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This Week in Managed Care: April 13, 2018

This week, the top managed care stories included President Donald Trump signing an executive order requiring the poor to get jobs or lose food and healthcare benefits; a CMS report found ethnic, racial, and gender disparities in Medicare Advantage plans; CDC highlighted the impact of HIV on America's youth.


The Trump administration adds new requirements for benefit programs, CMS highlights disparities in Medicare Advantage, and Sanofi offers new insulin discounts.

Welcome to This Week in Managed Care, I’m Laura Joszt.

New Executive Order

President Donald Trump this week signed an executive order to force the poor to get jobs or lose food and healthcare benefits.

HHS has allowed several states to add work requirements for those on Medicaid, and the Agriculture Department is pressuring states to do the same for those in the Supplemental Nutrition Assistance Program, formerly known as food stamps.

The order comes as CMS’ Seema Verma gave states new powers to undo a key piece of the Affordable Care Act.  This week, CMS said individuals who oppose abortion can claim a hardship exemption to avoid the individual mandate, if the only ACA plan offered in their county covers abortion.

Verma also finalized a rule to give the states the ability to narrow coverage under essential health benefits and cut back on the navigator program, ending the requirement that at least one provider be a consumer group based in the area.

Read more about the executive order.

Read more about Verma's rule.

MA Disparities

Seniors enrolled in Medicare Advantage are increasingly diverse, and their quality of care varies by race, ethnicity, and gender. That’s what CMS found in a report that examined 27 clinical care and 8 patient experience measures.

Today, 13% of Medicare Advantage beneficiaries are Hispanic, 10.4% are black, and 4.1% are Asian. About 56% are women.

Hispanics received worse care than whites for 11 of 27 areas, including:
  • Diabetes
  • Controlling blood pressure
  • Receiving a beta blocker after a heart attack
  • Management of COPD exacerbation
  • Initiation of treatment for alcohol or drug use
  • Avoiding drug-disease interactions in the elderly


Blacks received worse clinical care than whites on 8 measures, including:
  • Diabetes
  • Controlling blood pressure
  • Receiving a beta blocker after a heart attack
  • Avoiding drug–disease interactions in the elderly
  • Antidepressant management
  • Follow-up after a hospital stay for mental illness
Hispanic and black beneficiaries both reported worse patient experiences than whites, and Hispanics reported worse experiences on more measures.

Read more

Insulin Discount Program

Sanofi has announced an insulin discount program for people with diabetes who are uninsured or have high-deductible health plans.

The plan covers insulin glargine, a basal insulin sold as Lantus, and a new insulin lispro injection sold as Admelog, a new “follow-on” product that is a meal-time insulin that will compete with Eli Lilly’s Humalog. Total out-of-pocket costs will be $99 a vial or $149 for a box of 5 three millileter pens.

A company statement said the program is open to all non-federally insured patients, regardless of insurance status or plan design. The offer comes in response to the uproar over high insulin costs, which caused the 3 largest insulin manufacturers to be sued for racketeering.

Learn more.

National Youth HIV and AIDS Awareness Day

Tuesday marked National Youth HIV and AIDS Awareness Day, and CDC highlighted the impact the disease has on younger patients, with other groups calling for more education, resources, and research.

In 2015, 22% of all those newly diagnosed with HIV in the United States were between 13 and 24 years old, with most of them gay or bisexual men.

CDC reported that young black or Hispanic gay and bisexual men are at particularly high risk for HIV. But between 2008 and 2014, HIV infections fell 18 percent among gay and bisexual men. However HIV education dropped over this period—from 2000 to 2014, the share of US schools that required it fell from 64 percent to 41 percent. Only a fifth of male students who have sex with other males have been tested for HIV.

Read more.

Institute for Value-Based Medicine

Implementing the Oncology Care Model means engaging every stakeholder—but most of all the patients. That’s what experts shared last week in Orlando, Florida, at the first session of AJMC®’s Institute for Value-Based Medicine. Experts from Florida Cancer Specialists, Tennessee Oncology, and Southern Oncology Specialists brought insights from providers, pharmacy, and care management.

Read coverage of the session.

For all of us at the Managed Markets News Network, I’m Laura Joszt. Thanks for joining us.

 
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