This Week in Managed Care: April 30, 2016

This week in managed care included takeaways from the annual meeting of AMCP, the Supreme Court hears arguments regarding drug patent review, and CMS updates Medicaid managed care rules.

Hello, I’m Brian Haug, president of The American Journal of Managed Care. Welcome to This Week in Managed Care, from the Managed Markets News Network.

AMCP Annual Meeting Takeaways

Drug costs, biosimilars, and technology took center stage at the AMCP Managed Care and Specialty Pharmacy Annual Meeting, which took place in San Francisco last week. Our top 5 takeaways from the meeting:

  • Biosimilars are generating excitement
  • Cost remains top of mind
  • Patient demands are driving digital solutions
  • More breakthrough therapies and orphan drugs are expected
  • And the opioid epidemic is real

During the meeting, AJMC spoke with Dr Kelly Clark, president-elect of the American Society of Addiction Medicine, about the scope of the opioid epidemic. Watch the video interview.

For full coverage of the AMCP meeting, visit the conference page at

SCOTUS Hears Patent Arguments

A case heard before the US Supreme Court this week could have fallout for drug makers and consumers. The case concerns new rules for reviewing drug patents, which the drug industry is challenging. A lower court ruled in favor of the Obama Administration, and the 4 liberal justices—along with Justice Anthony Kennedy—sounded skeptical about the industry’s position during oral arguments Monday.

With the vacancy on the court due to the death of Justice Antonin Scalia, a tie would uphold the lower court, leaving the administration’s rules intact.

Updated Medicaid Managed Care Rule

This week, CMS finalized a long-awaited rule for Medicaid managed care and the Children’s Health Insurance Program. It’s the first time these rules have been updated in more than a decade, and the changes reflect the explosive growth in Medicaid that has come with the Affordable Care Act.

The final rule will allow for the first-ever public rating system of healthcare quality in Medicaid managed care, greater use of electronic notices for consumers, and more alignment between Medicare Advantage and the Medicaid programs on the federal marketplaces. The most controversial element is a medical loss ratio of 85%—which critics say will disrupt successful programs in some states.

Today, two-thirds of the 72 million Americans in Medicaid are enrolled in a private managed care plan, according to CMS Administrator Andy Slavitt. He said the new rule will allow states to continue transforming the delivery of care.

Slavitt wrote this week: “States are making gains in using population-based payments, episodes of care, and quality based payments. In addition, states operate 30 home health programs that focus on coordinating care for people with chronic conditions like obesity, diabetes, and mental health conditions.”

Reducing Readmissions

Finally, research published this week in The American Journal of Managed Care shows the value of care coordination in a key group at risk for hospitalization: children in Medicaid who have type 1 diabetes.

Researchers used electronic health records from a group of children’s hospitals to analyze whether being in traditional Medicaid or managed care had an effect on 90-day readmission after a child with type 1 disease was admitted to the hospital, including those admitted for diabetes ketoacidosis, a common and very costly condition in this population.

They found that those in managed care were less likely to be readmitted overall, and the amount saved across 42 hospitals over a three-year period was 2.6 million dollars. Read the full study.

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

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