This Week in Managed Care: December 5, 2015

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This week in managed care, an exclusive report on how Horizon Blue Cross Blue Shield of New Jersey's OMNIA plan will affect maternity patterns; a Senate investigation found Gilead Sciences knew its Sovaldi price was high; and World AIDS Day observes the progress made.


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.

OMNIA Under Fire

An exclusive report from The American Journal of Managed Care has revealed that Horizon Blue Cross Blue Shield of New Jersey’s population health initiative could have consequences for the state’s expectant mothers.

OMNIA, the insurer’s tiered network, has excluded 2 of the state’s busiest maternity hospitals from Tier 1, making them more expensive and less attractive options for expectant mothers. Already, OMNIA is disrupting physician relationships with patients as pregnant women are redirected to hospitals included on Tier 1, according to Saint Peter’s University Hospital.

Since it was announced in September, OMNIA has drawn resistance from urban mayors and legislators and is the target of 2 separate lawsuits.

To learn more, read the full story.

Hepatitis C Price Controversy

A US Senate committee report released this week found that Gilead Sciences knew its price for Sovaldi would cause payers to restrict patient access to the treatment and would present challenges for government health programs.

Approximately one-fourth of patients are initially denied life-saving hepatitis C drugs in an attempt to keep costs down, according to a Yale University study, and Blue Cross of California recently became the target of a lawsuit for limiting access to treatment to only the sickest patients.

Dr Scott Gottleib, with the American Enterprise Institute, explained that policy actions that bring more competition to the market could help curb the costs of these drugs. Watch the video.

World AIDS Day

This week, as the world observed World AIDS Day, the National Institute of Allergy and Infectious Disease released a commentary that called for the broader use of anti-retroviral therapy for prevention, not just treatment, of AIDS.

Drs Anthony Fauci and Hilary Marston reviewed the results of 3 key trials and found that early use of anti-retroviral therapy reduced HIV transmission and decreased the likelihood of patients developing other serious illnesses.

In the article, published in New England Journal of Medicine, Drs Fauci and Marston wrote, “Taken together, these studies provide an evidence-based blueprint for effective treatment and prevention of HIV infection and will serve as critical tools in the fight to end the HIV-AIDS pandemic.”

Diabetes Cases on Decline

Finally, the CDC released data that show a measurable drop in new diabetes cases for the first time in a generation. In 2014, there were 1.4 million new cases compared with 1.7 million cases reported in 2008.

However experts are unsure what is causing the decline: healthier eating and more exercising or if the disease has simply peaked.

Patient-Centered Diabetes Care

To learn more about diabetes and its treatment, register now to attend Patient-Centered Diabetes Care 2016, which will be held April 7 and 8 in Teaneck, NJ. The event offers unique perspectives on emerging topics in diabetes care from today's leading health experts. Register and learn more.

During the 2015 meeting, Dr Robert Gabbay, chief medical officer of Joslin Diabetes Center, explained the importance of attending. Watch the video.

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