In brief: Walgreens creates new pharmacy biz, CQRC contributes to hearing, OIG contacts CGM providers 

DEERFIELD, Ill. – AllianceRx Walgreens Pharmacy will become Walgreens Specialty Pharmacy effective Aug.1, 2024, in a move that Walgreens says will expand care for patients with complex, chronic conditions. 

Walgreens will now have nearly 300 community-based specialty pharmacies nationwide, with more than 1,500 specialty-trained pharmacists, 5,000 patient advocacy support team members and dedicated Specialty360 teams that support all specialty conditions and therapies. 

“With approximately $24 billion in annual enterprise specialty revenue, Walgreens Specialty Pharmacy is the largest independent provider that offers the industry's most robust specialty capabilities not vertically aligned with a pharmacy benefit manager,” said Rick Gates, chief pharmacy officer, Walgreens. “We have the flexibility to contract dynamically with any payer. We can partner directly with pharmaceutical manufacturers to facilitate products to market, including limited distribution drugs, and coordinate closely with providers to ensure patients experience a smooth start to treatment.” 

Under the new business, Walgreens Specialty Pharmacy will offer the following services at scale: 

• Gene and Cell Services Pharmacy and Innovation Center, a dedicated 18,000-square-foot center in Pittsburgh, with services and capabilities for emerging therapies, including innovative solutions for managing the complexity of the supply chain, logistics and financing, as well as clinical and social needs management to ensure success for patients and partners. 

• Four central specialty pharmacies, each holding several national pharmacy accreditations, where pharmacists and care teams across the country work together to dispense highly complex medications and help patients manage chronic or rare diseases and conditions. These pharmacies hold distinctions in oncology and rare/orphan conditions and offer patients and caregivers clinical services that drive engagement, adherence and outcomes. 

• A growing roster of 240 limited distribution drugs, including 40 narrow networks and 12 exclusive limited distribution drugs. 

In 2023, Walgreens Boots Alliance divested its final shares of Option Care, which it acquired in 2007. At the time, the company said it planned to use the proceeds of approximately $330 million to, among other things, “support strategic initiatives and health care transformation.” 

CQRC pushes SOAR Act as part of hearing 

WASHINGTON – The Council for Quality Respiratory Care submitted a statement highlighting the need for Medcare to standardize the process for determining medical necessity for home oxygen therapy as part of a recent congressional hearing on “Examining How Improper Payments Cost Taxpayers Billions and Weaken Medicare and Medicaid.” 

In the statement, the CQRC recommends CMS require Medicare contractors to use the clinical data element templates already created by the agency to establish beneficiary medical necessity, rather than relying solely on subjective notes written by a patient’s doctor in their medical record, which has led to “alarming” claims denials. 

“To address the problem of improper payments in supplemental oxygen therapy, we strongly urge the committee to instruct CMS to require Medicare contractors to use the CMS created clinical data element templates to establish beneficiary medical necessity,” the council stated. “This one step would create a comprehensive set of information for meaningful audit review and would address the problems created by contractors relying solely on physician notes." 

The hearing was held by the Energy & Commerce Committee Subcommittee on Oversight and Investigations in the House of Representatives. 

The CQRC’s statement also urged lawmakers to support the Supplemental Oxygen Access Reform (SOAR) Act, H.R. 7829 and S. 3821, which would mandate the use of a template for documentation, remove supplemental oxygen from Medicare’s competitive bidding program and permanently extend Medicare’s blended reimbursement rates, among other things. 

OIG contacts providers for CGM cost study 

WASHINGTON – The Office of Inspector General has begun sending emails and letters to a select group of continuous glucose monitor (CGM) suppliers as part of an evaluation for its study "Medicare Payments Compared to the Prices Available to Consumers and Suppliers for Continuous Glucose Monitors and Sensors," AAHomecare reports. This study aims to determine the cost-effectiveness of Medicare payments in comparison to the supplier’s acquisition costs and other prices available to consumers. “AAHomecare recommends suppliers diligently monitor their email and mail correspondence for any communication from the OIG,” the association stated in a bulletin. “It is imperative for suppliers who have received such requests to promptly respond within the specified timeframe to facilitate the OIG's analysis.” When the OIG announced the study in its Work Plan in November 2023, it noted CMS allowed more than $1.1 billion in Medicare Part B payments for CGMs and sensors in 2022. If the OIG identifies opportunities for Medicare to realize cost savings, CMS has the authority to either introduce CGMs into the competitive bidding program or exercise its authority of inherent reasonableness to adjust Medicare payments accordingly, according to AAHomecare. 

RestorixHealth, Accurate Healthcare partner 

METAIRIE, La., and NASHVILLE, Tenn. –  RestorixHealth, a national wound care solutions company, will no longer provide Part B product supplies to residents in skilled nursing facilities as part of a new strategic agreement with Accurate Healthcare. The agreement will expand Accurate’s services and, when combined with its current offerings of specialized DME and respiratory equipment, will position the company as a scaled, complete one-stop-shop for skilled nursing facilities, it says. “The opportunity to join services with a proven leader in Part B billing and wound care supplies and education is advantageous for our post-acute business,” said James Hobbs, president of Accurate. "The combined strength of RestorixHealth's field sales and service teams with Accurate's broad service and product offerings will enable accelerated growth and better position the combined company to deliver more value for our customers." Also under the agreement, Accurate will offer continued employment opportunities to key RestorixHealth employees focused on this market and purchase certain assets. “This is a great arrangement for all parties,” said Todd Newton, CEO of RestorixHealth. “This union of services allows our skilled nursing facility customers to continue to receive the excellent service they are accustomed to but enhanced by Accurate’s expanded and integrated offerings. And for RestorixHealth, under this arrangement, we will benefit from the instantly renewed focus on our core business, where we have tremendous growth opportunities.” 

Invacare moves for mobility 

ELYRIA, Ohio, and IRVINE, Calif. – Invacare has announced the launch of Move for Mobility, a global fundraising initiative in collaboration with its partner, Free Wheelchair Mission. As part of the initiative in May, hundreds of Invacare employees around the world will participate to support Free Wheelchair Mission’s work in providing life-changing wheelchairs to people living in remote communities with no access to mobility equipment. Invacare employees will take part by being active from walking, rolling, running or taking up a physical team challenge, all to raise awareness and funds. For every $96 raised, a new wheelchair will be donated, enabling people in remote communities to lead more independent and fulfilling lives. “By combining our joint resources and expertise, with our global partner Free Wheelchair Mission, we aim to raise awareness and help transform lives around the world,” Geoff Purtill, President & CEO at Invacare. “We look forward to taking part. I am personally very proud that hundreds of our employees have signed up to get active and support this cause.” Free Wheelchair Mission has provided more than 1.4 million wheelchairs to those living with disabilities across 95 countries. Founded in 2001 by Don Schoendorfer, Ph.D., it is a humanitarian nonprofit based in Irvine, Calif., that designs and manufactures cost-efficient, durable wheelchairs for individuals living with disabilities in developing countries. “We are grateful and proud of the strong partnership we’ve developed with Invacare over the past few years and are excited to see their teams moving in May to help us raise funds and awareness to provide wheelchairs to those who are waiting for them,” said Nuka Solomon, CEO of Free Wheelchair Mission. “Together, we are excited to work toward a long-term goal to get wheelchairs to communities with no access to mobility solutions.” For more information and to make a donation directly to Free Wheelchair Mission in support of Invacare Move for Mobility, visit www.invacaremoves.org. 

Soleo Health opens location in Mississippi 

RIDGELAND, Miss. – Soleo Health, a national provider of complex specialty pharmacy services, has opened its latest pharmacy and ambulatory infusion center (AIC) in Ridgeland, Miss. Soleo Health Jackson offers a broad range of specialty pharmacy services and infusion therapies to patients requiring complex specialty biologic and infusion therapies across Mississippi, including those in Jackson, Tupelo, Hattiesburg and throughout the Gulf Coast. “Soleo Health identified an opportunity to expand its reach in Mississippi by bringing its complex specialty pharmacy services to the marketplace,” said Susan Artabasy, regional vice president for Soleo Health's South Region. “Our local team of clinicians and supporting staff brings quality care, high service and industry experience to patient care statewide. Leveraging its strong relationships with prescribers, health systems, payors, pharmaceutical manufacturers, and soon, patients, Soleo Health Jackson expects to positively improve patient access and care from its state-of-the-art pharmacy.” The new Soleo Health Jackson location is a state-of-the-art pharmacy supporting patients in their homes or at its ambulatory infusion center. It boasts a custom-built ISO 5 clean room, an ultra-clean environment required for compounded sterile medication preparations. 

KFF updates Medicaid enrollment tracker 

WASHINGTON – At least 20.3 million Medicaid enrollees have been disenrolled as of April 18, 2024, based on the most current data from all 50 states and the District of Columbia, the Kaiser Family Foundation has reported. Overall, 31% of people with a completed renewal were disenrolled in reporting states, while 69%, or 44.4 million enrollees, had their coverage renewed (one reporting state does not include data on renewed enrollees), KFF reports. Other findings from the data, according to KFF: There is wide variation in disenrollment rates across reporting states, ranging from 57% in Utah to 12% in Maine; and across all states with available data, 69% of all people disenrolled had their coverage terminated for procedural reasons. 

Owlet, Wheel speed up access to monitoring device  

LEHI, Utah – Virtual care provider Wheel can now provide caregivers with timely prescriptions for BabySat, Owlet’s infant pulse oximeter, through a new strategic partnership. The new BabySat virtual telehealth services platform, managed and powered by Wheel, also integrates with DME suppliers who accept and can bill for the product through insurance providers, which may offer up to 100% reimbursement. “Home monitoring plays a pivotal role in safeguarding at-risk infants by improving access to health services,” said Jim Fidacaro, Owlet senior vice president and general manager of health care. “Owlet, in partnership with Wheel, can now enable parents to obtain prescriptions for BabySat directly via Wheel’s online portal and network of physicians. With a prescription, caregivers will then be able to order BabySat at little to no cost with insurance reimbursement.” The companies say this new, streamlined process makes advanced monitoring even more accessible by significantly reducing the effort and time needed to secure BabySat and get reimbursed through insurance or HSA/FSA. “This collaboration marks a significant milestone in our mission to expand health care access and simplify care delivery for all Americans — especially for growing families,” said Wheel CEO Michelle Davey. “Wheel’s virtual care platform helps streamline access to home monitoring, making Owlet’s BabySat pulse oximeter more convenient for new parents than ever before.”