This Week in Managed Care: February 1, 2019

This week, the top managed care news included House and Senate hearings on the cost of prescription drugs; a study finding patients with diabetes can be safely switched to cheaper insulin; and the first non-chemotherapy combination being approved for the treatment of chronic lymphocytic leukemia.

Congress opens hearings on drug pricing, a study finds patients can be safely switched to cheaper insulin, and an ibrutinib combination is approved for a new indication.

Welcome to This Week in Managed Care, I’m Samantha DiGrande.

Hearings on Drug Prices

Both the House and Senate opened hearings on the cost of prescription drugs on Tuesday, with the House Oversight and Reform committee and the Senate Finance committee taking testimony from families of patients, advocates, and leading researchers, including Peter Bach, MD, MAPP, director, Memorial Sloan Kettering Center for Health Policy and Outcomes; Avik Roy, president of the Foundation for Research on Equal Opportunity; and Aaron S. Kesselheim, MD, JD, MPH, of Harvard Medical School.

Senator Debbie Stabenow, D-Michigan, said it’s hard to understand arguments from pharma companies that drugs from Canada are not safe when some of her constituents can drive 10 minutes across the border to buy prescriptions at a 40% discount. She said, “We have trade on everything else, but we close the border on safe, FDA-approved drugs on both sides of the border.”

In the House, Roy and Kesselheim said patent protections and government coverage mandates are distorting markets at the expense of consumers. Support for reform in both committees was bipartisan, and skyrocketing insulin prices drew special scrutiny.

Said Senator Chuck Grassley, R-Iowa, chairman of the Finance Committee: “I have heard stories about people reducing their life-saving medicines, like insulin, to save money. This is unacceptable, and I intend to specifically get to the bottom of the insulin price increase.”

Leaders from the largest pharmaceutical companies did not send representatives to either hearing, but Grassley said he will make them testify. For more, visit

Switching from Analog to Human Insulin

As the House hearing opened, Kesselheim and authors from Harvard and CareMore Health published results that showed the health plan saved millions of dollars by safely switching Medicare beneficiaries with type 2 diabetes from analog to human insulin, an older formulation that costs much less.

The study appeared in JAMA and found:

  • The seniors had a slight increase in A1C that the authors said was not clinically significant.
  • Before the switch, 20 % reached the coverage gap, or “donut hole,” that required much higher out-of-pocket costs.
  • After the switch, only 11 % reached the coverage gap.

Said CareMore President Sachin Jain, MD, MPA, a co-author on the study: “As commonly used medicines like insulin become more expensive, we explored using older-generation medicines that may have equivalent clinical benefit but in fact cost much less. The analysis of our program demonstrates that this can be done safely and at scale. Novel medicines are only valuable to the extent that patients can afford to take them.”

For more, visit

FDA Approves First Non-Chemotherapy Combination for CLL

FDA this week approved an ibrutinib combination for frontline treatment of patients with chronic lymphocytic leukemia (CLL) or small lymphocytic lymphoma. Ibrutinib is sold as Imbruvica by Janssen. Ibrutinib used with obinutuzumab expands the label beyond monotherapy and marks the first non-chemotherapy combination for these two conditions.

The approval follows results of the iLLUMINATE study, presented in December at the American Society of Hematology in San Diego. The study showed the ibrutinib combination brought a 77% reduction in risk of progression or death compared with a chemotherapy combination. Among high-risk patients, the difference was even greater.

Said iLLUMINATE investigator Carol Moreno, MD, PhD, consultant hematologist, Hospital de la Santa Creu Sant Pau, Autonomous University of Barcelona: “In just a few years, Imbruvica has become an important treatment for CLL. Imbruvica as a single agent—and now as a combination with obinutuzumab—provides patients with CLL with an alternative to frontline treatment with chemoimmunotherapy.”

Thoughts on Medicare for All

Do Americans support Medicare for all? It depends on which argument they hear, according to results from a new Kaiser Family Foundation poll. The Kaiser Health Tracking Poll examined four approaches and found that when language changed so did the response:

  • The poll found 77%, including 69% of Republicans, favor letting people aged 50 to 64 buy coverage through Medicare.
  • The poll also found 75% of Americans, with 64% of Republicans, support letting those who lack employer coverage buy insurance through their state Medicaid plan.
  • Most Americans also support letting people buy coverage through a national government plan as long as they have the option to keep their current plan. However, support for this idea falls to 47 % among Republicans.
  • Support for Medicare for All plummets if people were required to buy coverage through a single government plan. Only 56% favor this, including only 23% of Republicans.

Drug Reform

Finally, the focus on drug prices in Congress this week brings speculation whether lawmakers are serious about real reform. Regulatory attorneys who spoke with our sister site, The Center for Biosimilars®, say that so far, activity in Congress has been all talk and no action, and most of the important steps have been taken in states.

Meanwhile, in a commentary for the upcoming issue of The American Journal of Managed Care®, co-editor-in-chief Dr. Mark Fendrick and co-author Darrell George argue that if reforms to reduce overall drug prices fail to address consumer out-of-pocket costs, they will fall short of tackling the real problem.

For more on the drug pricing debate, visit

For all of us at The Managed Markets News Network, I’m Samantha DiGrande. Thanks for joining us.