE Act, Efforts to Reduce Fraud, Waste and Abuse in Medicare Part D

 

March 7, 2018 

One of AMCP’s key strategic pillars is to advocate for legislation that will help advance the profession of managed care pharmacy. This function is on full display this week during our Annual Legislative Days event. I am proud to join nearly 20 of AMCP’s volunteer leaders and staff in a trek up Capitol Hill to meet with more than 50 House and Senate offices on two crucial issues:  

  • Passage of the Pharmaceutical Information Exchange (PIE) Act of 2018 (H.R. 2026).
  • Initiatives to reduce fraud, waste and abuse under the Medicare Part D program.

Visit http://amcp.org/AMCPPositions/. Read more. 

  

PIE Act Addresses Lag Between FDA Approval and Patient Access; Cantrell Makes Case for H.R. 2026 in The Hill 

 

February 7, 2018 

The FDA approved 46 novel drugs in 2017, a 21-year high. However, it could take as long as six months for some of these groundbreaking medicines to reach patients, as pharmaceutical review committees work their way through complex clinical information to determine how, when, and why a new drug should be prescribed. The way things stand now, the insurers and pharmacy benefits managers (PBMs) that set copayments, premiums, and reimbursement rates do not receive reliable data about a new treatment until it is approved by the FDA. But it can take months to assess that information and establish appropriate prescribing standards, meet state health insurance rate filings, fulfill Medicare and Medicaid requirements, and negotiate contracts with health care purchasers.

Read Cantrell’s full op-ed at bit.ly/2DQpuIZ   

 

New Strategic Plan Built on Close Look at Sector Changes and Challenges 

 

January 5, 2017 

I am delighted to announce the release of our new strategic plan, AMCP 2020, which will guide and strengthen the Academy as we enter our 30th year of serving thousands of professionals who make up managed care pharmacy. Read more.

 

The Strategic Planning That Goes into Developing AMCP's New Strategic Plan 

 
Dec. 6, 2017

The Academy will soon unveil a new strategic plan to guide our organization over the next several years. As it’s rolled out ‒ more on that next month ‒ I thought I would highlight some of the deliberations that went into developing the plan. Read more.

 

Speech at General Session of AMCP Nexus 2017 

 
October 31, 2017

It’s wonderful to be here in Texas. AMCP has many longtime members and friends from the great Lone Star State, including many from right here in the Dallas region. We also have many members from the Houston area. Our heart goes out to everyone in Texas affected by Hurricane Harvey, as well as all of the other recent storms and now the wild fires in California. Read more.

  
 

As the ACA's Future Remains in Limbo, PIE Legislation Moves Steadily Forward

 
September 28, 2017

Health care reform historically has been one of the most contentious issues on Capitol Hill. The current fight to repeal the Affordable Care Act (ACA) is just the latest in a string of battles that reaches back many decades, including to the founding of Medicare and Medicaid. Read more.

   

AMCP Offers Prayers, Collects Items for Victims of Hurricane Harvey; Will Deliver Portion of Socks Collected by AMCP Foundation to Houston Charities

 
September 5, 2017

Like everyone across the country, AMCP members and staff share a deep concern for the safety and wellbeing of thousands of people displaced by Hurricane Harvey. Read More.
 
   

NEJM Article on ‘Accelerated Approvals and Expensive Drugs’ Misses Promising Solution 

 

 August 21, 2017  

A recent article in The New England Journal of Medicine (NEJM) caught my attention for a couple of reasons. Read More

 

Leading on Today’s Most Pressing Challenges: AMCP Partnership Forum Develops Action Plan for Advancing Value-Based Contracting 

 
 

June 29, 2017 

One of the many things that I’m proud of at AMCP is our role as a convener. We bring together several times a year key stakeholders representing a diverse range of positions to address common health care challenges. Read More. 

 
 

My Recent "Field Trip" to Arizona Highlights AMCP's Breadth and Depth

 
 

May 31, 2017 

One maxim I hold dear is the value of getting out of the office now and then to see how things are working in the field. I had that opportunity recently with a “field trip” to the beautiful state of Arizona, where I participated in several events: a workshop on strategies to strengthen association governance, a conference on integrating data in pharmacy practice, a visit with student pharmacists, and a tour of an innovative MTM service center. ... Read more

 
 

AMCP Nexus 2017 Theme Announced: “Changing the Way We Pay for Health Care”

 
 

May 2, 2017 

Volume to value, quantity to quality: such transitions in health care today are like a rock tossed in a pond. The ripple effects are far-reaching and unstoppable. So important is this transformation that we’re dedicating a significant amount of programming to the topic at our fall conference in Dallas (Oct. 16-19). In fact, we’re calling it “AMCP Nexus 2017: Changing the Way We Pay for Health Care.” ... Read more.

 
 

Eye on the Hill: AMCP Sees Progress in PIE Bill and Will Continue to Promote Comprehensive Pharmacy Benefit in Health Care Reform Efforts

 
 

April 11, 2017 

Whoever said, “May you live in interesting times,” could have been talking about Congressional health care policy debates circa 2017. Never a dull moment!

Many things are happening on the health care legislative front, and AMCP has been in the thick of it. ... Read more.

 
 

Ripped from the Headlines - Annual Meeting Sessions Tackle Real-life Issues 

 
 

March 1, 2017 

Every morning — like many of you — I settle behind my desk, take a sip of coffee and read the AMCP Daily Dose. This publication, full of valuable news and information, frequently highlights issues and individuals we’re featuring at our Annual Meeting, March 27-30, in Denver. Several caught my eye recently. ... Read more.

 
 

AMCP Celebrates Early Win: FDA Issues Draft Guidance to Improve Communications Between Biopharmaceutical Companies and Population Health Decision Makers

 
 

February 1, 2017 

Sometimes the best laid plans are upended when you least expect it!

In mid-January, the FDA released draft guidance to facilitate the sharing of information between biopharmaceutical companies and population health decision makers. To say we were pleasantly surprised is an understatement. ... Read more.

 
 

Making PIE to Better Serve Patients

 
 

January 11, 2017 

Let’s imagine you’re a big city mayor and it’s time to order a new fleet of police cars for next year. Applying due diligence, you set out to compare various models from a variety of manufacturers. ... Read more.

 
 

Century Cures Act Advances AMCP's FDAMA Goals, Improves Value-Based Communications Between Manufacturers and Managed Care Pharmacy

 
 

December 22, 2016 

Who says Congress can’t get anything done…and with bipartisan support to boot? With impressive speed and purpose, the House and Senate overwhelmingly passed the 21st Century Cures Act in the waning days of the 114th Congress, followed by President Obama’s prompt signature. ... Read more.

 
 

Pharmacy Profession Comes Together to Help Document and Improve Patient Outcomes Through Medication Therapy Management

 
 

November 7, 2016 

People can accomplish remarkable things when they work toward a common goal. That’s what happened recently when a diverse group of pharmacy stakeholders gathered to develop standardized terms for medication therapy management (MTM) services. ... Read more.

 
 

AMCP really knows how to get things done!

 
 

October 13, 2016 

Not long ago a respected individual in the health care arena told one of my senior staff: “Compared to other associations I work with, AMCP really knows how to get things done.” You cannot imagine how proud I felt ... Read more.

 
 

AMCP Volunteers Are a Happy Lot

 
 

September 20, 2016 

There are many ways to measure the health and vitality of a professional association. The most crucial indicators, I’ve found, center on the engagement of an organization’s volunteers. This can be measured in the number of volunteer opportunities provided, the number of members who sign up, and the level of satisfaction they get from volunteering. ... Read more.

 
 

The Post Cites Pharmacists’ Expanding Role on Medical Teams

 
 

August 26, 2016 

Last week I saw a headline that jumped off the page: “America’s other drug problem: Giving the elderly too many prescriptions” (Washington Post, Aug. 15). I couldn’t read it fast enough and encourage members to do likewise, as it highlights two of the most important developments in health care. ... Read more.

 
 

Seizing Opportunity: AMCP Nexus 2016 Offers Knowledge, Advancement and More

 
 

August 3, 2016 

“Healing is a matter of time, but it is sometimes also a matter of opportunity,” said the great Hippocrates, father of western medicine.

Opportunity, in fact, is a crucial element in the work that managed care pharmacy professionals engage in every day to improve the health, wellbeing and “healing” of millions of patients. We seize opportunities to find the right medicines for the right patients at the right time. ... Read more.

 
 

BRC Now Lets You Look It Up

 
 

July 13, 2016 

It was only ten years ago when biosimilars were so new that the New York Times described them as “so-called.” As late as five years ago newspapers put quotation marks around the term, as in “biosimilars.” At the time some still called them “follow-on” biopharmaceutics. ... Read more.

 
 

Is FDAMA Section 114 Finally Ready for Prime Time?

 
 

June 24, 2016 

Information is the life blood of managed care pharmacy. Of the “competent and reliable scientific” variety, that is.

Our profession operates best when we have broad access to the latest evidence-based data on the multitude of products coming to market today. We can plan, we can assess. With this information, managed care pharmacy professionals can help health care providers and patients select the right drug for the right patient at the right time, while making appropriate use of our scarce health care dollars. ... Read more.

 
 

Getting it straight with the updated AMCP Format!

 
 

May 19, 2016 

Using the best evidence possible to make informed health care decisions is a hallmark of managed care pharmacy. But making sense of the data often is no easy task, especially when it comes to analyzing pharmaceuticals and the value they bring to patients and the health care system... Read more.

 
 

CEO Susan Cantrell Addresses AMCP Annual Meeting

 
 

May 10, 2016 

New&Views announces a new monthly column by CEO Susan A. Cantrell, RPh, CAE, on breaking news and critical issues. Her first column presents her recent address―her first to the membership―at AMCP’s recent Annual Meeting.

“It is truly an honor to be standing before you today as the Academy’s new CEO. While new to the AMCP staff, I’ve been an observer and at times a participant in the terrific work of this organization. ..." Read more.