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This Week in Managed Care: April 2, 2021


This week, the top news in managed care included COVID-19 cases surging as vaccine eligibility expands nationwide; Senate bill seeks to limit use of step therapy in employer health plans; a look into local and global awareness of the ongoing HIV/AIDS epidemic.

COVID-19 cases surge as vaccine eligibility expands nationwide, Senate bill seeks to limit use of step therapy in employer health plans, and a look into local and global awareness of the ongoing HIV/AIDS epidemic.

Welcome to This Week in Managed Care, I’m Matthew Gavidia.

Biden Admin Urges Preventive Action Amid Signs of COVID-19 Surge; States Open Vaccines to All Adults

This week, President Joe Biden and top health officials urged states to reinstate mask mandates and pause reopening plans amid surges of COVID-19 cases across the country.

Although far below the levels seen in December and January, average daily cases are up about 15% from 2 weeks ago, amounting to approximately 63,000 new cases each day, with rates of hospital admissions and currently hospitalized patients also growing by 4%.

“A lot of states and cities are pulling back on mask mandates. And what we're really trying to say is just hang on a bit longer,” said President Biden’s chief medical adviser Anthony Fauci, MD, in a statement to POLITICO. “The more you hang on, and don't just throw caution to the wind, the better chance there is of preventing a surge of cases.”

As the Biden administration pleads for patience, several states have already expanded eligibility for the vaccine to all adults this week, and the president noted that access to vaccines will open to roughly 90% of all Americans within the next 3 weeks.

COVID-19 vaccine hesitancy has been shown to be dropping nationwide, with the most positive change in the past month seen among Black Americans, whose polled rate of vaccination or intention to be vaccinated grew by 14 percentage points, according to Kaiser Health News.

RWE Shows Pfizer, Moderna Vaccines Highly Effective; COVID-19 Vaccine in Adolescents

Real-world study findings by the CDC indicate that the mRNA COVID-19 vaccines developed by Pfizer/BioNTech and Moderna are 90% effective in preventing infection.

Moreover, the Pfizer/BioNTech vaccine may prove effective for adolescents aged 12 to 15 years old as trial data, which have yet to be peer reviewed, shows higher antibody responses vs 16-to-25-year-olds from a previous trial, as well as no infections or serious adverse effects among participants.

Currently, even with 16% of adults fully vaccinated, experts warn that herd immunity will not be possible without inoculating children.

For more, visit AJMC.com.

Leveraging Health Data and AI to Predict COVID-19 Hotspots

Early on in the pandemic, having the ability to predict where outbreaks were going to take place could have proved vital in curbing spread across the nation’s most vulnerable communities.

In this week’s episode of Managed Care Cast, we speak with Nicole Neumarker, the executive vice president of development and innovation at Cotiviti, which recently developed a COVID-19 tracker map using big data models and artificial intelligence technologies that can accurately predict where in the United States new COVID-19 outbreaks would occur and show the relative risk of infection for people with underlying health conditions.

Having shared Cotiviti’s tracker map results at the 2021 AcademyHealth National Health Policy Conference, Nicole provides insight into what impact this technology could have in the future.

For the podcast, visit AJMC.com.

Senate Bill Seeks to Limit Use of Step Therapy in Employer Health Plans

Although utilized by payers in an effort to control skyrocketing drug costs, step therapy, along with prior authorization and formulary lists, has been cited by patient groups and providers to delay care prescribed by a physician.

Seeking to address these concerns, bipartisan legislation introduced in March in the Senate would create 5 situations where a patient would be exempted from step therapy in employer-sponsored health plans.

The Safe Step Act, sponsored by Senator Lisa Murkowski and 13 others, 5 Republicans and 8 Democrats, spells out 5 exemptions for patients by amending the Employee Retirement Income Security Act of 1974.

“Ensuring timely access to clinically appropriate treatment is critical to the well-being of millions of Americans living with rheumatic diseases,” said Blair Solow, MD, a practicing rheumatologist and chair of the Government Affairs Committee of the American College of Rheumatology, or ACR. “The Safe Step Act would put reasonable limits on insurers’ use of step therapy and create a clear and transparent process for patients and physicians to seek exceptions.”

Through the bill, plans would be required to respond to all exception requests within 72 hours, or 24 hours if the patient’s life is at risk.

The ACR said a version of the bill is planned to be reintroduced in the House of Representatives by Raul Ruiz, MD, and Brad Wenstrup, DPM, the 2 lawmaker-doctors who previously introduced the legislation in 2019.

For more, visit AJMC.com.

CeSHHAR Working to Improve HIV Service Uptake, Self-testing in Zimbabwe

As the first of a 6-part series on individuals and international organizations working to bring local and global awareness to the ongoing HIV/AIDS epidemic, The American Journal of Managed Care® spoke with Frances Cowan, MD, MSc, MRCP, MBBS, executive director of the Centre for Sexual Health and HIV/AIDS Research Zimbabwe, or CeSHHAR.

Founded in 2012 and headquartered in Harare, Zimbabwe, CeSHHAR conducts evidence-based research related to HIV/AIDS, its prevention, and policy making, as well as provides and implements sexual and reproductive health education and interventions in several key research streams: sex workers, masculinity, and children and adolescents.

“One of the things that we have been able to do with HIV is develop so many models of care that can be translated to improve other health conditions. We really have learned how to go after ensuring that people are screened for HIV, ensuring those who are screened positive get on treatments, and ensuring those who are on treatment stay on treatment,” said Cowan, who is also a professor of global health at the Liverpool School of Tropical Medicine.

In the interview, Cowan speaks further on CeSHHAR’s history, its programs, and continuing to make inroads against this 4-decades-old pandemic.

For more, visit AJMC.com.

2021 Community Oncology Virtual Conference

Next week, the Community Oncology Alliance, or COA, will present their 2021 Community Oncology Conference in a virtual format.

In a series of previews for the virtual meeting, we spoke with Jeff Patton, MD, the chief executive officer of OneOncology and chairman of the board for Tennessee Oncology, who will serve as co-chair for this year’s conference, and Ted Okon, executive director for COA, who will moderate several discussions regarding legislation in cancer care, with many more interviews set to be released leading up to the conference!

AJMC.com will bring you full coverage of the virtual meeting, which will take place from April 8-9.

For full conference coverage, visit AJMC.com.

For all of us at AJMC®, I’m Matthew Gavidia. Thanks for joining us!

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