Updates from your ACE team
We are officially a little more than 6 months away from the end of the year. Over the past 4 months we've seen a lot of changes from large companies send jobs that "have to be done from the office" to work from home and others telling their staff they'll be working from home for the rest of the year. COVID-19 has officially put some of us through the ringer, changed the way a lot of companies operate and has had a lot of influence on and within the health care industry.

The pandemic hasn't just brought everyone home through stay-at-home orders, it's also brought the nation an increase in mental health problems, alcoholism, and domestic violence cases. Everyone's emotions have been at a high since being home for the majority of the time and having to seek reasons to leave the home to clear their minds. The dogs of the Internet have even protested their several walks throughout the pandemic.

We've explored practice expansion and how it can assist you in the fight against COVID-19 and the importance of quality measures and telehealth and how they can fight against COVID-19 . This newsletter, we're talking about how COVID-19 has affected the pharmaceutical industry: the trends we've seen and where the experts expect them to go. We also have a few telehealth updates, new data that concerns pharmacy mail/home delivery programs and how they're expected to evolve or implode - depending on seniors, impressive data from one of our retro payment Medicaid projects, a new infographic from the National Association of Community Health Centers (NACHC) concerning community health centers' response to COVID-19 and developing vaccine news and antibody testing for COVID-19.

We wish everyone a happy early Independence Day. We will be closed for business operations on Friday, July 3, 2020 for the holiday. We will be back in the office on Monday, July 6, 2020.
How America has been coping with COVID-19
In addition to COVID-19 cases, regular sickness (common colds and and the end of the flu season) and allergy season, there has been a spike in episodes caused by domestic violence cases and other illnesses, specifically alcoholism and mental health. As people come back together, the common cold will most likely go around because everyone has been isolated and Americans miss their normal social interactions.

What was once illegal is now deemed essential: alcohol. According to an article from April 11, 2020 that compiles data from Nielsen and other credible outlets, America is drinking its way through the coronavirus crisis - and that's no party . According to the article, Americans are seeing an increase of alcohol sales mainly through large quantities of inexpensive alcohol. "According to Nielsen, for the week ending March 14, 2020 off-premise outlets such as liquor and grocery stores saw wine sales increase by 27.6 percent, spirits by 26.4 percent and beer, cider and malt beverages by 14 percent. Sales of 3-liter boxes of wine rose by 53 percent and 24-packs of beer increased by 24 percent. Online alcohol sales increased by 42 percent year-on-year." Prior to the riots throughout the nation, "multiple cities [were] reporting a decrease in property crimes, but a rise in domestic violence. Child abuse cases may also be on the rise - while national data is not available, a Fort Worth hospital that usually sees eight cases in a month saw six in a week." History shows that the habits being practiced now will become a problem later. Are you prepared?
COVID-19's influence on the pharmaceutical industry
COVID-19 has changed a lot of things within the healthcare system, including the pharmaceutical industry.

Drug Channels' blog post from Wednesday, May 27, 2020, Drug Channels News Roundup, May 2020: COVID-19 and Formularies, Retail-to-Mail Trends, ABC on Biosimilars, and Social Distancing the CVS Way , brings to light some important news and updates on the trends that started because of the pandemic and pieces together some different articles from experts that highlight what the trends might look like when the pandemic comes to an end.

"In late April, IQVIA surveyed representatives (see the results in the image below) from 43 U.S. payers and how they thought COVID-19 will affect formulary access decisions and utilization management." [The survey shows that] payers expect tighter formularies, greater patient cost-sharing obligations, higher rebates and more exclusions." IQVIA is updating the report on a weekly basis, which will be valuable to track how the pharmaceutical industry is impacted by the pandemic.
AISHealth's article from May 20, 2020, COVID-19 Pandemic May Change Rx Delivery Permanently addresses how state stay-at-home orders drove patients to sign up for home/mail delivery options. However, though there was a spike in March, the sign ups have since plateaued and retail pharmacy has taken a little bit of a hit. "Mike Shneider, principal at Avalere Health, [believes] consumers with chronic conditions and long-term medications are likely to [continue receiving their prescriptions in the mail] - assuming they are still available after the pandemic. [Schneider thinks that the] key to continuing the trend [depends on whether or not] seniors, the largest demographic of prescription drug users, [prefer] the mail order system." According to Drug Channel's blog post, COVID-19 will not have a large overall impact on the pharmaceuticals mail market share. In "2019, mail pharmacies accounted for 9 percent of total 30-day equivalent prescriptions [and] for the first 20 weeks of 2020, mail pharmacies have gained less than 0.5 percent of prescription share." While mail delivery prescription growth has not surpassed 2019's numbers, it has been making a come back over the past two weeks.

This is still developing and we'll keep you updated on this trend as it evolves.
Save lives with Rx home delivery
Last month we discussed the importance of a home delivery program and the benefits and conveniences it brings to your patient base. We can help you implement a home delivery program!
Are you following up on your self-pay now Medicaid later patients?
We have an exciting case study to share! We recently started working with one of our clients on a project to collect on their retro payment Medicaid. The following data comes from April 29, 2020 through May 2, 2020.

This FQHC regularly sends 215 Medicaid claims to the payer and receives $24,451.00 per month. Our retro payment Medicaid project collected 60 percent of a normal month and added it to their bottom line that would have otherwise possibly been adjusted.

For this project, we reviewed 21,350 claims. Of those, 279 claims were eligible for the program and provided a return of $15,015.62!

Are you ready to stop leaving money on the table?
Telehealth and pharmacy
Telehealth has been a big deal throughout the pandemic. It's been extremely useful for providers and clinicians in flattening the nation's curve by keeping patients home and treating patients with and without COVID-19. It has also been a helpful tool for pharmacists. A " study that evaluated a 6-month outpatient interprofessional telehealth chronic care management pilot program found that integrating a telepharmacist enhanced clinical services." A Telehealth presence in the pharmacy may "[allow] pharmacists to recognize gaps in adherence, which are primarily the result of [a] lack of access to medication, high-cost prescriptions, low health literacy and transportation issues."
Other important telehealth updates
Telehealth is not new; it's been around for the past 10 years. It just took a global pandemic for it to become actually easy and useful to healthcare professionals and patients. COVID-19 has helped it advance and transitioned it from being a luxury to a necessity and changed how patients, providers, clinicians and pharmacists use it to treat their patients. Pre-pandemic, patients couldn't use their personal cell phones to communicate with their provider, patients couldn't utilize telehealth from their homes, providers weren't able to bill payers at the same rate as an in-person visit and pharmacists weren't able to utilize the technology to assist patients.

The Centers for Medicare and Medicaid Services (CMS) has been diligently working on telehealth solutions that benefit everyone. On May 22, 2020, CMS released a press release, Trump Administration Announces Changes to Medicare Advantage and Part D to provide Better Coverage and Increase Access for Medicare Beneficiaries . The press release announced that CMS passed the final ruling on the “requirements that will increase access to telehealth for seniors in Medicare Advantage (MA) plans, expand the types of supplemental benefits available for beneficiaries with an MA plan who have chronic diseases, provide support for more MA options for beneficiaries in rural communities and expand access to MA for patients with End Stage Renal Disease (ESRD).” This change “encourages MA plans to increase their telehealth benefits and plan options for [the] beneficiaries [that are] living in rural areas.” This also provides Medicare “beneficiaries with ESRD more coverage choices” that are “more affordable.”
Click HERE for CMS' spotlights for FQHCs that address: COVID-19 Public Health Emergency (PHE) updates, new payment for telehealth services for RHCs and FQHCs, expansion of virtual communication services for FQHCs, revision of FQHC home health agency shortage Requirement for visiting nursing services, new virtual communication services and grandfathered tribal FQHCS.

COVID-19 has changed a lot of things within the healthcare system, including telehealth.
According to an Xtelligent Healthcare Media article from May 26, 2020 , "32 House members are [seeking] ongoing emergency efforts to relax telehealth regulations during the pandemic be continued 'for a reasonable transition period following [the pandemics] emergency period to collect appropriate data to provide an adequate amount of time to determine which of those flexibilities should be continued permanently.'" House members are most concerned about mental health patients.
Media watch and other useful info
The public has almost an overload of information right now and stress and anxiety levels are understandably high. Antibody testing seems to be something that the public is looking forward to as a peace offering; however, most don't understand what the antibody testing actually means for the individual having the test done. It is still unknown whether or not antibodies will prevent one from getting the virus or the severity of it if they do contract it.

The public has also been anxiously awaiting a cure for COVID-19, more specifically a vaccine. According to Kaiser Health News article that was published on May 21, 2020, Analysis: Get Ready for the Vaccine - They're Never Simple , offers some hopeful news "the relatively high number of new [COVID-19] cases [that are] being diagnosed daily - upward 20,000 - will make it easier to test new vaccines." The biotech company Moderna
has "reported promising results [from] the first eight of 45 people enrolled in an initial test of the safety and immune responses to its vaccine.” The company is simultaneously completing studies on animals and humans. It is still unknown what the successful parameters of the vaccine will be: “death, length of illness, hospitalization, the number of days a subject is infectious” or something else. More hopeful news is that “the Food and Drug Administration (FDA) [has] promised an accelerated review of the vaccine. The vaccine works by injecting pieces of synthetic viral RNA into the body to stimulate an immune response to the virus." While this is all sounding great, before we all collectively get too excited, we need to remember that the virus kills about 0.6 percent of those it infects while possibly hospitalizing six times that and consider that a vaccine might follow in the steps of the flu vaccine: it might be a seasonal vaccine that reduces the risk of contracting or severity of the illness.
NACHC published a new infographic that details the stats of community health centers' response to COVID-19 and how they're doing. The data is what has been reported since May 15, 2020.

Of the COVID-19 tests that have been given by community health centers:
  • 57 percent of patients tested were racial and/or ethnic minorities.
  • 72 percent of patients that tested positive were racial and/or ethnic minorities.

COVID-19 has brought extreme challenges to health centers' operations, staffing and budgets:
  • 49 percent of visits last week (May 4-8, 2020) were virtual visits.
  • 1,937 health centers sites temporarily closed due to COVID-19 from May 11-15, 2020.
  • 10 percent of health center staff are unable to report to work due to COVID-19 from May 11-15, 2020.
  • Health center visits decreased to 60% of normal rates, a slight increase from the week prior (May 4-8, 2020).
NACHC is following COVID-19. Stay updated with their COVID-19 information for community health centers HERE .

Patients across the nation have been staying home through the pandemic. CMS released a press release on June 9, 2020, Trump Administration Encourages Reopening of Healthcare Facilities . CMS' press release includes a guide for patients to follow for when they resume their normal healthcare routine(s).

CMS is tracking and following COVID-19. Stay updated with the latest information HERE .

Health Resources and Services Administration (HRSA) released a press release on May 28, 2020, The U.S. Department of Health and Human Services (HHS) Awards $15 Million to Combat the COVID-19 Pandemic in Rural Tribal Communities . "HHS, through HRSA [and the Coronavirus Aid, Relief and Economic Security (CARES) Act] awarded $15 million to 52 Tribes, Tribal organizations, urban Indian health organizations and other health services providers to Tribes across 20 states to prepare, prevent and respond to COVID-19 in rural tribal communities."

HRSA posted some new notices on the Office of Pharmacy Affairs website . Check to ensure your 340B pharmacy is compliant.

Stay updated with HRSA's latest information about COVID-19 HERE .