This Week in Managed Care: February 8, 2019

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This week, the top managed care news included President Trump's State of the Union address highlighting healthcare; HHS Secretary Alex Azar taking on drug rebates; and physicians asking Congress to fully implement the HITECH Act.


Healthcare was highlighted in the State of the Union, Alex Azar calls for taking on drug rebates, and physicians ask Congress to fully implement the HITECH Act.

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

State of the Union Addresses Healthcare

President Donald Trump trumpeted his healthcare agenda and made new proposals during Tuesday’s State of the Union address, which took place as Congress looks into the high cost of prescription drugs. Trump touted elements of American Patients First, his own plan to bring down drug costs:

  • He asked Congress to pass his plan for an International Pricing Index, saying, “It is unacceptable that Americans pay vastly more than people in other countries for the exact same drugs.”
  • He called for greater transparency across the healthcare system.
  • He voiced support for covering pre-existing conditions, even though critics note his administration is fighting this provision of the Affordable Care Act in court.

The president also had several new proposals. First Lady Melania Trump invited 10-year-old cancer survivor Grace Eline to highlight a plan to add 500 million dollars in new funding for childhood cancer research. Other new healthcare proposals are:

  • A call to eliminate HIV over the next decade.
  • A call for Congress to pass a bill to eliminate late-term abortion, which seems likely to reach the Supreme Court.

For more, visit

Azar Goes After Rebates

HHS Secretary Alex Azar said this week that tackling the prescription drug rebate system is an essential piece of bringing down high list prices and out of pocket costs for consumers. In his keynote address at the Academy Health National Health Policy conference, Azar outlined examples of how the rebate system drives up costs for drugs that are sometimes the only treatments patients can take for their conditions.

He called the rebates “kickbacks” and said the system distorts pricing, even for generic drugs.

He said, “By one estimate, a quarter of patients will pay more at the pharmacy counter by using their insurance to purchase the brand drug than they would pay if they just paid cash for the new generic.”

Azar highlighted administration proposals that include putting list prices for prescription drugs in TV ads, something the drug industry opposes.

For full coverage of the Academy Health conference, visit

HITECH Act Anniversary

This month marks the 10th anniversary of the HITECH Act, which put billions of dollars into technology for electronic health records to improve patient safety. But many feel that the reality of electronic health records (EHRs) have fallen short of their promise, and this week the American Medical Association and MedStar Health launched a campaign to push Congress to fully implement previous pieces of legislation.

Through the website, EHRSeeWhatWeMeanDotorg, they offer videos that show common EHR problems such as poor video display and complex workflows. MedStar built the site based on prior research.

EHR technology is dominated by two companies, Cerner and EPIC, and many physicians complain about the lack of interoperability, difficult data entry, and interfaces that haven’t kept pace with what is seen in the consumer marketplace.

In a Viewpoint in JAMA this week on the topic, Raj M. Ratwani, PhD, an EHR safety researcher and director of the MedStar Health National Center for Human Factors in Healthcare, suggests 5 strategies:

  • Create a national database of usability and safety issues.
  • Establish basic design standards.
  • Address unintended harms and vendor mistakes.
  • Simplify documentation required for usability.
  • Standardize usability and safety measures.

As FDA creates a process for real-world evidence to play a bigger role in regulatory decisions, the National Pharmaceutical Council (NPC) is educating stakeholders on what that process will look like. The council’s recent webinar addressed questions about the FDA framework, a December 2018 document that spells out the agency’s philosophy, requirements, and timetable for including real-world evidence in regulatory decisions.

Under the 21st Century Cures Act, FDA will issue up to five separate guidance documents through 2021. As NPC described, FDA’s principles for the process will be:

  • Are the real-world data fit for use?
  • Does the trial generating real-world evidence answer a regulatory question?
  • Does the study meet regulatory requirements?

Jennifer Graff, PharmD, vice president of comparative effectiveness research, NPC, said several questions about real world evidence will be answered: “How should it be used? How could it be used? And what are the safeguards that we need to ensure that it is being used appropriately? FDA has taken that work very seriously.”

For more visit

Cesarean Section Rates

Finally, the public health challenge of rising maternal morbidity and mortality has drawn attention to unnecessary C-sections. A study in the current issue of The American Journal of Managed Care® shows how difficult this issue is to correct.

The authors found that even when women had an interactive tool that helped them compare rates of C-sections among various hospitals, it did not prompt them to select hospitals with lower rates.

For the full study, visit

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