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This Week in Managed Care: January 13, 2017


This week, the top stories in managed care were that the Senate began the process of repealing the Affordable Care Act, Cigna and CVS moved away from the EpiPen, and the NCI Formulary will make it easier to study cancer drugs and their combinations.

Hello, I’m Laura Joszt, with The American Journal of Managed Care. Welcome to This Week in Managed Care from the Managed Markets News Network.

ACA Repeal Begins

This week, Republicans took a step toward repealing the Affordable Care Act, as the Senate passed a budget resolution early Thursday that would cancel major parts of the law. Democrats protested and forced Republicans to take votes against protecting Medicare, Medicaid, and other programs.

So far, there is no replacement plan for Obamacare, even though President-elect Donald J. Trump said this week he wants one as soon as possible.

Trump also called for reining in drug prices, and said because of its lobbyists, the pharmaceutical industry was “getting away with murder.”

“Our drug industry has been disastrous. ... We’re the largest buyer of drugs in the world and yet we don’t bid properly, and we’re going to start bidding and we’re going to save billions of dollars over a period of time.”

The Latest for EpiPen

One high-cost drug will soon be replaced on several formularies.

Cigna announced it would stop covering the brand-name Epi-Pen, and CVS Health said it would shift to cheaper, generic alternatives. Said Cigna: The generic version “has the same drug formulation and device functionality as the branded medication, but at a substantial cost savings.”

Cancer Drug Formulary

Gaining access to high-cost cancer drugs should be easier for researchers, thanks to a new formulary from the National Cancer Institute.

The partnership between NCI and the pharmaceutical and biotech industries will make it easier for researchers to study drugs and their combinations, by eliminating the lengthy negotiations to gain access for clinical trials. The change is possible because of the Cancer Moonshot program, which seeks to get drugs through the research pipeline faster so they can reach patients.

For more on this important change, read the article.

Patient-Centered Cancer Care

The patient’s voice has often been missing from clinical decisions, but that’s changing, according to Joseph Alvarnas, MD, an oncologist and hematologist with the City of Hope. Dr. Alvarnas, who is editor-in-chief of Evidence-Based Oncology, spoke with AJMC recently about making the patient the center of the discussion.

Watch the interview.

ESRD and Diabetes

Diabetes is the leading cause of kidney failure, which is one of the most expensive conditions in healthcare and requires dialysis or a transplant. And for years, Native Americans had higher rates of kidney failure of any ethnic group.

But a new report from CDC this week found that a population health effort by the Indian Health Service has cut the rate of Native Americans with diabetes who need dialysis by more than half. The news is important because it shows that team-based approaches that tie in behavioral health, community support, and transportation can save lives and cut costs, even with at-risk groups.

Said CDC Director Tom Frieden, MD, MPH: “When health systems, public health professionals, policymakers, and patients in the communities work together, these results show there are substantial improvements.”

Diabetes Prevention Program

The Council of Diabetes Prevention, a nonprofit group that mostly represents providers of the Diabetes Prevention Program, this week selected its first board of directors as it works to educate Congress about the unintended consequences of repealing Obamacare.

Anne Woodbury, the group’s executive director, explained that Medicare’s plans to pay for the DPP starting in 2018 rely on a waiver provision in the ACA. If the law is repealed, providers will need another path for reimbursement.

New board members who will be carrying this message are:

  • Marlayna Bollinger, of the Skinny Gene Project
  • Julia Hu of Lark Technologies
  • Dr. Neal Kaufman of Canary Health
  • Brenda Schmidt of Solera Health, and
  • Lisa Shaffer of the Blood Centers of America

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

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