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VerifiedRx

VerifiedRx

Auteur(s): Vizient Center for Pharmacy Practice Excellence
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 Delivering short doses of insight for hospitals’ frontline pharmacy professionals, the Vizient pharmacy team brings together experts to verify best practices for navigating today’s pharmacy practice challenges and accelerating career growth. It’s a prescription for success, delivered by the Vizient Center for Pharmacy Practice Excellence.Copyright 2025 All rights reserved. Développement commercial et entrepreneuriat Entrepreneurship Gestion et leadership Hygiène et mode de vie sain Science Troubles et maladies Économie
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  • 2026 OPPS Final Rule: What Hospitals Need to Know

    2026 OPPS Final Rule: What Hospitals Need to Know
    Jan 13 2026
    The Centers for Medicare and Medicaid Services has finalized the 2026 Outpatient Perspective Payment System (OPPS) rule, with most policies taking effect on January 1, 2026. Jenna Stern, Vice President of Regulatory Affairs and Public Policy at Vizient, joins host Carolyn Liptak, Pharmacy Executive Director in Vizient's Center for Pharmacy Practice Excellence, to discuss key updates to payment policies, payment rates, and quality provisions affecting Medicare beneficiaries receiving care in hospital outpatient departments and ambulatory surgical centers. Guest speaker: Jenna Stern Vice President of Regulatory Affairs and Public Policy Vizient Host:  Carolyn Liptak, MBA, RPh Pharmacy Executive Director Vizient Verified Rx Host Show Notes: 00:05 — Introduction Announcer welcomes listeners to VerifiedRx.Host Carolyn Liptak, Pharmacy Executive Director at Vizient, introduces the episode focus: the 2026 CMS Outpatient Prospective Payment System (OPPS) Final Rule.Guest: Jenna Stern, VP of Regulatory Affairs and Public Policy at Vizient. 01:12 — Overview of the OPPS Final Rule OPPS sets Medicare payment for most hospital outpatient services.Published annually (typically November), effective January 1.Covers payment rates, policies, quality programs, and compliance requirements.Note: CMS delayed enforcement of hospital price transparency requirements until April 1, 2026. 01:34 — Key Takeaways From the 2026 Final Rule Jenna’s high-level insights: Hospitals will continue facing financial pressure in 2026.Modest payment rate increase combined with reimbursement-reducing policies.Expansion of site-neutral payment policies will be particularly impactful.Rule reflects emerging administration priorities shaping future policy. 02:21 — OPPS Payment Rate Update for 2026 CMS finalized a 2.6% OPPS schedule increase factor for hospitals meeting quality reporting requirements. 02:40 — What the 2.6% Increase means Based on: 3% market basket update–0.7% productivity adjustment Results in a modest net increase.Slightly better than the proposed 2.4% increase, though still viewed as inadequate.CMS estimates $8 billion increase in total OPPS payments compared to 2025. 03:37 — 340B Remedy Offset: Background From 2018–2022, CMS paid for 340B drugs at ASP –22.5%.Prior Supreme Court decision from 2022 found that CMS lacked authority to vary rates as finalized in prior rulemaking (e.g., without using drug acquisition cost surveys to inform policy). 04:13 — 340B Remedy Offset in the 2026 Final Rule CMS considered increasing the remedy offset from 0.5% to 2%.Stakeholders strongly opposed the increase due to hospital financial strain. 05:10 — Final Outcome CMS retained the 0.5% offset for 2026.CMS signaled that larger offsets may be proposed for 2027.This marks the first year the remedy offset takes effect, 06:00 — Site-Neutral Payment Policy: What It Is Concept: same service = same payment, regardless of site of care.Hospital concern: policy reduces hospital reimbursement without accounting for site of care differences, patient acuity, overhead, or service complexity. 06:15 — Site-Neutral Expansion in the 2026 Rule CMS expanded site-neutral payment to include drug administration services at excepted off-campus provider-based departments. 07:08 — Financial Impact Reimbursement aligns with Physician Fee Schedule rates.CMS estimates $290 million reduction in outpatient spending for 2026.$220 million of savings accrue directly to Medicare.Not implemented in a budget-neutral manner. 08:14 — Non-Opioid Pain Management Payments Temporary additional payments began January 1, 2025.Authorized under the NO PAIN Act (Consolidated Appropriations Act of 2023). 08:28 — What’s New for 2026 CMS finalized the renewal of: 5 drugs13 medical devices eligible for separate payment in HOPD and ASC settings. Per statue, payments available through December 31, 2027. 09:32 — Process Improvements CMS will allow more frequent consideration of new qualifying products (not limited to annual updates).Quality criteria unchanged; timing flexibility added.CMS released guidance on how stakeholders can engage for inclusion. 10:58 — OPPS Drug Acquisition Cost Survey CMS finalized plans to survey hospitals on acquisition costs for separately payable OPPS drugs. 11:21 — Why CMS Is Advancing the Survey Addresses Supreme Court requirements from prior 340B litigation.Aligns with White House Executive Order on lowering drug prices.Positions CMS to use survey data for 2027 rulemaking. 12:47 — OPPS Packaging Thresholds for 2026 Drugs and biologics: Threshold remains at $140.Diagnostic radiopharmaceuticals: Increased to $655 (from $630).Products below thresholds retain Status Indicator “N” (packaged payment). 13:26 — Why Billing Packaged Drugs Still Matters Even though not separately payable, hospitals must bill for packaged drugs.Billing data feeds cost reports ...
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    20 min
  • The GOAT of GPO’s

    The GOAT of GPO’s
    Dec 30 2025
    Pharmacy buyers play a critical role in keeping hospitals running—and their partnership with a GPO can make all the difference. In this episode of Verified Rx, Jackie Stokes sits down with Theresa Brown and Michelle Crump, two powerhouse pharmacy buyers and members of Vizient’s Pharmacy Technician Committee, to talk about the tools, programs, and peer networks that help them thrive in their roles. From leveraging pharmacy analytics to navigating shortages, maximizing NovaPlus value, and strengthening buyer-to-buyer collaboration, this episode is packed with insights to help pharmacy teams work smarter, save money, and support better patient care. Guest speakers: Theresa Brown National Pharmacy Purchasing Specialist Prospect Medical Holdings Michelle Crump, ASBA, CPhT National Certified Pharmacy Technician Buyer Pharmacy Host: Jackie Stokes Program Services Manager Center for Pharmacy Practice Excellence (CPPE) Vizient Show Notes: [00:48] — Guest Introductions Theresa National pharmacy purchasing specialistBackground: inventory control, home infusion startup, pharmacy technician educator [01:14] — Michelle Nationally certified pharmacy technician since 2016Pharmacy buyer at a small independent county critical access hospitalTransitioned from accounting into pharmacy purchasing [01:26] — The Role of Vizient in Supporting Pharmacy Buyers Theresa: Biggest benefit: relationship with pharmacy executive & sourcing teamUses Pharmacy Analytics (formerly VSAP) to evaluate spend and inventory control across 63 facilities [02:16] — How Pharmacy Analytics Supports Buyers Theresa: Data mining on spend increases/decreasesTracks product returnsIdentifies sharing opportunities to prevent waste [02:59] — Michelle’s Experience Analytics helps mitigate wasteCollaboration with other buyers has been essential — especially for someone new to the buyer roleLearns navigation of Vizient systems and how to work with the local GPOPeer support helps demystify a “diverse and complex” buyer role [04:02] — Value of the Vizient Pharmacy Technician Committee Provides national peer networkingHelps buyers learn from subject matter expertsEven highly experienced buyers (35+ years) learn from every call [04:41] — Vizient Programs: NovaPlus, NES, Forum Calls, Hot Info Bimonthly Forum Calls Provide regulatory updatesHelp expand buyer knowledge in real time Hot Info Weekly Updates Keeps users informed on inventory, shortages, spend impacts [05:31] — Michelle on Program Impact Calls and shared expertise were critical when she was newNovaPlus program especially valuable in critical access settings [06:32] — Deep Dive: How the NovaPlus Program Works Michelle explains: NovaPlus (Y-label) aligns with manufacturer-labeled products (M-label)Quarterly rebates provide significant savingsCritical access hospitals benefit via 340B optimizer software that extracts outpatient utilization to qualify for discounted M-label purchasingCan result in “significant savings” depending on contract structure [08:38] — What If NovaPlus Pricing Isn’t the Best Price? Michelle: Buyer’s responsibility to identify price discrepanciesCommunicates with Vizient representative to reassess contracting needsOften resolved through rebates or future price adjustments [09:30] — Theresa: Price challenges taken seriouslyMany result in price reductions visible in Hot Info the next weekDemonstrates importance of strong GPO relationships [10:07] — Understanding NES: NovaPlus Enhanced Supply Theresa: Her hospitals are exploring NES participationRequires 90% compliance (higher than standard 80%)Benefits include prioritized product access during shortagesCritical when national backorders exceed 200+ itemsEnsures better patient care continuity [11:34] — Supply Assurance & Mitigation Strategies Michelle: During the North Carolina hurricane, Vizient’s mitigation strategy was “imperative”Vizient engaged Baxter directly to resolve critical fluid shortagesSmall hospitals especially reliant on support in crisis situations [12:36] — Theresa: Shortage team provides substitution guidance and clinical appropriateness informationVizient recommendations support discussions with local clinical teamsCrucial during COVID start date — her first day in national role [13:23] — Continuing Education (CE) Programs Theresa: Vizient CE programs help maintain technician licensureWebinars are interactive, engaging, and more informative than generic CE resources [14:07] — Networking and Pharmacy Aggregation Groups (PAGs) Theresa: PAGs offer cost savings and peer collaborationAbility to share information and bring value back to her own network [14:44] — Michelle’s Example of System-to-System Collaboration Shared compounded syringes (from a 503B facility) with another hospital to prevent wasteHighlights real-world benefits of PAG networking [15:52] — Addressing National Challenges Together Theresa: PAG ...
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    19 min
  • Return of Pipeline 2026 – Cell and Gene Therapies

    Return of Pipeline 2026 – Cell and Gene Therapies
    Dec 9 2025
    In Part 2 of the 2026 pipeline series, host Carolyn Liptak welcomes Dr. Amanda Frick, Senior Clinical Manager, Strategic Clinical Intelligence at Vizient, to explore the advanced therapies pipeline: cell therapies, gene therapies, tissue-engineered products, and combination advanced therapy products. The discussion explores major pipeline trends, six leading products to watch, and the growing innovation expected to shape clinical practice in 2026. Guest speakers: Amanda Frick, PharmD, BCPS Senior Clinical Manager, Strategic Clinical Intelligence Spend Management Vizient Host: Carolyn Liptak, MBA, BS Pharm Pharmacy Executive Director Center for Pharmacy Practice Excellence (CPPE) Vizient Show Notes: [00:05] — Introduction Announcer opens the episode.Host Carolyn Liptak introduces the focus on advanced therapies: cell & gene therapies, tissue-engineered products, and combination products.Guest: Dr. Amanda Frick, Senior Clinical Manager, Strategic Clinical Intelligence at Vizient. [01:07] — Defining Advanced Therapies FDA groups cell and gene therapies within advanced therapies.Total FDA-approved advanced therapies: 46.Amanda monitors 29 drug-like therapies within that group. [02:01] — Pipeline Size and Approval Activity S. pipeline: 264 agents in development.About 10 agents approach FDA decision annually.Actual approvals: 5–7 per year on average. [02:56] — Big-Picture Trends in Cell & Gene Therapy Oncology dominates 40–50% of all CGTs in development.Expanding into autoimmune, neurology, and earlier-phase therapies for diabetes, angina, osteoarthritis. Movement toward allogeneic ("off-the-shelf") therapies Designed to overcome limits of autologous cell manufacturing.Reduces wait time and manufacturing failures. Resurgence of therapeutic vaccines Currently 3 approved (Sipuleucel-T, Talimogene, Papzimeos).20+ vaccines in the pipeline, largely targeted to cancer.CE program coming Jan 29. [06:13] — Therapy #1: Tabelecleucel or Tab-cel (Allogeneic EBV-Specific T-Cell Therapy) First allogeneic T-cell therapy expected in the U.S.For EBV-positive post-transplant lymphoproliferative disorder (PTLD).“Off-the-shelf” and donor-derived. [07:07] — Clinical Need & Outcomes Currentstandard of care: rituximab.After relapse, survival <1 month (HSCT) or <4 months (solid organ).Phase 3 data: 90% one-year survival. Regulatory Status Prior FDA CRL due to manufacturing (third-party issues).Expected approval: January 10, 2026. [09:00] — Therapy #2: Kresladi (Autologous Gene Therapy for LAD-I) Treats severe leukocyte adhesion deficiency (LAD-I), typically diagnosed in infancy.Could eliminate need for stem cell transplant (often limited by lack of matched donors). [11:39] — Clinical Outcomes Phase 1/2 data (n=9): 100% survival at one yearMajor reduction in hospitalizationsDiscontinuation of prophylactic antibiotics Regulatory Status Multiple delays due to CMC (chemistry, manufacturing, controls) questions.Resubmitted Oct 2025; anticipated approval March 28, 2026. [13:27] — Therapy #3: ORCA-T (Enhanced Allogeneic Stem Cell Transplant) Allogeneic hematopoietic stem cells + regulatory and conventional T cells (Tregs + Tcons).Designed to improve: Graft-versus-tumor effectGraft-versus-infection protectionReduction in graft-versus-host disease (GVHD) [14:31] — Clinical Significance Could markedly improve quality of life after transplant. Regulatory Status Anticipated approval: April 6, 2026. [15:01] — Therapy #4: Vusolimogene oderparepvec (RP1) (RP1 — Oncolytic HSV-1 Virus) Off-the-shelf genetically modified HSV-1 oncolytic virus.For advanced melanoma after prior PD-1 inhibitor therapy. [16:17] — Why It Matters Currently, poised to compete with Amtagvi (TIL therapy).TIL therapy is autologous and slow to manufacture; RP1 is ready-to-use and combines with nivolumab (Opdivo). Regulatory Status PDUFA: April 10, 2026. [16:34] — Therapy #5: INO-3107 (Therapeutic Vaccine for RRP) Targets HPV 6 and 11, which cause recurrent respiratory papillomatosis (RRP).Patients can require several surgeries per year to remove papillomas. [17:34] — Vaccine Mechanism DNA plasmid (vs viral vector in PAP).Lower insertional oncogenesis risk.Potentially improved durability of response. Regulatory Status Manufacturer aims to finish BLA by end of 2025.Expected approval (with priority review): mid–late 2026. [19:17] — Therapy #6: Clemidsogene lanparvovec (Intracerebral Gene Therapy for Hunter Syndrome) One-time treatment for MPS II (Hunter syndrome).Designed to deliver therapy directly into the brain to address neurological progression. [21:21] — Competing Agent Emerging New enzyme therapy tivedenofusp alfa crosses the blood-brain barrier — unlike current ERT (idursulfase).Expected approval: April 5, 2026.Raises payer & clinical sequencing questions: One-time gene therapy vs repeat annual enzyme therapyDurability vs cost (ERT ~$500K/year) Regulatory Status Clemidsogene lanparvovec anticipated ...
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    24 min
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