VerifiedRx

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.

  1. HACE 1 DÍA

    Inside the Medicare Transaction Facilitator: Early Wins and Growing Pains

    In this episode of VerifiedRx, Carolyn Liptak is joined by Dr. Jennifer Tussey, Senior Specialty Pharmacy Manager at BJC Health, to discuss early experiences with the Medicare Transaction Facilitator (MTF) and the Medicare Drug Price Negotiation Program. From managing complex data flows and delayed payments to coordinating cross-functional teams and evolving workflows, they share practical insights from the first cycle of implementation. Tune in to learn what’s working, what’s challenging, and how health systems are adapting in real time.   Guest speaker:    Jennifer Tussey, PharmD, CSP, AAHIVP Senior Specialty Pharmacy Manager Specialty, Oncology, Mail Order BJC Health East Region   Host:   Carolyn Liptak, MBA, BS Pharm Pharmacy Executive Director, Regulatory Compliance Vizient Center for Pharmacy Practice Excellence   Verified Rx Host    00:05 — Introduction Announcer welcomes listeners to VerifiedRx, produced by the Vizient Center for Pharmacy Practice Excellence.   00:14 — Episode Overview Host Carolyn Liptak introduces the topic: early experiences with the Medicare Drug Price Negotiation Program (MDPNP) and the Medicare Transaction Facilitator (MTF). Discussion focuses on: Implementation planning Early operational challenges Payment and data flow issues Lessons learned from initial rollout Guest: Dr. Jennifer Tussey, Senior Specialty Pharmacy Manager at BJC Health.   00:14 — Key Program Definitions Medicare Drug Price Negotiation Program (MDPNP): Created under the Inflation Reduction Act (2022) Allows CMS to negotiate prices for select high-cost drugs without generic/biosimilar competition Establishes a Maximum Fair Price (MFP) Medicare Transaction Facilitator (MTF): Operational system supporting: Data exchange Payment processing Coordination between CMS, manufacturers, and dispensers Ensures Part D beneficiaries receive negotiated pricing   02:00 — Health System Context Jennifer oversees specialty, oncology, and mail-order pharmacy operations within BJC Health’s east region. Approximately 12 pharmacies impacted by MTF processes.   02:27 — Implementation Strategy Initial steps: Participation in CMS webinars Formation of a multidisciplinary team Key roles involved: Pharmacy leadership Data analyst Business manager Reconciliation technician Revenue cycle team Responsibilities include: Tracking claims and payment status Managing 340B eligibility Reconciling payments across multiple systems (MTF, Beacon, internal systems)   03:54 — Enrollment Experience Enrollment process was relatively straightforward: Entity signatures System setup for remittance processing Complexity increased post-enrollment due to: Data fragmentation across systems Limited access for revenue cycle teams Required strong coordination across departments.   05:09 — Data & Payment Flow Challenges Data flow remains slow but improving. Current timeline: ~19 days for payment finalization Up to 45 days for resolution if inquiries are required Early collection rates: Initially ~10% Improved to ~60%   05:09 — Operational Workflow Adjustments Monitoring cadence evolved: From daily tracking → now biweekly review cycles Teams review claims approximately 45 days in arrears.   06:02 — Inquiry & Tracking Challenges System limitations: Inquiry submissions may not be saved reliably Lack of built-in tracking tools Requires manual documentation and tracking to monitor claim status and follow-ups.   06:18 — Managing Payment Inconsistencies Payment discrepancies handled through inquiry process. Key challenges: Delayed initiation (must wait for processing window) Extended resolution timelines (up to 45 days) Requires proactive and continuous follow-up.   06:53 — Financial & Resource Challenges Low reimbursement margins under standard refund amounts. Even large systems with wholesale discounts experience tight margins. Significant FTE investment required to manage the process. Smaller systems may face: Greater operational burden Limited staffing capacity   07:33 — Operational Evolution Processes are continuously evolving. Key success factors: Ongoing process refinement Strong internal documentation Rapid incorporation of lessons learned Example: Identifying system issues with inquiry tracking and adjusting workflows accordingly   08:14 — Key Advice: Patience & Persistence Success requires: Patience with slow-moving processes Meticulous follow-up Strong tracking systems (e.g., Excel-based workflows) High claim volume (500+ scripts at a time) necessitates structured tracking tools.   09:07 — Additional Financial Considerations Low net margins combined with high operational workload. Challenges amplified for: Smaller pharmacies Systems with fewer resources Emphasizes importance of operational efficiency and resource planning.   09:36 — Final Takeaways MTF implementation is: Complex Resource-intensive Still evolving Key themes: Strong cross-functional collaboration is essential Processes will require ongoing refinement Financial sustainability remains a concern   09:46 — Closing Carolyn thanks Jennifer for sharing insights and real-world experience. Reminder to subscribe, provide feedback, and stay engaged with VerifiedRx content.   Links | Resources:  Medicare Drug Price Negotiation Program: Click Here   Medicare Transaction Facilitator General Resources: Click Here   Pharmacy and Dispensing Entity Resources: Click Here   Subscribe Today! Apple Podcasts Spotify YouTube RSS Feed

    10 min

  2. 17 MAR

    Checkpoint Change: Rethinking How PD-1/PD-L1 Inhibitors Are Delivered

    Immune checkpoint inhibitors targeting PD-1 and PD-L1 have transformed the treatment landscape across a wide variety of cancers, becoming foundational therapies in oncology. Dr. Stacey Sobocinski and Dr. Michele Rice join host Dr. Kerry Schwarz to discuss what the new subcutaneous PD-1/PD-L1 immune checkpoint inhibitors could mean for oncology practice. They cover the three agents that have become available in subcutaneous formulations, their advantages and disadvantages, other important operational, financial, clinical, and safety issues for health systems to consider.   Guest speaker:     Stacey Sobocinski, Pharm.D., BCPS Associate Director, Pharmacy Medication Management & Informatics MD Anderson Cancer Center    Michele Rice, Pharm.D., BCOP Senior Consulting Solutions Director Vizient Pharmacy Enterprise Solutions Host:   Kerry Schwarz, Pharm.D., MPH Senior Clinical Manager, Evidence-Based Medicine and Outcomes Vizient Center for Pharmacy Practice Excellence     Show Notes: 00:05 — Introduction Announcer welcomes listeners to VerifiedRx, produced by the Vizient Center for Pharmacy Practice Excellence. 00:14 — Episode Overview Host Kerry introduces the topic: new subcutaneous formulations of PD-1 and PD-L1 immune checkpoint inhibitors. These therapies have traditionally been administered intravenously (IV) in infusion centers. Recently approved subcutaneous versions include: Pembrolizumab (Keytruda Qlex) Nivolumab (Opdivo Qvantig) Atezolizumab (Tecentriq Hybreza) Potential benefits include shorter administration times and relief for infusion centers operating at capacity. Guests: Stacy Sobacinski, Associate Director of Pharmacy Medication Management and Informatics, MD Anderson Cancer Center Michelle Rice, Senior Pharmacy Enterprise Solutions Director, Vizient 01:39 — Clinical Data: Efficacy, Safety & Pharmacokinetics Subcutaneous formulations were approved in combination with hyaluronidase, allowing full-dose subcutaneous administration. Clinical studies demonstrated: Comparable pharmacokinetics Similar efficacy Similar safety profiles compared to IV formulations The main difference observed was local injection site reactions, expected with subcutaneous administration. 02:32 — Confidence in Clinical Comparisons Although direct head-to-head trials are limited, extensive experience with IV formulations supports confidence in safety and efficacy. Differences largely relate to administration method, not drug activity. 03:11 — Operational Impact: Changes to Workflow Subcutaneous administration introduces new operational considerations. Shorter injection times may appear advantageous, but real-world workflow impact is still being evaluated Much of a patient’s visit still involves: Waiting room time Laboratory testing Provider visits Care coordination   04:06 — Chair Time vs Total Visit Time For therapies previously requiring longer infusions, switching to subcutaneous injections can significantly reduce chair time. For therapies previously infused over 30 minutes, the difference between IV and subcutaneous administration time may be less impactful.   04:24 — Administration Challenges Subcutaneous doses are not small-volume injections. Injection volumes may reach 10–15 mL Nursing considerations include: Patient tolerance for larger-volume injections. IV infusions allow nurses to start the infusion and attend to other tasks. Subcutaneous injections require continuous nursing presence during administration. This may increase direct nursing time.       05:05 — Equipment Considerations Some centers may use syringe pumps to administer subcutaneous injections. Many adult infusion centers do not currently have pumps since chemotherapy is typically delivered via IV using infusion pumps. Implementing syringe pumps could require additional equipment and associated procedures.   05:32 — Operational Complexity Transitioning to subcutaneous therapy involves more than simply switching order sets. Organizations must evaluate: Staffing models Nursing workflows Equipment availability Infusion center capacity management.   06:25 — Financial Considerations Subcutaneous formulations are currently priced roughly at parity with IV versions. Manufacturers may be incentivized to transition providers to subcutaneous formulations before biosimilars enter the market.   07:07 — Anticipating Market Dynamics Over time, pricing strategies may shift to encourage broader adoption. Biosimilar competition for these agents is expected within the next few years.   07:11 — Site of Care Considerations Adoption may vary by care setting: Hospital outpatient departments Physician offices Freestanding infusion centers   08:06 — Strategic Timing Decisions Health systems may weigh: Operational advantages of subcutaneous administration Potential cost reductions from future biosimilars Some organizations may delay adoption until biosimilar competition arrives.   08:24 — Infusion Center Optimization Subcutaneous therapies could increase turnover. Some centers may develop “express lanes” for subcutaneous administration.   09:01 — Payer Influence If subcutaneous formulations are perceived as cheaper or operationally simpler, payers may: Restrict site of care Prefer administrations in physician offices or non-hospital settings.   09:45 — Key Questions for Health Systems Organizations should consider: What value does the new dosage form provide? Which patients benefit most from subcutaneous administration? How will payer policies evolve?   10:05 — Evaluating Clinical Value Institutions often approach new dosage forms with caution. Subcutaneous PD-1/PD-L1 inhibitors may not offer the administration time reductions seen with other biologics because there is not as large of a difference in administration times (30 minutes versus 5 minutes).   10:53 — Patient Selection Considerations Subcutaneous formulations may be most beneficial for patients: Receiving monotherapy With difficult IV access Patients receiving combination therapies may see less benefit since IV access is already required.   11:12 — Additional Patient Factors Some patients have low body mass or cachexia, making high-volume subcutaneous injections more difficult. Physicians may prefer individualized treatment decisions rather than blanket formulary changes. 11:33 — Final Thoughts Transitioning to subcutaneous PD-1/PD-L1 inhibitors involves clinical, operational, and financial considerations. Observation times, administration practices, and workflow models continue to evolve. Ongoing monitoring of emerging best practices is encouraged. 12:15 — Closing ongoing monitoring of emerging best practices. Listeners are invited to subscribe and follow VerifiedRx for future episodes.   Subscribe Today! Apple Podcasts Spotify YouTube RSS Feed

    12 min

  3. 4 FEB

    Winter 2026 Spend Management Outlook

    Dr. Jeni Hayes, Senior Clinical Manager, Strategic Clinical Intelligence, and Dr. Heather Pace, Senior Clinical Manager, Ambulatory Care, join host Carolyn Liptak to discuss the Vizient Winter 2026 Spend Management Outlook, with a focus on pharmacy projections and key changes from prior outlooks. The episode also covers ambulatory care and self-administered drugs, biosimilar therapeutic insights, and dynamic pharmacy market forces.   Guest speaker:  Jeni Hayes, PharmD, BCPS   Senior Clinical Manager, Strategic Clinical Intelligence Vizient Spend Management Solutions   Heather Pace, PharmD   Senior Clinical Manager, Ambulatory Care Vizient Center for Pharmacy Practice Excellence     Host:   Carolyn Liptak, MBA, BS Pharm Pharmacy Executive Director, Regulatory Compliance & Revenue Integrity Center for Pharmacy Practice Excellence (CPPE) Vizient   Show Notes: 00:05 — Introduction Announcer welcomes listeners to Verified Rx, produced by the Vizient Center for Pharmacy Practice Excellence. 00:14 — Episode Overview Host Carolyn Liptak, Pharmacy Executive Director at Vizient, introduces the Winter 2026 Spend Management Outlook (SMO). Focus areas: Pharmacy inflation projections Acute vs ambulatory care trends Provider-administered vs self-administered drugs Biosimilar therapeutic insights Dynamic pharmacy market forces shaping 2026–2030 Guests: Jeni Hayes, Senior Clinical Manager, Strategic Clinical Intelligence Heather Pace, Senior Clinical Manager, Ambulatory Care 01:09 — What Is the Spend Management Outlook (SMO)? Biannual Vizient publication projecting price trends across healthcare spend categories. Pharmacy headline: Inflation slightly lower than last edition Total spend still rising, driven by utilization growth and new technologies 01:49 — Top-Line Pharmacy Inflation Projection 2.84% projected drug inflation for purchases between July 2026 – June 2027. Down from 3.35% in the prior edition. Based on October 2024 – September 2025 wholesaler data. Heavily weighted toward highest-spend drugs. Contracted products show lower inflation; non-contract drugs still ~70% of spend. 02:45 — Inflation by Site of Care Acute Care 3.03% projected inflation Driven by: Sugammadex Kcentra Clotting factors Ambulatory Care 2.85% overall, but with key divergence: Provider-administered drugs: 3.35% Self-administered drugs: 2.43% 04:02 — Provider-Administered Drugs: What’s Driving Growth Oncology infusions are the main drivers. Key agents: Keytruda Darzalex Faspro Continued growth due to: Expanded indications Increased outpatient infusion utilization Oncology split by site of care: Inpatient: High-cost CAR T (e.g., Yescarta) Outpatient: Infusions, bispecifics, emerging cellular therapies Emphasizes importance of site of care strategy. 05:14 — Self-Administered Drugs: Utilization Over Inflation Five key drivers: Autoimmune / inflammatory: Skyrizi, Dupixent, Rinvoq Diabetes / metabolic / weight loss: Ozempic, Wegovy, Mounjaro, Zepbound Spend growth fueled by: Media exposure Expanded indications Increased patient demand Opportunity for: Retail & specialty pharmacy optimization Margin capture Patient support (adherence, counseling, benefits investigation) 06:45 — New Section: Dynamic Pharmacy Market Forces (2026–2030) Seven strategic forces influencing pharmacy practice: Growth in specialty and cell & gene therapies Expansion of value- and outcomes-based contracting Siteofcare shifts toward ambulatory and home Digital transformation & automation Supply assurance and resilience Expanded pharmacist clinical scope & workforce models Regulatory and policy efforts to lower drug prices 340B changes IRA Medicare Part D negotiations 09:37 — Practical Takeaways for Pharmacy Leaders Use 2.84% inflation as a baseline — then customize using Vizient Pharmacy Analytics. Leverage segmented views to prioritize: Acute vs ambulatory strategies Provider-administered vs self-administered drugs Identify top spend movers and align them with long-term market forces. Consider: Specialty pharmacy expansion Site of care optimization 10:48 — Biosimilar Therapeutic Insights: 2025 Recap Heather Pace highlights: Shift from biosimilar approval to active adoption management. Ustekinumab (Stelara) as defining example: Multiple biosimilars Uptake driven by payer and PBM strategy Utilization varies widely based on: Formulary design Benefit alignment Biosimilars now actively steered, not passively adopted. 11:50 — Why Stelara Was a Turning Point PBM-developed, private-label biosimilars drove adoption. Net cost and copay design outweighed: Interchangeability status Manufacturer differentiation Sets expectations for future biologic launches. 12:25 — Operational Impact for Health Systems Expect payer-specific product preferences. Frequent switching will become routine. Key considerations: Siteofcare mandates Product presentation Supply chain logistics Billing & reimbursement complexity Clinical barriers are decreasing; workflow flexibility is critical. 13:09 — What to Expect From Biosimilars in 2026 Faster adoption timelines Earlier payer-driven switching Fewer preferred products Less reliance on reference product trial periods 13:45 — Biosimilars With Major 2026 Impact Eylea — multiple launches expected post-litigation Xolair — expansion into asthma/allergy and retail specialty Perjeta — oncology pathway disruption expected late 2026 / early 2027 15:01 — 2025 Biosimilars Impacting 2026 Ustekinumab (Stelara): broader formulary shifts Denosumab (Prolia, Xgeva): full year of impact; all interchangeable Eculizumab (Soliris): first rare-disease biosimilar entry 15:58 — FDA Biosimilar Guidance to Watch Late-2025 FDA guidance: Reduced reliance on clinical efficacy trials Greater emphasis on analytical similarity Aims to: Reduce development cost Accelerate market entry 16:26 — Interchangeability: Where Things Are Headed Moving toward expectation that all biosimilars are interchangeable. Shifts responsibility to: Payers Health systems Pharmacists managing transitions and education 17:17 — Biggest Shift in the Biosimilar Landscape Faster launches Larger scale adoption Payer strategy more influential than timing of approval Success depends on: Formulary fit Channel alignment Operational simplicity 17:41 — Final Biosimilar Insight Biosimilar strategies must be molecule-specific. One-size-fits-all approaches are no longer effective. 18:13 — Final Thoughts on the SMO Inflation projections are a starting point. Leaders should: Focus on top spend drugs Understand siteofcare and specialty drivers Translate projections into actionable budgets 18:40 — Resources Winter 2026 Spend Management Outlook available on Vizient’s SMO Hub. Includes current and prior editions and related insights. 18:58 — Closing Carolyn thanks Jeni and Heather. Reminder to subscribe, like, and share feedback. Verified Rx is produced by the Vizient Center for Pharmacy Practice Excellence.   Links | Resources:  Vizient Spend Management Outlook webpage Vizient Winter 2026 Spend Management Outlook Vizient Biosimilars Therapeutic Insights   Subscribe Today! Apple Podcasts Spotify YouTube RSS Feed

    20 min

  4. 27 ENE

    CDC Childhood Immunization Schedule Updates (January 2026)

    John Schoen, Senior Clinical Manager of Evidence-Based Medicine and Drug Information in Vizient's Center for Pharmacy Practice Excellence and Vizient's vaccine subject matter expert, joins host Stacy Lauderdale to discuss key updates to the CDC's childhood Immunization schedule and what they mean for practice.   Guest speaker:   John Schoen, PharmD, BCPS   Senior Clinical Manager of Evidence-Based Medicine and Drug Information    Vizient Center for Pharmacy Practice Excellence     Host:   Stacy Lauderdale, PharmD, BCPS   Associate Vice President  Vizient Center for Pharmacy Practice Excellence   Verified Rx Host    Show Notes: 00:00 — Introduction Announcer welcomes listeners to Verified Rx, produced by the Vizient Center for Pharmacy Practice Excellence. 00:14 — Episode Overview Host Stacy Lauderdale introduces the topic: updates to the CDC’s U.S. Childhood Immunization Schedule, revised January 20, 2026. Goal of the episode: explain what changed, what didn’t, and what it means in practice for providers, pharmacists, and families. Guest: John Schoen, Senior Clinical Manager of Evidence-Based Medicine and Drug Information at Vizient and vaccine subject matter expert. 01:16 — What Changed in the CDC Immunization Schedule CDC reorganized the schedule into three recommendation categories. Vaccines were reclassified, not removed. Number of diseases covered under “routine” recommendations decreased from 17 to 11 due to recategorization. 01:50 — Stated Rationale Behind the Changes Rationale provided in executive summary of scientific assessment. The supporting scientific assessment is available online and referenced for transparency (link in resources below). 03:19 — Were Any Vaccines Removed? No vaccines were removed from the CDC schedule. Some vaccines were shifted into different recommendation categories. 03:40 — Category 1: Routine Childhood Vaccinations Vaccines still routinely recommended for all children include: MMR (measles, mumps, rubella) Polio Tdap / DTaP Hib (Haemophilus influenzae type B) Pneumococcal HPV Varicella (chickenpox) 04:27 — Category 2: Vaccines for High-Risk Populations Vaccines recommended for children who meet specific high-risk criteria: RSV monoclonal antibodies (mAb) Hepatitis A Hepatitis B Quadrivalent meningococcal Meningococcal group B Dengue 05:19 — What Changed vs. Stayed the Same Hepatitis A, Hepatitis B, and quadrivalent meningococcal moved from routine to high-risk RSV mAb recommendations are effectively unchanged, as high-risk infants are defined as those born to mothers who did not receive the maternal RSV vaccine. Dengue remains risk-based. Meningococcal group B remains a mix of risk-based and shared clinical decision-making. 06:31 — Category 3: Shared Clinical Decision Making (SCDM) Defined by ACIP as an individualized decision made jointly by provider and parent/guardian. Allows vaccination when risk-based criteria are not met but benefit is still considered. 06:52 — Vaccines Under SCDM Vaccines now include: Influenza COVID-19 Rotavirus Hepatitis A Hepatitis B Quadrivalent meningococcal Meningococcal group B 08:05 — What’s New in SCDM Influenza and rotavirus moved from routine to SCDM. Hepatitis A, hepatitis B, and quadrivalent meningococcal also shifted. COVID-19 moved to SCDM in September 2025 for individuals ≥6 months. 08:28 — Insurance Coverage Implications No expected changes in coverage. Vaccines recommended by CDC as of December 31, 2025 remain: Covered without cost-sharing under Affordable Care Act (ACA) plans. Covered by Medicaid, Children’s Health Insurance Program (CHIP), and Vaccines for Children (VFC) program. 09:14 — Impact on Pharmacy Vaccine Access Pharmacists are considered healthcare providers under CDC SCDM definitions. Authority to administer vaccines primarily determined by state laws. Standing orders, protocols, and collaborative practice agreements may need to be updated, as applicable, to address language related to ‘routine’ immunizations for children. 10:27 — Recommendations for Providers & Organizations For providers: Become familiar with schedule changes. Be prepared for patient and parent education. Recognize differences between CDC and other professional guidelines. For organizations: Review EHR documentation and order sets. Consult local state regulations to ensure compliance with vaccine administration practices. Review standing orders/protocols and collaborative practice agreements to determine if revisions are needed. Monitor vaccine utilization and adjust inventory accordingly. 11:24 — Resources & Closing Additional CDC and Vizient resources will be linked in the show notes. Announcer closes with subscription and feedback reminder. Links | Resources:  HHS press release on changes to childhood immunizations schedule Assessment of US childhood and adolescent immunization schedule HHS fact sheet: CDC childhood immunization schedule Revised CDC child and adolescent immunization schedule ACIP shared clinical decision-making recommendations   Vizient resource Minute Market Insight   VerifiedRx Listener Feedback Survey: We would love to hear from you - Please click here   Subscribe Today! Apple Podcasts Spotify YouTube RSS Feed

    12 min

  5. 13 ENE

    2026 OPPS Final Rule: What Hospitals Need to Know

    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    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 drugs 13 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 used to calculate future bundled payments. Failure to bill can result in inaccurately low reimbursement. 14:14 — Elimination of the Inpatient-Only (IPO) List CMS finalized a three-year transition to eliminate the IPO list by January 1, 2029. 14:32 — Why This Change Is Significant IPO list historically ensured certain services were provided inpatient only. CMS emphasizes provider judgment in determining site of care. Raises concerns about: Patient safety Payer coverage changes Pressure to move services outpatient 16:28 — ASC Covered Procedure List Expansion CMS expanded the ASC Covered Procedure List. Enables more Medicare covered services to be performed in the ASC settings. 16:48 — Price Transparency: Still a Priority No major overhaul, but continued refinement. CMS exploring new uses of price transparency data beyond patient comparison. 17:46 — Most Critical Policies to Watch Jenna highlights: Modest OPPS payment increase Site-neutral payment expansion 340B remedy offset Drug acquisition cost survey Broader regulatory activity beyond OPPS 18:43 — Available Vizient Resources OPPS Final Rule Summary Government Relations & Public Policy Summaries  Advocacy 19:20 — Closing Carolyn thanks Jenna for her insights. Reminder to subscribe, like, and share feedback. VerifiedRx is produced by the Vizient Center for Pharmacy Practice Excellence.   Links | Resources:  Medicare Program: Hospital Outpatient Prospective Payment and Ambulatory Surgical Center Payment Systems; Quality Reporting Programs; Overall Hospital Quality Star Rating; Hospital Price Transparency; and Notice of Closure of a Teaching Hospital and Opportunity To Apply for Available Slots: Click Here CMS fact sheet on the Final Rule: Click Here Outpatient Prospective Payment System (OPPS) Drug Acquisition Cost Survey: Click Here Vizient Office of Public Policy and Government Relations final rule summary:  Click Here Final List of Qualifying Products for Separate Payment for non-opioid pain medications: (Table 136, pgs. 1138-1140)   VerifiedRx Listener Feedback Survey: We would love to hear from you - Please click here   Subscribe Today! Apple Podcasts Spotify YouTube RSS Feed

    20 min

  6. 30/12/2025

    The GOAT of GPO’s

    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 specialist Background: inventory control, home infusion startup, pharmacy technician educator [01:14] — Michelle Nationally certified pharmacy technician since 2016 Pharmacy buyer at a small independent county critical access hospital Transitioned from accounting into pharmacy purchasing   [01:26] — The Role of Vizient in Supporting Pharmacy Buyers Theresa: Biggest benefit: relationship with pharmacy executive & sourcing team Uses 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/decreases Tracks product returns Identifies sharing opportunities to prevent waste [02:59] — Michelle’s Experience Analytics helps mitigate waste Collaboration with other buyers has been essential — especially for someone new to the buyer role Learns navigation of Vizient systems and how to work with the local GPO Peer support helps demystify a “diverse and complex” buyer role   [04:02] — Value of the Vizient Pharmacy Technician Committee Provides national peer networking Helps buyers learn from subject matter experts Even highly experienced buyers (35+ years) learn from every call   [04:41] — Vizient Programs: NovaPlus, NES, Forum Calls, Hot Info Bimonthly Forum Calls Provide regulatory updates Help 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 new NovaPlus 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 savings Critical access hospitals benefit via 340B optimizer software that extracts outpatient utilization to qualify for discounted M-label purchasing Can 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 discrepancies Communicates with Vizient representative to reassess contracting needs Often resolved through rebates or future price adjustments [09:30] — Theresa: Price challenges taken seriously Many result in price reductions visible in Hot Info the next week Demonstrates importance of strong GPO relationships   [10:07] — Understanding NES: NovaPlus Enhanced Supply Theresa: Her hospitals are exploring NES participation Requires 90% compliance (higher than standard 80%) Benefits include prioritized product access during shortages Critical when national backorders exceed 200+ items Ensures 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 shortages Small hospitals especially reliant on support in crisis situations [12:36] — Theresa: Shortage team provides substitution guidance and clinical appropriateness information Vizient recommendations support discussions with local clinical teams Crucial during COVID start date — her first day in national role   [13:23] — Continuing Education (CE) Programs Theresa: Vizient CE programs help maintain technician licensure Webinars 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 collaboration Ability 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 waste Highlights real-world benefits of PAG networking   [15:52] — Addressing National Challenges Together Theresa: PAG roundtables help uncover shared struggles (e.g., DSCSA serialization issues) Members provide actionable advice on what’s working in their systems Reinforces “we’re all in the same boat”   [16:50] — Supporting and Elevating Pharmacy Technicians Jackie’s goal: Support technicians and recognize the value they bring Committee exists to uplift and empower pharmacy buyers/techs [17:05] — Michelle: Worked with leadership to create a tiered technician level system Helps techs gain skills, feel valued, and earn raises Improves career satisfaction and retention   [17:46] — Closing Reflections Theresa: Being part of Vizient is “an honor and a privilege” Values shared knowledge and strong relationships [18:00] — Michelle: Gratitude for collaboration and guidance over the years Vizient connections were vital for adapting to the buyer role   VerifiedRx Listener Feedback Survey: We would love to hear from you - Please click here   Subscribe Today! 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    19 min

  7. 09/12/2025

    Return of Pipeline 2026 – Cell and Gene Therapies

    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 year Major reduction in hospitalizations Discontinuation 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 effect Graft-versus-infection protection Reduction 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 therapy Durability vs cost (ERT ~$500K/year) Regulatory Status Clemidsogene lanparvovec anticipated approval: February 8, 2026. [22:45] — Cost, Value, and Durability Considerations Gene therapies may reach multi-million-dollar cost brackets. Durability becomes critical for payer adoption. Hospitals face long onboarding timelines for advanced therapies and must choose which to implement. [22:56] — Where to Learn More Spend Management Outlook (formerly Pharmacy Market Outlook) Oncology and pediatric Vizient therapeutic web pages FDA cell/gene therapy webpage CE session on therapeutic vaccines (Jan 29) [23:46] — Closing Carolyn thanks Amanda. Reminder to subscribe, send comments, and explore further resources from Vizient.   Links | Resources:  Spend Management Outlook: Click here Therapeutic class insights: Click here FDA webpage: Click here   Subscribe Today! Apple Podcasts Spotify YouTube RSS Feed

    24 min

  8. 25/11/2025

    Pipeline 2026: The Movers, the Shapers, & What Matters

    If you're wondering which therapies may influence care delivery, budgets, and decision making in 2026, the pipeline offers an early preview and it points to a year defined by innovation. We're seeing new first in class treatments, thoughtful next generation agents, and a biosimilar market where fewer launches are offset by important competitive shifts driven by recent approvals. John Schoen and Heather Pace from the Center for Pharmacy Practice Excellence join Stacy Lauderdale, Associate Vice President of Evidence-Based Medicine and Drug Information and your Verified RX program host to highlight pipeline agents worth watching and discuss what they may mean for care delivery and spend management in the year ahead.   Guest speakers:  John Schoen, PharmD, BCPS   Senior Clinical Manager of Drug Information    Vizient Center for Pharmacy Practice Excellence    Heather Pace, PharmD Senior Clinical Manager of Drug Information    Vizient Center for Pharmacy Practice Excellence      Host:   Stacy Lauderdale, PharmD, BCPS   Associate Vice President  Vizient Center for Pharmacy Practice Excellence   Show Notes: [01:01] — Episode Scope The focus is non-CGT therapies; CGT pipeline will be covered in Part 2. [01:50] — Therapeutic Areas With the Most Approvals Oncology leads the pipeline. Others include infectious disease, neurology, rare disease, endocrine, hepatology, dermatology, and rheumatology. [02:37] — Biosimilars in 2026: Momentum or Headwinds? Discussion of potential “biosimilar void”—only 10% of expiring biologic patents have biosimilars in development. Emerging role of PBM private-label biosimilars. [03:51] — FDA Draft Guidance on Interchangeability FDA exploring interchangeable designation for all biosimilars. Potential shift away from clinical efficacy studies in favor of analytical comparisons. Guidance still in draft and open for public comment. [05:34] — John’s Top Picks for First-in-Class Agents 06:11 — Orviglance First manganese-based, oral MRI contrast agent. Advantages for patients with kidney impairment. Used for liver imaging. [06:20] — Why Non-Gadolinium Matters Lower risk of nephrogenic systemic fibrosis. [06:46] — Tabelecleucel First allogeneic EBV-specific T-cell therapy. For EBV-positive PTLD post-transplant. Could become new standard of care. [07:42] — Tanruprubart First therapy specifically for severe Guillain-Barré Syndrome (GBS). Shows improved outcomes over IVIG and plasma exchange. [08:20] — Comparing to Standard of Care Review of improved real-world data outcomes. [09:03] — Therapies That May Shift Care Delivery [09:32] — Icotrokinra: First oral IL-23 antagonist for plaque psoriasis. [10:00] — Insulin Icodec First once-weekly basal insulin for type 2 diabetes. Resubmitted after safety concerns in type 1 diabetes. [10:59] — Honorable Mentions Camizestrant SERD for ER+/HER2– metastatic breast cancer. Ensitrelvir (COVID-19) Oral option for pre-exposure prophylaxis. Also being evaluated for treatment. Doravirine + Islatravir (HIV) Introduces new NRTTI class. Cefepime + Zidebactam Active against metallo-β-lactamase–producing organisms. 14:05 — Key Biosimilar Launches Omalizumab (Xolair) First biosimilars in asthma/allergy space. Aflibercept (Eylea) High competition expected pending litigation. Pertuzumab (Perjeta) First biosimilar anticipated in oncology. [15:31] — Biosimilars Approved in 2025, Impacting 2026 Ustekinumab (Stelara): first full year of competition Denosumab (Prolia/Xgeva): 10–15 biosimilars expected Eculizumab (Soliris): notable for rare disease market entry [17:17] — John’s Closing Thoughts Strong mix of first-in-class advances and next-gen convenience therapies. [17:36] — Heather’s Closing Thoughts 2026 will focus on speed and scale after the 2025 biosimilar wave. Pharmacists pivotal in ensuring smooth patient transitions.   VerifiedRx Listener Feedback Survey: We would love to hear from you - Please click here   Subscribe Today! Apple Podcasts Spotify YouTube RSS Feed

    19 min
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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.

Información

  • Creador
    Vizient Center for Pharmacy Practice Excellence
  • Años de actividad
    2020 - 2026
  • Episodios
    122
  • Clasificación
    Apto
  • Copyright
    © Copyright 2025 All rights reserved.
  • Mostrar sitio web
    VerifiedRx

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