Welcome to the first UC Health Newsletter of 2025! We’re excited to kick off the year by sharing the highlights from our recent Town Hall and the bold plans shaping our future. 

A Transformative Year Ahead The healthcare industry is evolving rapidly, and 2025 promises to be a year of innovation and opportunity. At UC Health, we’re embracing these changes to improve care, drive groundbreaking research, and strengthen our communities. Rising drug costs, groundbreaking treatments for neurological conditions and rare diseases, and the integration of artificial intelligence are just a few of the challenges and opportunities we’ll tackle together. 

Our Vision in Action Our mission remains steadfast: to protect and improve the health of all Californians while setting a national and global example. Through our Strategic Framework, we’re focusing on key priorities: 

• Expanding access to quality, patient-centered care. 

• Building a diverse, interdisciplinary workforce. 

• Advancing health equity and strengthening community partnerships. 

• Driving innovation through translational research. 

• Ensuring fiscal resilience and operational excellence. 

Making It Personal This year, we’re committed to making an even greater impact—together. Our pharmacy team, for instance, is using cutting-edge tools to improve medication safety, streamline processes, and deliver better outcomes. Whether it’s through leveraging AI to reimagine care delivery or fostering collaboration across campuses, we’re creating a future where everyone thrives. 

Join Us on the Journey As we advance these initiatives, your voice and engagement are essential. Let’s make 2025 a year of collaboration and meaningful progress. Together, we can achieve remarkable things. 

Thank you for being part of UC Health’s journey. Stay tuned for updates and opportunities to contribute to our shared success. 

Here’s to a year of innovation, inspiration, and impact! 

Updated project pitch form is now available!  

This year, we launched an updated research and/or major project pitch form with the intention of creating a more streamlined and accessible mechanism to solicit collaboration on projects when desired. This initiative was designed to foster easier communication and engagement with teams across different UC sites, ensuring that potential projects can be explored efficiently. By simplifying this process, we anticipate several key benefits, including broader patient inclusion, more expansive eligibility criteria, and enhanced applicability of findings across diverse clinical settings. These advantages also enhance the likelihood of manuscript acceptance, aligning with our strategic priorities. The form is divided into two core components to facilitate a thorough yet focused project proposal process. First, the "Major Project/Research" section adheres to the major project definition outlined by ASHP and UC, requiring at least 100 hours of longitudinal resident work. This ensures that the proposed project is sufficiently comprehensive and impactful to justify the collaboration effort. Second, the "MUE Ideas" section is specifically aimed at projects intended to improve medication use processes, which is currently being utilized by institutions such as UCD, UCSD, and UCSF. These projects focus on optimizing the medication use process, ensuring better patient outcomes, and contributing to the advancement of clinical practice within our individual UC sites. Together, these two components of the form serve to align proposed projects with both institutional goals and wider healthcare improvement initiatives, offering a clear pathway for successful collaboration and impactful research outcomes. 

A link to the form can be found on https://uchealthpharmacy.org/projects-research or the announcements section of the UC Health Pharmacy SharePoint.  

Thank you to our Residency PCT Project subgroup for all their hard work on this initiative. Those members include Dexter Wimer (UCSF), Jeremiah Duby (UCD), Christopher Yamamoto (UCLA), Mira Bakas (UCI), Benjamin Lee (UCI), and Craig Stevens (UCSD).  

This section was created with the assistance of ChatGPT to generate sentence transitions and content continuity. 

First UC wide Pharmacy Policy Use of Externally Supplied Medications in UC Outpatient and Clinic Settingsgoes live, and the Retail Pharmacy Collaborative Team conducts large scale vaccine pilot. 

On January 4th, 2025 the Use of Externally Supplied Medications in UC Outpatient and Clinic Settings policy finished its yearslong process become a full policy. The policy had been an interim policy since 2020, but it had yet to go through a full UC wide review by our Schools of Medicine, Pharmacy and the UC Health Leadership and sites.  As part of the transition, the policy got a bit of a face-lift, adding in some exemptions and exceptions based on the practices of our clinics and pharmacies in the 4 years since the interim policy was implemented.  For example, when a patient receives medications through a patient assistance program directly from a manufacturer, that would be exempted from this policy since those drugs come in from a different pathway.  Additionally, there may be some exceptions needed from time to time based on shortages, etc., which are accounted for in the policy.  The policy is currently on the UCOP Policy website but will move to our new UC Health Pharmacy website shortly, and more work will be done to socialize the policy across the system and find ways to move currently externally supplied medications back into our approved distribution pathways.  

In other ambulatory care news, the Retail Pharmacy Collaborative Team (PCT) conducted a pilot to provide much needed vaccines to their patients in the Retail space.  UC Davis served as one of the sites of the pilot, and they were able to provide vaccinations to approximately 300 patients during the pilot project at one of their Retail Pharmacy sites.   The pharmacy team collected reimbursement data, patient satisfaction data, and lessons learned from the experience.  Overall, their pilot was a great success, with high patient satisfaction being a highlight of this new service, and they have hopes to expand their work to other UC Davis Retail Pharmacies soon, along with providing their pilot lessons learned as a roadmap for implementation of a full retail vaccination program to other UC Retail pharmacies within the UC system. More details to come! 

Congratulations to Kanika on her family expansion!  Kanika had a baby girl in December and will be out on leave for a few months.   

In her absence, we wanted to share a brief update on some of the great projects that Specialty is working on this year, and into the next year with our new Strategic Plan work.  First, the group is working on expanding the RAPID3 project.  RAPID3 is a score used to determine the severity of rheumatoid arthritis and helps determine if the patient’s medication is working appropriately.  Prior to their project, the RAPID3 score was only used when required by a payor for a prior auth, but since the team has begun their work, they have captured this score for about 1200 patients systemwide.  This work has highlighted the value of measuring data to improve care, and in the next year, this group will be working to improve this measure further by expanding it out to other patients within the system. 

In addition, the group will be working on a new patient scoring tool called POEM (Patient Oriented Eczema Measure) for 2025, with a similar process.  First, they will start by developing a Tableau dashboard at our Central Data Warehouse to determine our current state of measurement, then they will work to increase the capture rate of this score for our patients over time.   

Other Specialty teammates are working on improving their URAC accreditation, gaining access to more LDD drugs for their patients and improving sustainability by improving their packing process.  

IV Fluid Shortages, Plasma is Thicker than Water: A tale of betrayal, half-truths and triumph over adversity

In late September 2024, Hurricane Helene caused a nationwide shortage of intravenous (IV) fluids in the United States. The storm significantly damaged Baxter International's North Carolina facility, which produces about 60% of the country's IV fluids. This disruption overwhelmed an already stressed distribution network, resulting in a critical shortage of supplies, akin to trying to get water from a faucet when the pipes and reservoir are empty. 

During this period, UC was actively negotiating a long-term agreement for IV solutions, independent of Baxter. Historically, Baxter had been the largest supplier of IV solutions in the US, but their terms were not favorable to most customers. UC also had additional business concerns that needed to be addressed at the time that were unique. 

Hurricane Helene exacerbated these issues, halting Baxter's ability to supply any solutions within a reasonable timeframe. In response, the UC team and its campus partners swiftly secured an arrangement with ICU Medical. ICU Medical had already been considered a leading option for diversifying the solution supply chain in 2025 to reduce dependency on Baxter. 

With the new agreement in place, each campus quickly began restricting the use of IV solutions, changing policies, limiting products, and utilizing pre-made solutions. We coordinated directly with ICU Medical for ordering all IV products, working closely with the supply chain. The agreement is staged to meet our total needs by mid-2025, transitioning from direct orders at the beginning of 2025. This includes Medline and Cencora stocking our allocations for ordering. 

While Baxter claims to be operating at 100%, neither we nor the distributors have seen significant inventory replenishment. Even with ICU Medical's support, challenges remain with certain products like ACD, dialysis solutions, and small volume bags. However, our immediate action and coordinated efforts have placed us in a better position than most facilities.

How are UCs navigating the challenges of 340B HRSA audits, 340B rebate shifts, and Medi-Cal underpayments? From compliance triumphs to potential multi-million-dollar impacts, these critical updates reveal the high stakes in the evolving 340B landscape. Stay ahead of the curve and learn how these changes could reshape the future of the 340B program. 

HRSA Audits: UCI and UCD Preparedness In late 2024, UCI and UCD underwent comprehensive HRSA audits that tested their 340B compliance. Both audits followed a rigorous methodology, including the review of 60 samples, site visits, and interviews with key staff. A notable focus was on Medi-Cal enrollment forms for child sites without UB-04 billing, a shift from previous audits. Despite this unexpected scrutiny, both campuses provided the necessary documentation, ensuring no duplicate discounts were identified. The final audit reports are expected within 6-12 months, based on historical timelines. 

The Shift to 340B Rebate Models Major drug manufacturers are driving a pivotal change by proposing a rebate model for 340B drugs. Four manufacturers (BMS, Eli Lilly, J&J and Sanofi) filed lawsuits to shift to a 340B rebate model. Historically, manufacturers have offered upfront discounts but the new model mandates submitting claims data to third-party platforms like Beacon or Kalderos to secure rebates. The financial implications are significant, with UC Health anticipating a $148 million impact. Of this, $42 million is tied to contract pharmacy claims where rebates will be permanently denied. Sharing claims data could mitigate $106 million, but stringent eligibility checks may still result in denied rebates. Outcomes from these lawsuits have the potential to change 340B forever. 

Addressing DHCS Underpayments A 2021 DHCS self-audit letter required California’s 340B entities to repay overpayments. UC Health entities repaid more than $5 million in 2022. Follow-up audits revealed $1.6 million in underpayments for UCSD and $944k for UCD. Kelsey Bagheri (Principal Counsel at UCOP) reviewed the Medi-Cal statute and found language that allowed these underpayments to offset additional overpayments, saving UCs approximately $2.5 million. This outcome underscores the value of vigilance in identifying and applying regulatory opportunities. 

New employee health plan design will place more focus on UC Health pharmacies by driving more patients to specialty pharmacies with higher quality scores and outcomes.  

About Pharmacy Networks Pharmacy networks are a list of pharmacies that members can go to in order to fill their medications.  Larger networks are usually more expensive for both patients and plans.  By limiting the network cost generally will go down and quality metrics will be higher 

UC Blue and Gold Network changes slated for 2025 will drive additional value into UC pharmacies by aligning patients with better clinical management.  During the calendar year, the Blue and Gold network design will be changed from an open network design to a more closed design.  This change will limit the number of specialty pharmacies that can fill prescriptions for UC employees.  Changing the network design will not change the member out of pocket costs in any way.  Currently there is over $30M of specialty spend going through a variety of pharmacies, by limiting the network UC is committed to helping patients find the highest quality of care at the best price.  Over the long run, this network change will result in lower cost of care and higher quality for members.  A network change will allow UC to better track members and their outcomes.  This change will ensure that members get appropriate care and reduce waste on unnecessary prescriptions.  Analysis is underway to identify the list of drugs and list of pharmacies that will be in the final network solution, but this change will be implemented by 7/1/25 at the latest.