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OPERATIONS & MGMT
ASHP drug forecast takes COVID-19 into account ........................4 COVID-19 pushes more at-home cancer care ..... 6 Pharmacists shine in primary care clinics ........
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HEM/ONC IN FOCUS
Pharmacogenomics testing, breast cancer breakthrough, growth of oral chemotherapy, and more ............................
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CLINICAL
Wormwood for COVID-19? Not so fast! .....................
CMS Eyes Deeper 340B Rate Cuts; Hospitals Cry Foul
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ospitals that serve large numbers of patients who are uninsured or covered by Medicaid and Medicare took another big hit on Aug. 4, when the Centers for Medicare & Medicaid Services (CMS) unveiled a new round of cuts to the federal 340B drug program as part of its 2021 Medicare Hospital Outpatient Prospective Payment System (OPPS) and Ambulatory Surgical Center Payment System Proposed Rule (CMS-1736-P). The additional 6.2% cut to Medicare Part B reimbursement for 340B drugs came just a few days after the Court of Appeals for the District of Columbia Circuit upheld the 2018 OPPS final rule that cut reimbursement for 340B drugs by nearly 30%. The proposed rule ends up with a 340B reimbursement rate of average sales price (ASP) minus 34.7%, with 6% added overhead
What Have We Learned? How Do We Move Forward? O
n Jan. 19, a patient who had recently returned from Wuhan, China, walked into an urgent care clinic in Washington state with a cough. The rest is history (N Engl J Med 2020;382[10]:929-936). The patient was the first one in the United States to be diagnosed with SARS-CoV-2, the virus that causes COVID-19. He was admitted to Providence Regional Medical Center, one of 51 facilities that make up Providence St. Joseph Health, located throughout several western states, Texas and Alaska. Quickly, it became obvious that this was no ordinary infection. “As a system, we suddenly found ourselves as one of the locations in the national spotlight,” with the outbreak affecting every aspect of the hospital, including the pharmacy, said Jennifer Fulmer Groves, RPh, MPH, the system’s vice president of pharmacy operations. Continued on page 22
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REVIEW ARTICLE
Biosimilars in Oncology Managing Product Selection: Part 1 of 3 See insert after page 14.
COVID-19:
Continued on page 21
TECHNOLOGY
Website shines light on COVID-19–related diversion ...........................
Volume 47 • Number 9 • September 2020
Dose Rounding A Hedge Against High Cancer Cost
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s the volume of costly new biologic oncology drugs expands, health systems increasingly are turning to automated dose rounding protocols to reduce the use of single-use vials and trim millions from their overly burdened drug budgets. The University of California, San Francisco (UCSF), for example, last year saved roughly $2.5 million in drug costs based on average wholesale price (AWP) by rounding doses of 21 oncology medications, Continued on page 18
Communication Is Key During Pandemic
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well-executed communication approach has been key to coping with the first wave of the COVID-19 pandemic, experts said during a recent webinar hosted by the Institute for Safe Medication Practices (ISMP) and ECRI, an organization that focuses on health care safety, quality and cost-effectiveness. Paul Milligan, PharmD, a system medication safety pharmacist at BJC HealthCare, in St. Louis, said the health system had to cope with a flood of demand for hydroxychloroquine (HCQ) for COVID-19 prophylaxis. To ensure appropriate prescribing and preserve stock for those who needed it— including patients with rheumatoid arthritis,
Special Focus:
COVID-19 Pandemic More coverage on pages 4, 6, 8, 10, 25, 26.
systemic lupus erythematosus and malaria—BJC HealthCare formed a COVID-19 Treatment Guidance Task Force to develop COVID-19 policies and therapy guidelines, including parameters for use of HCQ. The system’s antimicrobial stewardship pharmacist facilitated the task force, which also included infectious disease and intensive care providers and pharmacist specialists, Dr. Milligan said. “As the risk-to-benefit evidence [for HCQ] became stronger, we identified current prescribers of the drug and communicated directly with them [about] the risks of QT prolongation, particularly when [HCQ is] used with azithromycin.” Continued on page 24