This Week in Managed Care: December 8, 2017

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This week, the top managed care stories included CVS' proposal to purchase Aetna, which could reshape healthcare; a new study that looks at who is dying in hospitals from opioid use; and CMS reported that healthcare spending grew more slowly in 2016.


The CVS-Aetna deal could reshape healthcare, a new study looks at hospital deaths from opioids, and FDA is finishing 2017 with a flourish.

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

CVS—Aetna Merger

CVS Health announced Sunday it plans to buy Aetna for $69 billion, which would pair the health insurer with a giant drug chain and pharmacy benefit manager.

The deal could reshape the healthcare industry, but many experts believe the two giants came together out of fear that Amazon could start selling drugs online. The merger between players in different industries still has to be approved by the Justice Department, which previously blocked Aetna’s proposed merger with Humana, along with a merger of Anthem and Cigna.

Learn more.

Opioid Mortality

Who is dying in hospitals from opioids? Over the past 2 decades, the rate of deaths from people hospitalized for abusing these drugs has quadrupled, especially among older whites with low-incomes. That finding, reported this week in Health Affairs, comes after Dr. Zirui Song and his colleagues mined a national database of hospital inpatients to better understand the rising toll of the opioid epidemic.

In an interview with AJMC®, Song said the findings point to the need for more hospital personnel to respond to patients with severe opioid poisoning. “Currently, we have lots of awareness about the opioid epidemic—people treated at home and on the street are heavily attended to by emergency personnel.”

Song’s findings show that while hospital death rates from overdoses of other drugs are stable, deaths from opioids are stretching hospital personnel thin.

The study concluded: “Until community-based efforts to tackle opioid misuse have taken root, treating opioid addiction and better equipping hospitals to care for patients with increasingly severe opioid abuse may help the healthcare system combat the rising mortality rates of patients hospitalized for opioid use disorders.”

Song is a winner of the Seema Sonnad Emerging Leader in Managed Care Research Award from The American Journal of Managed Care®.

Check out the full interview.

Healthcare Spending Growth Slows

Healthcare spending grew at a slower pace in 2016, but still makes up a higher share of the economy than it did in 2015.

That’s what the CMS Office of the Actuary concluded in a report in Health Affairs, which found that healthcare spending grew 4.3% to $3.3 trillion last year, after rising above 5% in each of the 2 prior years.

The rate of spending was on par with healthcare spending in the years after 2008, when the nation was recovering from the recession. The actuary noted that by 2016, coverage expansions seen under the Affordable Care Act were largely complete.

However, the actuary also found that healthcare spending as a share of gross domestic product rose to 17.9%, up from 17.7% in 2015. Said Micah Hartman, a statistician with the office and lead author of the article, “In 2016, the slowdown in healthcare spending followed significant insurance coverage expansions under the ACA and very strong growth in retail prescription drug spending in 2014 and 2015.”

Read more about the report.

The Latest at FDA

FDA is busy as 2017 comes to a close, with approvals for new drugs and diagnostic tests and indications for existing ones.

Foundation Medicine received approval for FoundationOne CDx, a first-of-its-kind companion diagnostic test for solid tumors. The test works by examining all classes of genomic alterations in 324 genes known to cause cancer growth.

In addition, the test received a simultaneous decision for a National Coverage Determination from CMS, which means that Foundation Medicine will not have to seek separate approval from each Medicare region.

To treat breast and metastatic stomach cancer, Mylan and Biocon received FDA approval last Friday for Ogivri, a biosimilar for the top-selling cancer therapy trastuzumab, sold as Herceptin.

Said Mylan Chief Executive Heather Bresch, "The approval of Ogivri represents a monumental achievement for Mylan to increase patient access to biosimilars and deliver significant savings to the US healthcare system.”

That same day, Amgen received a new indication for Repatha, the PCSK9 inhibitor previously approved to lower low-density lipoprotein cholesterol in high-risk patients. Based on results of the FOURIER trial released earlier this year, Repatha is now approved to lower the risk of heart attacks, strokes, and coronary revascularization surgeries in patients with heart disease.

Finally, Novo Nordisk received approval for semaglutide, to be sold as Ozempic, for the treatment of type 2 diabetes. The GLP-1 receptor agonist outperformed its competitor, Eli Lilly’s Trulicity, in a head-to-head trial earlier this year, and it comes to the market with cardiovascular results already in hand.

ASH Annual Meeting

AJMC® will be on the road again this weekend, as we bring you coverage of the 59th annual meeting of the American Society of Hematology from Atlanta, Georgia.

There’s still time to sign up for our conference coverage e-mails, and you can follow us on Twitter, too.

Visit the conference page to see the latest coverage.

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

Thanks for joining us.