This episode discusses the 2023 Inflation Reduction Act and HHS's authority to negotiate prices for high-cost drugs in Medicare Part D. In addition to the initial list of 10 drugs, HHS is now focused on medications used in the hospital and covered under Medicare Part B.
The GameChanger
HHS updates the Inflation Reduction Act that will impact over 750, 000 people.
Host
Geoff Wall, PharmD, BCPS, FCCP, BCGP
Professor of Pharmacy Practice, Drake University
Internal Medicine/Critical Care, UnityPoint Health
Jake Galdo, PharmD, MBA, BCPS, BCGP
CEO
Seguridad
Reference
https://www.cms.gov/files/document/reduced-coinsurance-certain-part-b-rebatable-drugs-april-1-june-30-2024.pdf
https://www.hhs.gov/about/news/2024/03/26/hhs-announces-savings-41-prescription-drugs-thanks-inflation-rebates-from-biden-harris-administrations-lower-cost-prescription-drug-law.html?utm_source=MarketingCloud&utm_medium=email&utm_campaign=PT+Daily+March+27&utm_content=PT+Daily+March+27
Pharmacist Members, REDEEM YOUR CPE HERE!
Not a member? Get a Pharmacist Membership & earn CE for GameChangers Podcast episodes! (30 mins/episode)
CPE Information
Learning Objectives
Upon successful completion of this knowledge-based activity, participants should be able to:
1. Describe the monetary impact of the Inflation Reduction Act.
2. Discuss how the Medicare Part B drug addition will benefit patients.
0.05 CEU/0.5 Hr
UAN: 0107-0000-24-136-H04-P
Initial release date: 4/08/2024
Expiration date: 04/08/2025
Additional CPE details can be found here.
This episode discusses the 2023 Inflation Reduction Act and HHS's authority to negotiate prices for high-cost drugs in Medicare Part D. In addition to the initial list of 10 drugs, HHS is now focused on medications used in the hospital and covered under Medicare Part B.
The GameChanger
HHS updates the Inflation Reduction Act that will impact over 750, 000 people.
Host
Geoff Wall, PharmD, BCPS, FCCP, BCGP
Professor of Pharmacy Practice, Drake University
Internal Medicine/Critical Care, UnityPoint Health
Jake Galdo, PharmD, MBA, BCPS, BCGP
CEO
Seguridad
Reference
https://www.cms.gov/files/document/reduced-coinsurance-certain-part-b-rebatable-drugs-april-1-june-30-2024.pdf
https://www.hhs.gov/about/news/2024/03/26/hhs-announces-savings-41-prescription-drugs-thanks-inflation-rebates-from-biden-harris-administrations-lower-cost-prescription-drug-law.html?utm_source=MarketingCloud&utm_medium=email&utm_campaign=PT+Daily+March+27&utm_content=PT+Daily+March+27
Pharmacist Members, REDEEM YOUR CPE HERE!
Not a member? Get a Pharmacist Membership & earn CE for GameChangers Podcast episodes! (30 mins/episode)
CPE Information
Learning Objectives
Upon successful completion of this knowledge-based activity, participants should be able to:
1. Describe the monetary impact of the Inflation Reduction Act.
2. Discuss how the Medicare Part B drug addition will benefit patients.
0.05 CEU/0.5 Hr
UAN: 0107-0000-24-136-H04-P
Initial release date: 4/08/2024
Expiration date: 04/08/2025
Additional CPE details can be found here.
Hey, ce Plan members from CE Impact, this is Game Changers. I'm Jen Moulton, and with me today I have not one, but both of our favorite contributors, doctors Jeff Wall and Jake Galdo. My job today is going to be moderating these two and keeping them on task and focus, so it's not a small job, but it's my job today, so hello to you both.
Speaker 2:Hello.
Speaker 3:Hi, welcome, you've already got us on focus, jen, you hardly had to do anything, and here we are.
Speaker 1:I know, and here we are. It's like where do we go next? All right, so here's where we're going next. Today's topic is a big one because the whole world, I think, is talking about this and hoping that we see some relief for patients, but we're talking about the rate of inflation and drug crisis and what our government is trying to do about it. So, jake, I am going to turf it to you to get us started on this topic, because it's a big one, so we want to jump right in today.
Speaker 2:Awesome. Thanks, jen, and thanks, jeff for tagging and teaming this with me. You'll find out why very, very shortly. So we are recording this on April 1st so April Fool's Day and March 26th, so all of five days ago, the Department of Health and Human Services did a new announcement saying that they are updating the Inflation Reduction Act rebate program. So this is our big drug pricing thing that happened with the IRA, which is kind of a big deal. This is the major legislation that we've seen with this, one of the major legislations we've seen come out in the last couple of years, and it really focused on drug pricing, because that's what we always talk about. We always talk about the cost of drugs, cost of drugs, cost of drugs. Candidly, though, if you hear Jenna and I talk about this, we'll highlight the fact that health inequities cost more than the cost of drugs, and I'll also point out that the hospital system I'm sorry, jeff is actually more expensive than the cost of drugs.
Speaker 2:So, even though we're going to talk about the cost of drugs, I think it's very prudent to highlight that drugs are not the driver cost of healthcare expenditures. The number one driver of healthcare expenditure is hospitalization and hospital costs, which include drugs. I'm not going to forget that, but just generally speaking, anytime we talk about drug pricing, I think it's fair to point out that this is the thing that we as patients experience, but it is not the ultimate driver of healthcare expenditures. Regardless of all of that, we now have this Inflation Reduction Act that 41 drugs to a new rebate program based off of 45 HPICS codes. We'll come back to that in a second. And what's very interesting about this? So that was March 26. Starting today, april 1, it's going into effect. They did not give a lot of lead way whatsoever with this initiative.
Speaker 2:Yeah, and everything they're looking at right and the holiday weekend, it's lots of things going on.
Speaker 1:It's the beginning of the month, by the way, your pricing is changing.
Speaker 2:Yeah Right, so many little things. So, starting today, new pricing is going into effect and they look at it on a quarterly basis. So everything that we're talking about is for the April 1st to June 30th quarter, and this evaluation of pricing is based off of the rate of inflation at the US level. Versus the rate of price increase for the drugs, there's this 20 percent threshold. So 20 percent is kind of normal, quote, unquote, which I don't know whenever 20% was normal. Um, I want to say none of us here have probably ever received a yearly bonus or yearly pay raise of 20%, and I'm saying that knowing that I used to work closely with Jen. So, jen, I'm really sorry for saying that out loud, but like we talk about the rate of inflation, 20% seems kind of crazy to me.
Speaker 1:Yeah Well, that would be my worst. To be able to do that Right.
Speaker 2:Yeah Well that would be my wish, Jake, to be able to do that Right we would want to do that.
Speaker 1:We want to do that. So we just need to negotiate drug prices with everybody, and then we can get that 20%. We're being California, and what was that? Today too right Goes into effect.
Speaker 2:Everything's changing today.
Speaker 1:It's not a joke.
Speaker 2:And so it's going to impact 750,000 people. So over 750,000 Medicare beneficiaries are on one of these medications, one of these 41 medications, and the anticipated savings to the individual is anywhere from $1 to $3,575, which is a crazy spread per dose. This isn't per month, it's not per year, it's per dose. Again, some of these medications might be dosed once a month, but again, it's kind of interesting to see that there's this reduction in price anywhere from $1 to $3,500. And so how does this ultimately work? Drug companies are going to have to give their rebate for the drug pricing based on that 20% threshold back to Medicare. That Medicare payment is going to go towards the Medicare trust fund. So you know, we talk about trust fund babies. Apparently, medicare is a trust fund baby and it's going to be funded by part of these rebates. All of the rebates are actually going to be retrospective for 2023 and 2024, and that the government will not be invoicing the drug companies until no later than the fall of 2025. Nobody's going to see this on their bottom line right now, but it's forthcoming, and so this is kind of happening. And so you know, we see that the government announced this. We started to understand how it's going to work.
Speaker 2:And then I got to the section where it talked about the drugs and I was really excited and it said we will be focusing on Part B, as in boy drugs, and I went well, this has absolutely nothing to do with me. Maybe I should call Jeff Because, as some of you might remember, jeff and I talked about this topic a year ago when we talked about the IRA first doing drug rebates, and it was for oral agents, it was for Part D drugs, something that we see in the community pharmacy setting, and so you know I got really excited. This talked about the expansion of medications. I was like, awesome, what are the new ones? And then they said Part Boy and I called my friend Jeff and said what's going on?
Speaker 3:So, jeff, yeah, you know, and I had read the blurb but, jake, I hadn't done the detail, as always you're really good at doing. But yeah, I mean that was definitely. The first thing I saw was that, unlike the first 10 drugs, which I mean definitely you know, had both you know big DOACs on it, had you know some other had an SGL2 drug, if I remember right on the original list of 10 medications that are definitely in the top 50 prescribed and dispensed medications in outpatient settings in the United States.
Speaker 3:There are some of those here, but it is far more targeted in two areas. One is medications that are almost always just given in the hospital setting, but also a large number of direct targeted oral chemotherapy agents, and so I think that was some of the big differences and certainly the relief in the latter, the relief in the direct targeted therapies is is huge because, as everybody knows, those drugs are, you know, thousands of dollars a month and and you know, I read, a, read a statistic last year or the year before that you know said something like 70 to 75% of all patients who take these direct oral drugs have are on some sort of patient assistance program, whether it's, you know, helping with their co-insurance, because most of the drugs are so expensive they don't even count for a co-pay. So you'd end up having to pay 10, 20% of the drug. So with you know, co-insurance, co-pay, total pay, something along those lines. So the vast, vast majority of people are already getting a little bit and I emphasize, or a little bit of help with some of these oral direct targeted agents, and so the fact that no-transcript. You know, decrease in overall costs should help insurance companies with that price and then hopefully decrease the co-insurance or the co-pay that a patient has to pay, because, again, most patients now with any, especially any sort of solid tumor, breast cancer, urinary tract cancer, lung cancer, they're all going to be on these direct targeted therapies.
Speaker 3:So I think that's, you know, an area, that kind of crosses. You know the world of J-CAS and outpatient pharmacy. In my world, though, a lot of these drugs are so expensive that regular outpatient pharmacies can't even carry them after being specialty pharmacies. But then you get back into the inpatient setting and I have to admit I was kind of surprised by some of the drugs here. Some of them are notoriously expensive in an inpatient setting, for example, argatreban, which is a drug that's the only FDA-approved drug for hepatitis B thrombocytopenia though, frankly, we cheat and use things like fondapirinux sometimes, but it is the only drug and it's notoriously expensive, somewhere between $1,000 and $1,500 a day for treatment. And the fact that there's about a 17% decrease in one of the brands is again, I think, will help you know the bottom line of a lot of hospital pharmacies and as well as, hopefully, eventually you know that savings coming down to the patient as well. Several of the older drugs for acute rejection Atgam and a couple other of these medications is also on the list. Not I mean expensive as well, but not nearly as expensive as, for example, some of the direct targeted therapies that we were talking about.
Speaker 3:There was a 16% decrease in the long-acting forms of penicillin the bicillin injection. I don't know if those of us who are more veteran people out there may remember when you were little kids and you were sick and your parents brought you to the doctor and they gave you like a single shot. They didn't give you antibiotics, they just gave you a shot of penicillin in the butt. That's what those are. We use them for things like like syphilis and stuff. Today. I didn't realize it was that expensive and I did look and I mean, while they're not nearly as expensive as, again, these more modern direct targeted therapies, there's several hundred dollars a shot and I did not realize that. I would have thought that these long acting penicillin derivatives have been really inexpensive about a 16% drop in that some other medications. There's a couple of drugs, more modern drugs used for the treatment of chemotherapy, induced nausea and vomiting, especially the pepper tent derivatives, the NK one receptor antagonists have long been known to be really expensive. When I talk about treatment of nausea and vomiting.
Speaker 3:I always note that even the generic versions of some of these agents so they're oral are actually pretty pricey. The discount isn't quite as high on these medications, but the fact that they're on the list at all is pretty interesting. The hypergamma globulin for tetanus, which I have only seen ever used once in my life, thank goodness, because people do tend to get their tetanus shot. It may be one of the few vaccines that it doesn't have a garner a lot of controversy right now. So that's. You know that there's about a 20% decrease on that. Lupron Depot, that's another big one for prostate cancer, usually like late stage hormone sensitive prostate cancer about a 20% drop in that. So I thought that was pretty good. And then, surprisingly, they go into antibiotics somewhat, and two of the big ones that I noted were Babamir. Babamir is a carbapenem drug derivative that's actually FDA approved for carbapenemase resistant organisms.
Speaker 3:You're talking about, you know, kpcs or CRE type organisms that are traditionally resistant to just about everything you throw at them. They're gram negative organisms, enterobacter stuff like that. I'm fortunate enough that I live in a part of the country that I almost never see these, but certainly if you practice on the coast, if you practice in Chicago, detroit, you're, you're absolutely going to see those bad organisms and these newer antibiotics you know are just they're hundreds of dollars a day, you know. Whereas you know a day of ceftriaxone is like 50 cents, you know, a day a day of even a more powerful antibiotic, like you know, cents, you know a day a day of even a more powerful antibiotic, like you know, zosyn or meropenem is only a few dollars a day. So the fact that that some of these newer antibiotics that are, you know, four or five, $600 a day, it really puts a strain on on a lot of inpatient costs and things like that.
Speaker 3:So you know that, that there's about a 20% decrease in that, which is nice.
Speaker 3:Tigacycline, which is a tetracycline derivative, used a lot for you know it can be used for MRSA, it can be used for some weirdo gram negatives that are super resistant. It also made the list with about a 10% decrease. And then I think the last one that I think affects both inpatient and outpatient is Prolia. So Prolia, um, as everyone, as people know it's, it's a, it's a ligand receptor that's used for for um, osteoporosis, um, but it's also used for hypercalcemia malignancy and that's where I see it used in the hospital in a patient who can't tolerate uh or or is not a candidate for an intravenous bisphosphonate, uh, proli is kind of the second line drug that can be used for hypercalcemia malignancy. Uh, I actually had a case of that just a, two, three weeks ago. We had a patient who um had severe renal insufficiency, was was approaching dialysis and came in with a calcium of 16 with symptoms of hypercalcemia, and the nephrologists were extremely reluctant. The patient was on, wasn't on dialysis, yet they were extremely reluctant to give the patient an intravenous bisphosphonate. We can certainly get into a debate about whether or not, those drugs are truly dangerous in that population. But the fact was the nephrologists just weren't having it. So we actually gave a dose of Prolia and it worked actually pretty decently in about the same timeframe about two, about two to three days.
Speaker 3:And again, prole is used outpatient as well, as we all know for for osteoporosis. So I mean I think that that you know there's there's a big difference here, obviously from the first-hand drugs and I agree with with jake that yeah, there's a lot of medications that are going to be more in my realm than his, but I think you know there's definitely going to be relief, uh, for a lot of cancer patients. Um, that you know there's definitely going to be relief for a lot of cancer patients that you know that there's going to be some decrease in their co-insurance or their co-pay. I'm hopeful that some of the drugs here, which have, you know, a notorious reputation for being pretty expensive, that will take, you know, the pressure off the directors of pharmacy when they're looking at their budget, so we can use these drugs a little more frequently. So that's kind of where I'm at, jake.
Speaker 3:I mean, and as you noted, you know, when I started reading up for this and I saw Part B. I mean, yeah, the light kind of flashed in my head and went Part B, you know what, you know, sort of thing. So you know, and of course that means using J codes and stuff like that. So I don't know, you know, what's your take on?
Speaker 2:that. Well, I think what's interesting is that there are 41 unique drugs but 45 J codes that they're kind of going off of there there's there's one or two C codes in there as well. I think what's most interesting to me when you kind of walk through the list of medications that you covered with us, is the number of either manufacturer specific agents so like you know, like like a cyclin, they're calling out specifically the accord derivative or, with you mentioned argatriband. They have two and they said that they are not therapeutically interchangeable, one by accord and one by aromatics. So I thought it was really interesting that some of the drugs it's just like all medications and then others are just like only these by this one manufacturer. So I thought that was kind of a salient kind of call out. You know, do you have any insight? Because I have no idea Jeff.
Speaker 3:You know I think it brings. The other question is, I mean, looking at the kind of wide ranging selection and I'm sure there are people you know in CMS who you know. I mean I'm sure there's lots of people in CMS, but I think there's a lot of you know in CMS who you know. I mean I'm sure there's lots of people in CMS, but I think there's a lot of you know way more smarter people than I am that are sitting down and looking at programs and looking at forecasting models. That says, okay, you know why did we pick these 45 drugs? Because I can tell you, while these are pretty, they are some common drugs for certain types of cancers. For example, I can count on two hands the number of times I've used Argatreban in the last 12 months. We just don't use that much because hit isn't all that common anymore. So you know, you know stuff like that I you know there's definitely some. You know some of these drugs, for example, nausea, vomiting, some of these antibiotics the Vibramir is a good example. I mean you know, yes, if you practice on the coasts or some other big cities, you're going to use a little bit of this drug. But again, you know, even in hospitals where CREs are relatively common. Bottom line is that is that 90% of people are not going to need them. We're still going to use good old fashioned you know ceftriaxone, good old fashioned, you know P PIP tase on stuff like that.
Speaker 3:So you know they did. They did pick drugs that were expensive, but they didn't pick drugs that work, I think in in most hospitals in common use. And, as you point out, they did pick drugs that had J codes attached, which you know. If I had $1 for every time, a rep was in my office saying great news, dr Wall, our super expensive drug that you don't want to put on formulary here at your health system, we got a J code for it and I'm like uh-huh. And so you know what that means. And I'm like uh-huh and they're like well, that means Medicare is going to pay most of it and it's going to be great.
Speaker 3:And what I've tried to explain to reps before know reps before on this is that you know that's all terrific but because of the siloing of healthcare, our director of pharmacy isn't going to get a pat on the head saying, well, you know, you're using this unbelievably expensive drug but fortunately, with the J code we're going to get 90% of that back instead of 60% of the back. It doesn't matter, I mean, the bottom line is that is that you know we're going to get graded on how are, how expensive the drug budget is and and and. So you know there's, I think, you know. I think I wonder if, if, if that this selection was done, you know semi-scientifically, but largely because these were all part B drugs, so it comes from a different pot of money than the part B drugs do. And I suspect that, even though these aren't the more common drugs that have J codes associated with them, I suspect that they were drugs that were costing CMS an arm and a leg, for whatever reason.
Speaker 3:And they literally looked at the two different brands of our Gatcher band and said, okay, brand A is the charge on even with the J code is X and brand B is Y, and that's why we're going to pick, you know, we're going to pick these versions and we're going to pick that discounting, because the discounting is significantly different One's almost 20 percent, one's only about 4 percent. So I suspect that's what happened. I would, I'd like to think it was a little more scientific than literally throwing you know darts at a wall saying, okay, well, it hit our gadget band, so I guess that's the one we're going to use.
Speaker 2:So you know. So yeah, and clinically.
Speaker 3:No, there's no difference clinically. You know, our gadget bands, our gadget bands, our gadget bands.
Speaker 2:So yeah, so yeah, and that that makes sense. And I really like how you kind of broke that down, cause I mean that that's some of the stuff that that jumps out to me and and to your that it was a little bit more evidence-based driven, not an evidence-based that we think in healthcare, but evidence-based from a financial kind of data informatics, in the sense like when we looked at the Part B drugs, they were very mindful not to be lopsided on any one life science company, and so if they did an SGLT2 from life science company one, then they didn't do a DOAC from life science A as well. They would change it up. So I think that you know to your point that might kind of play around with it.
Speaker 2:So I guess one last thing that kind of jumps out to me and I'd love your kind of insider thoughts on it, is there is a stark amount of antibiotics and you know we think about antimicrobial resistance, we think about antimicrobial stewardship and we think about the fact that there's not new antibiotics coming out, and oftentimes there's not new antibiotics because everybody says there's no money there and this is not going to be a commentary on the R&D of a medication, so we're going to ignore that aspect of it. So the other thing that we hear about antibiotics, though, are drug shortages, and forgive me, but I feel like penicillin was a shortage recently, yet I see the branded penicillin long-acting on this list.
Speaker 2:So any thoughts on how those factors might play into this pricing strategy.
Speaker 3:Yeah, that's a great question, Jake. And yeah, I mean you know for a while there you're right we're while we were unable to get the I mean not depot but long acting, you know, injectable versions of penicillin. The CR formulation for a while was pretty much unattainable and you know if you work in an emergency room you know where they're treating, you know STIs. They were really having to kind of hop around and do some other things using alternative agents. They were really having to kind of hop around and do some other things doing alternative agents. But as far as I know, those are kind of kind of back on the market.
Speaker 3:The problem is, you know, with several of these medications, especially the generic ones and again by someone you could argue whether it's generic or not.
Speaker 3:But I mean, when you're kind of the only game in town, one wonders, you know if, if a drug has a history of shortages, if you already all of a sudden tell a company you know, okay, well, you know, we're now going to pay you 20% less for that same medication.
Speaker 3:I mean I, you know I'm like what you see a lot on social media. I don't think that drug companies are quite that nefarious, but I mean you do wonder if they're like well, you know we're not going to put that much, you know we're going to put less effort into a product that is, just frankly, less profitable. I mean, you know, can we put more effort into making sure the supply you know line of, you know why, you know a drug, as opposed to X drug, is going to be stable for a long period of time? Again, I don't think that would happen on purpose, you know. I. Just you know it's, you know not to quote the godfather, I mean, it's just business, it ain't personal sort of thing. But I, you know, I do wonder if that is going to happen.
Speaker 3:Obviously that won't happen with the really expensive chemo drugs because you know A you know the profit on those is so much higher than with generic medications that I suspect that these companies can absorb that 20% hit. You know I'm not going to be happy about know and that they're not going to be happy about it, but there's there. There's certainly not going to be a losing proposition for them for these medications, just because the profit is just so incredible. So, yeah, I think it has the potential in drugs that have already been shown to have large shortages, to to potentiate that. But I think for most of the, especially the, the direct oral chemotherapy drugs, I doubt it'll have much of an effect.
Speaker 1:Yeah, and I think you know, just jumping in and at the risk of, you know, sending this conversation for another two hours, because I think we could talk about this forever.
Speaker 1:But you know, jake, your comment at the beginning about, you know, the cost of drugs, I mean this is one way to tackle it. I mean we've got, you know you talk about drug therapy problems, which you know was related to the hospitalizations you mentioned, but I mean, I think that is more than two times now the cost of the actual drugs. So that's a big issue that I would love to hear either of your feedback on. And then, of course, you know we all things go back to the PBMs. You know I don't think we want to go there today but again, like, the cost of of drugs per se is really coming from a lot of other places besides the tangible drug. So you know, I, you know I appreciate that we're, you know, trying to address this issue, but I mean, I, you know, in all reality, like those other things I feel like would be more impactful, and this is kind of a low lift.
Speaker 3:I mean, yeah, I agree, you know and Jake I'm sure can speak a hundred times more eloquently than I on on, you know, the evil that is PBMs. You know notice that nobody else is laughing, because you know they totally, they totally agree with that sentiment.
Speaker 1:For that, but also you know they totally agree with that sentiment, but also you know just the drug therapy problem. Like can we, you know, pay pharmacists to manage that which needs to be managed, and you know we're just putting all of our money to the drug Right? I mean, you know a good example are STIs, you know.
Speaker 3:I mean, I think that there's been some success in HMOs of having a pharmacist run STI clinic, right, that you know. Basically, you know a patient goes to their primary care doctor or urgent care in ER and does in fact get diagnosed with an STI, and you know the pharmacy clinic is next door or they've got a, they've got a, a agreement with a, usually, you know, small, independent pharmacy that they basically, you know, have the medication on board, give the medication to the patient.
Speaker 3:If it's a single dose, which it often is, you know, kind of direct observed therapy, they take it right then and there, and then follow up with them in a week and say you know, how are you feeling? You know, are our symptoms getting better, et cetera, et cetera, et cetera. And I mean that would absolutely increase compliance. I think it would probably do a good job of educating patients on more safe sex practices during the treatment of those STIs and probably decrease transmission. So I mean, yeah, I think that there's absolutely some examples of that, especially pharmacies, I think.
Speaker 3:Try to do as good a job as they can with these unbelievably expensive chemo agents monitoring patients for side effects. Job as they can with these unbelievably expensive chemo agents monitoring patients for side effects, of which there are, you know, some very bizarre ones. You know, yeah, people don't throw up and their hair doesn't fall out and all that stuff that we usually associate with chemo, but make no mistake, they still have some pretty bizarre side effects. So monitoring that thing is worth it too. So I mean, jake, I mean, in your world, is, you know, is that, is that, that I know it's feasible and I know you have the talent and the skills to pull it off. But, like everything else you know, show me the money right.
Speaker 2:Well, I think you know, ultimately this goes back to the role of the pharmacy, and I'm going to I'm pivoting us right. We're talking about the IRA for drug costs in health systems. But, to Jen's point, we spend twice as much money on inappropriate use of medications than we do on appropriate medications, and that's more of the outpatient data that we're looking at. And so this whole idea of medication optimization, making every encounter count, making sure the right dose gets to the right patient for the right reason, which is the bare minimum that we should be doing in a community setting, in any setting, because that's our role as a pharmacist, you know, translates downstream so much. And so, ultimately, I think what's an interesting kind of a side or thought process here is don't cut the reimbursement on drugs, pay me more for the medications, but pay me relative to my ability to make sure it is the right medication and optimized medication right. So you're paying for quality at a pharmacist and pharmacy technician intervention side. That does drive down overall healthcare costs. So you know it's. It's stop looking at pharmacy and medications as a cost center and look at it as an investment into lowering healthcare costs.
Speaker 2:Obesity therapy we can get somebody to lose some weight. Then that drives down their sleep apnea, it drives down hospitalization, heart attacks, strokes, diabetes, and the list goes on and on and on. Heck. Some of the studies now show that our GLP-1 drugs used for weight loss address gambling, because it's the addiction that's happening, right. So think about the impact of a person with severe mental illness that goes bipolar, that goes into like a gambling binge and totally ruins everybody's lives. What happens if we give them a GLP-1, now, they're not gambling, right? The ROI is there, but we sometimes don't look at it that way. We just say it's expensive, I don't want to do it.
Speaker 2:Yet the overarching ROI is truly there for a lot of these therapies in the outpatient setting.
Speaker 1:Yeah, the direct line isn't there. Necessarily. You can't see the direct line. Yeah yeah, such a good point. Okay, well, anything again. We could talk about that forever, so we'll just leave it at that. Jeff or Jake, anything else to wrap up on this topic? It's a big one this week.
Speaker 3:I can tell you. I can list you half a dozen drugs that I use far more commonly than the ones listed on here that are still real pricey, you know. I mean they're pricey as many of the medications if I can say hey look, I know that not only does we have a J-code payment, but it's going to take 20% off the top, with rebates of the cost to the hospital pharmacy. I think that will let up the brakes a little bit when we want to use these medications. So I'm hoping for that. Whether it happens or not, who knows?
Speaker 2:I think for me. The last thing that I would highlight is that this is all part of the Medicare Part D quarterly sales pricing. This data is publicly available. One if you like data, you can play with it. But two, you don't need to have only a five-day notice that this is about to happen, so you can go to that quarterly reporting. You can pay attention to these trends and do data-driven decisions at your health system on what to stock or not stock and how to manage things.
Speaker 1:Yeah, really good point, jake. Yeah, thank you, because sometimes it does feel like, wow, this just came up, but they've been talking about it for a long, long time and you have to. It takes a little time, but you need to stay in those circles so you know what's coming. You can react to it a little bit quicker. Yeah, great point. Well, thank you to you both. Big topic, and that's it for this week. So if you are a CE plan member, be sure to claim your CE credit for this episode by logging in at CEimpactcom and, as always, have a great week and keep learning. Thanks to you both. We'll talk soon.