This Week in Managed Care: December 15, 2017

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This week, the top managed care news included coverage from the 59th American Society of Hematology Annual Meeting and Exposition; recommendations on the use of diabetes drugs with cardiovascular indications; and a new study found that despite changes in insurance plans to give consumers more clout, unnecessary medical spending remains a problem.


ACA open enrollment ends in many states, more promising results are seen with CAR T treatments, and the American Diabetes Association recommends drugs with cardiovascular indications.

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

ACA Sign-Up Deadline

Today is the deadline in most states for enrolling in health coverage for 2018 through the Affordable Care Act (ACA).

While CMS shortened the open enrollment period to prevent people from waiting until they were sick to buy coverage, there are 2 types of special enrollment periods for 2018 that may have an impact on sign-ups.

The first affects those whose plan is discontinued for next year, and the second affects people who were affected by hurricanes in Texas, Florida, and Puerto Rico.

Policy analyst Shelby Gonzales told Kaiser Health News she worries some consumers will not know how to activate special enrollment periods. “The bottom line here is many consumers experienced a discontinuation of their plan this year. Notices are complicated, and these consumers, in particular, are going to get several notices which may result in more confusion.”

CAR T at the ASH Annual Meeting

Updates in CAR T-cell treatments were big news at the 59th American Society of Hematology Annual Meeting and Exposition in Atlanta.

Results from the JULIET trial, which involved Kymriah in patients with diffuse large B-cell lymphoma, achieved a 53 percent overall response rate in 81 infused patients, including a 40 percent complete response at three or more months of follow-up.

Results for patients in the ZUMA-1 trial, involving patients with refractory, aggressive non-Hodgkin lymphoma, showed a 42% ongoing response with Yescarta.

Kymriah, 1 of the 2 FDA-approved CAR T-cell treatments, may have new uses in the future, according to Stephen Schuster, MD, of Penn Medicine. Watch the interview.

Read the full coverage of the meeting of the American Society of Hematology.

Diabetes Drugs Recommendations

More than 2 years after the first trial showed that a diabetes drug could prevent cardiovascular deaths, the American Diabetes Association has included recommendations on this use.

The 2018 Standards of Diabetes Care contain specific recommendations for using liraglutide, empagliflozin and canagliflozin to reduce cardiovascular risk for patients with diabetes and a history of heart disease.

The Standards also include new recommendations on the following:

  • Use of CGM
  • Lipid management
  • Screening for diabetes in teens
  • Personalization of care for older adults

However, the ADA did not follow the recent recommendation from the American Heart Association and the American College of Cardiology to lower the threshold for high blood pressure for people with diabetes.

Read more.

Switching to a Consumer-Directed Plan

Finally, a new study in The American Journal of Managed Care® finds that despite changes in insurance plans to give consumers more clout, unnecessary medical spending remains a problem.

The study, by researchers from the USC Schaeffer Center and the RAND Corporation, found that consumer-directed health plans had little or no effect on curbing spending on 26 specific services that health industry groups called “low value.”

Said study author Neeraj Sood, PhD, of the USC Price School of Public Policy, “Consumer-directed health plans are a type of high-deductible plan that was basically created to save money and encourage consumers to spend less on healthcare. But we can't find any impact from these plans on spending for low-value services that provide unclear or no clinical benefit to patients.”

Read the full study.

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