Direct-to-Consumer Advertising Distorts Prescription Drugs’ Benefits and Costs - AAFP
Prescription advertising is about to become a political football in the United States—Super Bowl reference intended. In this case, the AAFP is highlighting the actual cost ($288,000) of a drug advertised during the Super Bowl, compared to the promoted price (as low as $5 per dose). This pricing discrepancy is made possible through the deductible rebate card program.
It’s not an outright lie—the patient’s out-of-pocket cost after the rebate is indeed $0 to $5 per dose, but only if the insurer covers it. The negotiated rate with Medicare, however, is a different story.
As the AAFP points out, this is not a drug a physician would typically prescribe today for even serious plaque psoriasis. While it is an effective medication, it is generally reserved for patients who have not responded to more affordable alternatives or have encountered issues with anti-TNF therapies.
Direct-to-consumer (DTC) prescription advertising first appeared in the 1980s but didn’t gain traction until 1997, when the FDA clarified how risk and benefit information should be presented—often alongside glowing, happy images of elderly patients. Given some of the more extreme examples and the rise of DTC telehealth from the same pharmaceutical companies, pushback is growing.
Direct-to-Consumer Advertising Distorts Prescription Drugs’ Benefits and Costs - AAFP
How the AMA Meets Need for New Telehealth CPT Codes | American Medical Association
Telehealth is safe—for now. It’s been extended until at least April, or whenever the latest continuing resolution runs out. (We’re still no closer to actual legislation defining telehealth services and reimbursement.)
In the meantime, CMS has expanded coverage for additional reimbursable items and is maintaining the suspension of frequency limitations. They’ve also officially defined phone calls under telehealth:
"Interactive telecommunication system” will now permanently include two-way, real-time audio-only communication technology for any Medicare telehealth service furnished to a beneficiary…”
Basically, for when you just can’t get people to hop on a Zoom call. 😄
Oh, and expect new CPT codes in the EHR soon!
How the AMA Meets Need for New Telehealth CPT Codes - AMA
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