This Week in Managed Care: December 12, 2015

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This week in managed care, an analysis found the penalty for being uninsured will exceed the cost of insurance for most Americans in 2016, thousands met for the annual meeting of the American Society of Hematology, and Horizon Blue Cross Blue Shield's OMNIA plan gets good news and bad news in New Jersey.


Hello, I’m Justin Gallagher, associate publisher of The American Journal of Managed Care.

Welcome to This Week in Managed Care, from the Managed Markets News Network.

Uninsured Penalty

Starting in 2016, it looks like we will reach a tipping point when it won’t make sense to pay the tax for not being insured. According to an analysis from the Kaiser Family Foundation, for most Americans, buying the least expensive health plan on the federal marketplace exchange will cost less than the tax, which will cost $969 on average for those still without health coverage.

Rates of uninsured Americans have dropped dramatically since 2013, from just over 17 percent to 11.7 percent, but rates vary by state. To learn more about the differences across the country, read our story.

ASH Annual Meeting

This week, thousands of scientists and clinicians gathered in Orlando, Florida, for the 57th Annual Meeting of the American Society of Hematology.

As always, the FDA update was a highlight of the meeting, but this year’s news was especially exciting, with three new therapies for multiple myeloma approved just weeks before the conference. Two monoclonal antibodies—daratumumab and elotuzumab—and ixazomib, an oral protease inhibitor, were all approved this November.

Said moderator Dr Vincent Rajkumar of the Mayo Clinic, “Things have moved very well, and most of this is because we now have a plethora of new drugs to support care pathways.”

For complete coverage of ASH 2015, visit our conference page.

Enrolling in Clinical Trials

Of course, one of the challenges of bringing new therapies to market is the difficulty of finding the right patients to enroll in clinical trials.

Recently, Dr Robert Green, vice president of clinical strategy at Flatiron Health, spoke with AJMC about using electronic medical records to find patients who could benefit from taking part in a trial. Watch the video.

Tiered Network Controversy

This week, Horizon Blue Cross Blue Shield of New Jersey received both good news and bad news on its effort to get its OMNIA health plan to customers.

An appeals court denied a request to stop enrollment in the plan, and the court battle now appears headed to New Jersey’s Supreme Court. Meanwhile, 2 senators introduced four bills that would overhaul how tiered plans are created, including one that would put the brakes on OMNIA for a year.

So far, AJMC has not found another state in the country that has taken such far reaching steps to rein in tiered networks. In an exclusive, a spokesman for America’s Health Insurance Plans told AJMC: “This approach will have the harmful effect of stifling innovation and options for consumers, limiting choice, flexibility, and preventing health plans from finding additional ways to make health insurance more affordable for consumers.”

Top Healthcare News in 2015

What do YOU think is the top healthcare story of 2015? High drug prices? The ruling in King v. Burwell? Maybe the end of the Sustainable Growth Rate formula?

You can find those choices and other on our website through next week. Cast your vote, and look for our story during the holidays to learn whether your favorite is our readers’ choice for the year.

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