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This Week in Managed Care: February 9, 2018


This week, the top managed care stories included Indiana being approved as the second state to implement work requirements in Medicaid; research found 5-year survival rates for cancer are increasing; coverage from the American Society of Clinical Oncology's 2018 Genitourinary Symposium.

Indiana adds Medicaid work requirements, 5-year survival rates for cancer are increasing, and research finds risk-sharing contracts could bring down drug prices.

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

Adding Medicaid Work Requirements

Indiana became the second state to add work rules for people receiving Medicaid, as Indiana Governor Eric Holcomb announced that CMS had approved the Section eleven-fifteen waiver to the state’s Healthy Indiana Plan, known as HIP.

Among the features of the waiver:

  • $80 million in annual funding to fight opioid addiction
  • A lockout provision if recipients fail to follow rules, including an annual process to determine eligibility
  • An expansion of services to connect recipients with job or education opportunities

HIP, developed under former Indiana Governor Mitch Daniels, expanded when Vice President Mike Pence was governor and CMS Administrator Seema Verma was a consultant to the state. As part of Medicaid expansion, HIP included premium requirements and other eligibility rules.

An estimated 91,000 people have lost coverage since 2015, although until now they could return to the rolls if they could prove eligibility. About 400,000 people in Indiana are on Medicaid.

Meanwhile in Virginia, Democratic Governor Ralph Northam released an analysis that showed adding Medicaid work requirements could cost 100 million dollars by the second year of the program. A Republican critic said the estimate is based on outdated information.

5-Year Cancer Survival Rates

Global surveillance data published in The Lancet show that 5-year survival rates for cancer are on the rise generally, even for some of the most lethal cancers. Findings from the CONCORD-2 program show:

  • Survival rates were highest in the United States, Canada, Australia, New Zealand, Finland, Iceland, Norway, and Sweden.
  • Five-year survival rates for women with breast cancer vary widely; the rate is 90.2% in the United States but only 66.1% in India.
  • Southeast Asia had the highest 5-year survival rates for gastrointestinal cancer, but lower rates for melanoma and blood cancers.

Read more.

Cancer Mortality, Disparities Discussion

While there is good news in cancer death rates, mortality data also show care disparities within the United States.

Otis Brawley, MD, chief medical and scientific officer for the American Cancer Society, spoke with Patricia Salber, MD, MBA, about the need for more work to resolve disparities in the latest installment of Managed Care Cast.

You can listen at AJMC.com or through one of these podcast services:

iTunes: http://apple.co/2eYWTss

TuneIn: http://bit.ly/2gv7iwj

Stitcher: http://bit.ly/2gCqtFg

Risk-Sharing Contracts

Can risk-sharing contracts help bring down drug prices? Research from the University of Florida School of Pharmacy finds these agreements between pharmaceutical manufacturers and health plans could be the answer.

Robert Navarro, PharmD, and his collaborators find these contracts work best when both sides can agree on a common set of performance metrics. Said Navarro: “The impact of these risk-sharing arrangements is that drug companies share financial risks with plans and patients, and the contracts help plans make value-based drug coverage decisions. While drug prices may increase, these shared-risk contracts help reduce the net cost of providing expensive new drugs to patients.”

However, risk-based contracts have been more successful in Europe than in the United States.

ASCO GU Symposium

Finally, AJMC® is in San Francisco this week for the ASCO Genitourinary Symposium.

For coverage of the meeting, “Translating Evidence into Multidisciplinary Care,” visit our conference page.

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

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