Friday Shorts: Compound drug problem, AI, hospital at home and mpox vaccines
November 15, 2024
1. Weight loss drug compounder used non-sterile ingredients
The Food and Drug Administration reported that the California drug compounder Fullerton Wellness had been closed down after it was found to have used non-sterile ingredients in compounded medications, including GLP-1 medications used for weight loss. Compounded GLP-1 medications can cost as little as a fifth of the cost of brand name drugs, and they are widely available from 503b pharmacies, which are licensed to manufacture sterile medications in bulk.
In the WTW 2024 Best Practices in Healthcare Survey, almost half (48%) of employers reported at least some interest in obtaining compounded drugs, and 7% said they were very interested. Employers will want to use well-vetted suppliers if they choose to use compounded medications. They should be aware that the FDA might instruct compounding pharmacies to stop manufacturing these medications in bulk as the shortage of brand name drugs is resolved.
2. Large language model (AI) doesn’t necessarily improve physician clinical reasoning
Source: Goh, et al JAMA Network Open October 28, 2024
Artificial intelligence could dramatically improve medical care -- giving clinicians access to important insights and improving clinical reasoning. JAMA Network Open reported on a randomized study where 50 physicians were given 60 minutes to respond to questions about six clinical cases. Half were allowed to use conventional reference material, and half were given access to a large language model (LLM). Those using the LLM spend a bit less time, but their diagnostic reasoning scores were not much improved.
The authors concluded that the LLM did not improve diagnostic reasoning scores. The LLM on its own, though, outperformed both physician groups. Artificial intelligence is advancing rapidly, and I fully expect clinicians to be using this technology extensively in the coming years.
3. Some hospitals are cutting back on hospital at home
Offering hospital-level monitoring at home for patients sick enough to otherwise take up a hospital bed could work well from a medical, social and economic perspective. Home hospitalization means patients can stay in familiar surroundings while monitored remotely and with frequent nursing visits. A home hospitalization costs less than a facility hospitalization and doesn’t require building new hospital beds that cost between $2 and $5 million each. Studies have shown that hospital at home is safe for people with a subset of common illnesses, including pneumonia and heart failure.
Modern Healthcare reports that some hospitals are cutting back on their investments in home hospitalization, though. Hospital at home does not improve finances for hospitals that have plenty of empty beds, and nursing shortages have caused staffing difficulties. So far, hospital at home has mostly been offered to Medicare beneficiaries, and commercial payers have not yet started to reimburse this service.
Here's a link to an article on clinical transformation written by Patricia Toro, MD MPH and me last fall.
4. Mpox vaccination generally covered without cost sharing
There have been over 33,000 cases of a more dangerous strain of mpox in both Africa and Europe that have led to over 1,000 deaths, making it even more important that those at risk are vaccinated. The US Preventive Services Task Force recommends two doses of the Jynneos vaccine for those with mpox exposure, men who have sex with men, those with HIV and those at higher risk for sexually transmitted infections. The vaccination costs about $300 per shot.
The New York Times ran an article expressing concern that some people with insurance might not get vaccinated until the requirement for cost share waiving kicks in on January 1, 2025 since they could face cost sharing. The good news is that our pharmacy team has checked with the major PBMs, and all of them have the Jynneos vaccine already on their ACA formulary set to waive cost sharing.
Here’s a link to an Harvard Business Review article (2022) on what employers should know about Mpox written by Patricia Toro, MD MPH. Mpox was formerly known as “monkeypox.”
5. Follow up on vaccinations
I posted early last week early last week about the importance of vaccinations. A few colleagues reached out to share their own stories about the importance of vaccination:
Mumps:
Having mumps was not fun. My friend in first grade got it and developed encephalopathy and I never saw him again.
Measles:
Despite being vaccinated, my brother contracted measles when I was a kid in the 1980s. It was truly awful. My mom took him to the hospital not knowing what it was and we were ushered out of there so quickly we didn't even know what hit us. We had to quarantine in our house for a couple of weeks. A public health nurse called us every single day for an update and to make sure we weren't going out anywhere.