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Health Care & Law
The authors underscore the importance of understanding standards and procedures as they discuss two lawsuits that arose from drug injury.
Despite a slow legislative start by President Trump, new federal and state regulatory health care changes will have important implications for pharmacists, P&T committees, and patients.
Over the past few years, P&T committees have been evolving to deal with care at expanding sites within an organization, across a larger system, or involving multiple organizations. The authors consider one aspect of this expansion—medication system failures—that requires the attention of P&T policy.
The pharmacy benefit management (PBM) industry has recently fallen into the crosshairs of government investigations about the high cost of pharmaceuticals. The authors focus on the PBM-based P&T and formulary practices under scrutiny.
The authors consider market stakeholder consolidation, market-driven efficiency demands, consumerism, and legal enforcement of patient rights related to access to appropriate drugs and posit how future P&T committees may approach these issues.
Telehealth is becoming mainstream in the U.S., as more consumers, employers, hospital systems, and even insurers adopt the technology. The authors explore the challenges of regulation, reimbursement, and licensing as the modality evolves.
Biosimilars represent a potential savings opportunity for both payers and patients, but how and when the new agents will be accepted and prescribed is uncertain.
Involving pharmacists in the process of comparing the medications that should be ordered for a patient with the new medications that are currently ordered and resolving differences improves accuracy, decreases mortality, and improves transitions of care.
Although the health care marketplace is changing rapidly, some things have not changed, including the need for P&T committees and organizations’ management to beware of ethical and legal issues such as discrimination, quotas, and understaffing.
A malpractice claims analysis by an insurer, Healthcare Providers Service Organization, provides recommendations for avoiding errors and injuries. Case examples relate these suggestions to situations that are common in health care settings.
A comprehensive analysis of malpractice claims experience from a professional liability insurer, Healthcare Providers Service Organization, can help P&T committees better understand the risks and challenges they encounter each day.
State policies vary regarding the legal use of marijuana for medicinal purposes. Pharmacists, physicians, and P&T committee members must become familiar with the laws in their states before assuming that this controlled substance can be legally prescribed or dispensed to patients.
Among the health care changes this year: revenues to hospitals will be lower, payments to physicians will be modified, and more patients will be covered by Medicaid.
The ACO model is considered an important achievement of health care reform legislation. However, ACOs might not be able to deliver on their promises in part because of the slowly recovering economy. It is also not clear how much money will be saved, and not all hospitals plan to participate.