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This Week in Managed Care: February 15, 2019


This week, the top managed care news included increased demand for long-acting contraception since President Trump took office; a payer decision on an insulin pump alarmed diabetes advocates; and despite being involved in cancer treatment decisions, many primary care providers don't feel prepared to do so.

Demand is up for long-acting birth control, a payer decision on insulin pump technology alarms diabetes advocates, and a study finds some primary care doctors lack comfort making cancer decisions.

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

Demand for Long-acting Contraception

Donald Trump’s election as president sparked a jump in demand for long-acting reversible methods of contraception. That’s the finding reported last week in JAMA Internal Medicine. Researchers at Harvard examined claims data for women aged 39 to 45 from a year before the election and immediately afterward. They found that after November 8, 2016, the jump in long-acting methods equaled 700 more insertions per day.

Said Lydia Pace, MD, MPH, of Harvard Medical School and Brigham and Women’s Hospital, “Our report tells us something about women’s health preferences in a changing political climate. Women responded to this political event by seeking out this method of contraception, perhaps because the threat of losing access expedited a decision or encouraged them to seek a method they previously hadn’t considered.”

Since the time frame captured in the study, the Trump administration has issued rules that would make it easier for some employers to exclude birth control from health plans. Two federal judges have blocked those rules in court.

For more visit ajmc.com.

Medtronic for Youth With Type 1 Diabetes

In 2016, United Healthcare created an uproar among advocates for those with type 1 diabetes when it made Medtronic its preferred provider of continuous glucose monitoring technology. Now, advocates led by JDRF are protesting UnitedHealthcare’s decision to extend that policy to youths as young as 7 years old.

A UnitedHealthcare spokeswoman said patient safety and avoiding high and low levels of blood sugar prompted the decision to make the Medtronic MiniMed 670G, a hybrid closed loop system, the preferred product. FDA expanded approval for the device to youth in June 2018.

But Cynthia Rice, vice president for advocacy and policy for JDRF, said not every insulin management device works the same way in every patient, and people with type 1 diabetes should have choices.

“The reason why a doctor might choose one insulin pump over another depends on a lot of factors—how well the sensor works, the emergency alerts to let people know they’re about to have a severe low blood sugar...United Healthcare is really an outlier here," said Rice.

For more visit ajmc.com.

Primary Care Proviers and Cancer Treatment Decisions

Primary care providers (PCPs) are critical to managing patients with cancer. But a new study finds they may lack knowledge and a comfort level in making important decisions for their patients. A new study in the journal Cancer reported on this lack of comfort, even though a third of primary care physicians took part in decisions for their breast cancer patients.

Said Lauren Wallner, PhD, MPH, a health services researcher at the University of Michigan Rogel Cancer Center: “Primary care physicians may be involved in cancer care earlier than we thought. If we are going to promote their involvement, we may need to start doing that earlier, around the time of initial treatment, and ensure PCPs have the information they need to effectively participate in the decision-making process.”

The more ability primary care doctors had to take part in the decision process, the more likely they were to discuss options with their patients, the results showed.

Payment Ideas for Curative Therapies

How can the healthcare industry bring cutting-edge gene therapies to patients without breaking the bank for payers? The question was the topic of a one-day event in Washington, DC, “Paying for Cures,” hosted by the FoCUS Project at MIT. The conference discussed Massachusetts pilot projects on performance-based annuities with commercial payers, and milestone-based contracts with public payers.

Said Jane Barlow, MD, MPH, MBA, of Real Endpoints, an advisory company, “You have to cover what needs to be covered in order to be competitive and attractive, but also, you don’t want to cover things that others aren’t covering so you don’t get adverse selection.”

Biomarkers, Clinical Trials, and Weighing Options

Finally, the February issue of Evidence-Based Oncology features interviews with leaders in immuno-oncology, including Janice Mehnert, MD, who leads the Phase 1 Developmental Therapeutics Program at Rutgers Cancer Institute of New Jersey.

In a wide-ranging interview, Mehnert discussed the need to include more diverse patient populations in clinical trials, including those with comorbidities. She also discussed:

  • The need for better biomarkers
  • The need for more education of the healthcare team about toxicity of immunotherapy
  • The need for patients newly diagnosed with cancer to take time to get expert opinions

For the full interview, visit ajmc.com.

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

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