• Center on Health Equity and Access
  • Clinical
  • Health Care Cost
  • Health Care Delivery
  • Insurance
  • Policy
  • Technology
  • Value-Based Care

This Week in Managed Care: April 12, 2019


This week, the top managed care news included CDC clarifying its opioid guidelines for chronic pain; pharmacy benefit managers testifying before a Senate committee; Sanofi expanding its insulin savings program starting in June.

CDC clarifies its opioid guidelines, pharmacy benefit manager (PBM) executives take their turn in front of a Senate committee, and Sanofi extends its insulin savings program.

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

CDC Clarifies Opioid Guidelines for Chronic Pain

Oncologists and hematologists praised a clarification from the CDC about the use of opioid pain medication for cancer patients and survivors, as well as those sickle cell disease. The clarification comes after physicians reported that payers were not properly interpreting 2016 guidelines from the CDC, which were designed to prevent primary care physicians from improperly using opioids for temporary conditions.

This week, the American Society of Clinical Oncology, the American Society of Hematology, and the National Comprehensive Cancer Network released a letter from CDC that responded to concerns the groups raised over the past year.

The February letter from the groups stated: “Although the CDC guideline clearly states that the guideline is not intended to apply to this population, many payers are still inaccurately applying the CDC guidelines to patients in active [cancer] treatment for coverage determinations relating to opioids.”

The 2016 guideline was developed in response to the dramatic rise in opioid-related deaths over the past decade.

For more, visit ajmc.com.

PBM Executives Testify Before Congress

Committees in Congress have recently heard from patients affected by high drug prices and from drug company executives. On Tuesday, the pharmacy benefit managers had their turn before the Senate Finance Committee.

Chairman Chuck Grassley, R-Iowa, and Ranking member Ron Wyden, D-Oregon, gave the PBM leaders a bipartisan grilling on whether high-cost therapies with rebates have any value or simply drive up the overall cost of prescription drugs. Said Wyden, “Whether pharmacy benefit managers bring any real value to taxpayers is a mystery.”

Steve Miller, MD, executive vice president and chief clinical officer of Cigna, which owns Express Scripts, said 90% of prescriptions that PBMs fill are generics, and rebates only apply in specific cases.

PBMs placed the blame on behaviors from drug companies, such as extending patents. Said Derica Rice, executive vice president of CVS Health and president of CVS Caremark, “When we have competition, we can bring down drug prices.”

The Trump administration has discussed ending rebates in Medicare Part D. PBM leaders at the hearing said they are willing to share more information about rebates with the committee as long as competitive information does not become public.

For more, visit ajmc.com.

Sanofi Offer Sets Monthly Price of $99 for Insulin Supply

The cost of insulin has been one of Grassley’s top targets, and this week Sanofi said it will expand its insulin savings program starting in June.

The company announced this week that it is expanding its Insulins Valyou Savings Program so that people with diabetes can pay $99 for either 10 boxes of insulin pens or ten 10-mililiter of insulin vials per month.

A year ago, Sanofi launched the Insulins Valyou Savings Program, which let patients pay cash for set prices of $99 for one 10-mililiter vial or $149 for a box of pens. Company officials said that program has saved patients $10 million.

Said Michele Carnahan, Head of North America Primary Care at Sanofi: “By giving those who require both long-acting and/or mealtime insulins or use more than one box of pens or one vial per month access to their insulins for one flat price, we aim to help limit the burden on the individuals who have high out-of-pocket costs at the pharmacy counter.”

Doctors More Likely to Overprescribe Antibiotics During Telemedicine Visits

Doctors are more likely to overprescribe antibiotics for children during a telemedicine visit, a new study has found. While telemedicine can increase access to care, the new study in the journal Pediatrics found some drawbacks. Children with respiratory infections are more likely to receive antibiotics and less likely to receive evidence-based antibiotic management during telemedicine visits compared with primary care or urgent care visits.

Despite the expansion of telemedicine, the American Academy of Pediatrics advises against its use in this type of acute pediatric care due to concerns over limited physical examination capabilities and a lack of access to patient records.

Said lead author Kristin Ray, MD, MS, pediatrician, Division of General Academic Pediatrics, UPMC Children’s Hospital, and lead author of the study: “As a general pediatrician, I’m interested in making care easier and less burdensome for families, and I think there are many technological innovations that aim to do this, but I think it also is important to make sure the quality of the care that children receive remains high.”

Institute for Value-Based Medicine Coming to California

Finally, join us April 17 at the Loews Santa Monica Beach Hotel for a gathering of the Institute for Value-Based Medicine, “Diabetes Management: Advances in Treatment and Management to Reduce Cost and Improve Outcomes.”

Peter Butler, MD, professor of medicine at the David Geffen School of Medicine at UCLA and director of the Larry L. Hillblom Islet Research Center, will serve as chairman and moderator, and he will be joined by panelists:

  • Anne Peters, MD, director, USC Clinical Diabetes Program, and professor of clinical medicine, Keck School of Medicine of USC
  • Karol Watson, MD, PhD, professor of medicine/cardiology, David Geffen School of Medicine at UCLA
  • Sachin Jain, MD, MBA, president and chief executive officer, CareMore Health

For information and to register, visit ajmc.com.

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

Related Videos
Chase D. Hendrickson, MD, MPH
Steven Coca, MD, MS, Icahn School of Medicine, Mount Sinai
Matthew Crowley, MD, MHS, associate professor of medicine, Duke University School of Medicine.
Susan Spratt, MD, senior medical director, Duke Population Health Management Office, associate professor of medicine, division of Endocrinology, Metabolism, and Nutrition,
Stephen Nicholls, MD, Monash University and Victorian Heart Hospital
Amal Agarwal, DO, MBA
Dr Robert Groves
Dr Robert Groves
Jeremy Wigginton, MD
Related Content
© 2023 MJH Life Sciences
All rights reserved.