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This Week in Managed Care: December 22, 2017


This week, the top managed care stories included the elimination of the Affordable Care Act's individual mandate; a new gene therapy for inherited vision loss that could cost $1 million; and a study found that social isolation can increase the risk of type 2 diabetes.

The tax plan ends the individual mandate, a new cure for blindness could cost a million dollars, and a study finds that being isolated can put you at risk for type 2 diabetes

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

Goodbye, Individual Mandate

Americans will no longer be required to buy health coverage under the tax plan that Congress passed this week.

The individual mandate, one of the core elements of the Affordable Care Act, put penalties on those who did not buy coverage to ensure that the risk pool included enough young, healthy Americans.

Experts have predicted that premiums on the individual market could rise up to 10% once the mandate is removed, putting coverage out of reach for some. Members of both parties said removing the individual mandate would force discussions about the rest of the ACA.

Said Senator Lindsey Graham, R-South Carolina, “I think we're all going to say that we ripped the heart out of Obamacare with the individual mandate. It's pretty hard to rip the heart out of it and not replace it.”

$1 Million Gene Therapy

The FDA this week approved the first gene therapy for inherited vision loss caused by faulty gene mutations, but it will likely come at high price.

Spark Therapeutics’ Luxturna is approved for both pediatric and adult patients with a form of retinal dystrophy that can lead to total blindness.

While a price has not been announced, the company’s CEO has said it could cost one million dollars per patient, based on what curing blindness might mean in direct and indirect costs for patients and their families.

However, the Institute for Clinical and Economic Review found that the therapy should cost between $231,000 and $573,200.

Read the full story.

Pharma Spending

A year after both presidential candidates talked about reining in drug prices, the pharmaceutical industry spent $7 million on a campaign to draw attention to groundbreaking work on fighting diseases.

According to Kaiser Health News, the Pharmaceutical Research and Manufacturers of America, or PhRMA, also contributed heavily to individual candidates and to both the Republican and Democratic Governors’ associations, which each received more than $300,000.

Advocacy groups that received funds included the American Lung Association, the Lupus Foundation of American and the Juvenile Diabetes Research Foundation, known as JDRF. In the past year, the three major insulin manufacturers have been sued over high prices in a class action lawsuit.

Social Connections and Type 2 Diabetes Risk

A new study finds there’s a direct relationship between the size of a person’s social network and the chance that person will develop type 2 diabetes.

The study in BMC Public Health is not the first to connect social isolation and chronic disease, but researchers who questioned nearly 3000 participants in the Maastricht Study pinned down factors that contribute to the development of diabetes and how men and women respond differently.

Among the findings:

  • Having friends within walking distance is especially important for women in avoiding diabetes.
  • A social network that includes friends helps more than one with lots of family members.
  • Men who live alone are at especially high risk of diabetes.

The lead author said health systems could look at helping at-risk patients improving their social connections as a low-cost way to prevent diabetes. She wrote: “Socially isolated individuals could be encouraged to improve their lifestyle, for instance lose weight and become more physically active, in a setting that increases their social integration. Such interventions should enable extension and broadening of the social network, by supporting them to make new friends.”

Technology in Cancer Care

The new issue of Evidence-Based Oncology looks at the role of technology in cancer care—from its place in the clinic visit to its role in guiding care decisions.

The current issue covers:

  • How EHR documentation can help physicians but interfere with doctor-patient communication
  • How social media is changing the way patients are recruited for clinical trials
  • How technology is being used to track patient-reported outcomes in oncology

Check out the full issue.

Finally, your vote matters in picking the top managed care story of 2017. There’s no shortage of choices—so vote and look for this year’s winner.

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

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