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This Week in Managed Care: January 20, 2017


This week, the top managed care stories included news that Republicans will introduce legislation to replace the Affordable Care Act, a report found the abortion rate hit a historic low, and results showed Januvia is safe for the oldest patients, even if they have cardiovascular risk.

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.

New Administration, New Healthcare Law

Donald Trump is now the 45th president of the United States, and Congress is at work to help him repeal and replace the Affordable Care Act (ACA).

After House and Senate votes to start the repeal process through a budget resolution, Senators Susan Collins, R-Maine, and Bill Cassidy, R-Louisiana, are expected to introduce legislation next week that would give states the flexibility to keep the ACA as it is or use federal dollars to fund a replacement plan.

CBO Projects ACA Repeal Impact

The bill change comes after the Congressional Budget Office reported this week that a full repeal of Obamacare without a replacement would cause 18 million people to lose coverage in the first year. That number could rise to 32 million over the next decade.

Keeping a requirement for payers to cover pre-existing conditions while removing the individual mandate would cause premiums to rise at least 20% in the individual market. The CBO said repealing the ACA would bring great uncertainty to the healthcare market. The report found: “The ways in which individuals, employers, states, insurers, doctors, hospitals, and other parties would respond … are all difficult to predict,”

Abortion Rate at Historic Low

A separate report from the Guttmacher Institute found that broader availability of birth control under the ACA helped contribute to the lowest abortion rate since the procedure became legal nationwide in 1973.

In 2014, 19% of pregnancies other than miscarriages ended in abortion, which was an 11% decline from 2011. The ACA’s contraception mandate took effect in 2012, but it was not the only factor in the declining abortion rate.

The report found that states enacted 100 new restrictions to abortion between 2008 and 2011, and more have come over the past 5 years. The report found: “Abortion is an important indicator of unintended pregnancy, but it is unclear whether the most recent decline in abortion is due to fewer women’s having unintended pregnancies, more women’s being unable to access abortion services or some combination of these dynamics.”

For more on the report, read our article.

CV Safety for Januvia

New results show that a top-selling therapy for type 2 diabetes is safe for the oldest patients, even if they have high cardiovascular risk.

Sitagliptin, sold as Januvia, was found safe for patients over age 75 in a new analysis from the TECOS trial, which first reported results in June 2015. The new results in Diabetes Care found:

  • No effect on death rates from cardiovascular events
  • No effect on hospitalization rates from heart failure
  • No increase in hypoglycemia

Januvia, the first drug approved in the DPP-4 inhibitor class, has been a top seller for Merck but has been facing competition from newer drugs, especially SGLT2 inhibitors.

Coverage From ASH 2016

You can find full coverage from the 58th annual meeting of the American Society of Hematology in a special issue of Evidence-Based Oncology, featuring several studies involving ibrutinib and CAR-T cell immunotherapy.

For the full issue, click here.

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

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