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This Week in Managed Care: January 24, 2020


This week, the top managed care stories included a case involving health coverage for birth control reaching the Supreme Court; polls on healthcare anger President Trump; a popular diabetes drug receives a new indication.

A case involving health coverage for birth control reaches the Supreme Court, polls on healthcare anger President Trump, and a popular diabetes drug receives a new indication.

Welcome to This Week in Managed Care. I’m Gianna Melillo.

Supreme Court Takes Up Case of Employers Denying Birth Control Coverage

The Supreme Court announced last week it will hear a case that asks whether employers can keep birth control out of their health plans on religious grounds. This is the third time the court has considered the Affordable Care Act’s contraception mandate, but the first time since Justices Neil Gorsuch and Brett Kavanaugh were appointed.

Attorneys general in Pennsylvania and New Jersey challenged the Trump administration’s 2017 rule change that gave employers an exemption.

Said Pennsylvania Attorney General Josh Shapiro: “Two federal courts have blocked the Trump administration’s rules because they would allow virtually any employer to deny women access to contraception for any reason—including the belief that women should not be in the workforce.”

In 2014, the court ruled in the Hobby Lobby case that requiring family-owned businesses to pay for insurance that covers contraception violates the Religious Freedom Restoration Act of 1993. The Trump Administration is relying on the act for its argument.

Said Kristen Waggoner of the Alliance Defending Freedom, a religious liberty group: “They’re not interfering [with employees’ choices]. This is about whether a person can run their business in a way that’s consistent with their beliefs.…It’s about the right of all religious organizations and people of faith.”

For more, visit ajmc.com.

Trump Reportedly Unhappy With Azar

News reports this week say President Donald Trump is unhappy with polls that show voters prefer Democrats on healthcare, and HHS Secretary Alex Azar is feeling his wrath. Both The New York Times and POLITICO reported that Trump lashed out at Azar over polling results during a phone call, because the president feels he is not getting credit for actions to lower drug prices.

Administration steps, such as a plan to import drugs from Canada, are not offsetting public sentiment over a lawsuit backed by the Department of Justice that threatens the ACA’s protection for pre-existing conditions.

A White House spokesman downplayed any differences: “There’s no daylight between the White House and HHS as we work to implement the president’s policies and improve the American healthcare system for everyone, not just those in the individual market.” Judd Deere, White House spokesman,

in POLITICO report.

For more, visit ajmc.com.

Semaglutide Approved for Cardiovascular Risk Reduction in Adults With T2D

FDA has added a new indication to semaglutide, Novo Nordisk’s top-selling type 2 diabetes drug sold as Ozempic. The GLP-1 receptor agonist, given once a week by injection, is now approved to reduce cardiovascular risk in adults with type 2 and known heart disease. Results are based on the SUSTAIN-6 cardiovascular outcomes trial, which found the drug reduced events like heart attacks and strokes in these high-risk patients by 26%.

Said Novo Nordisk’s Dr Todd Hobbs, “Today’s milestone establishes Ozempic as an option for patients to help address two critical aspects of managing type 2 diabetes, blood sugar control and cardiovascular risk reduction, in those with known heart disease.”

Novo Nordisk also added data to the label for an oral form of semaglutide, although that form of the drug does not yet have a cardiovascular indication.

For more, visit ajmc.com.

ASH 2019 Recap Available Now in Evidence-Based Oncology

If you missed December’s meeting of the American Society of Hematology in Orlando, you can catch up on the key results with our special recap issue of Evidence-Based Oncology, which is now available online.

Coverage in the issue includes:

  • Updates and interviews on the next wave of CAR T-cell therapy
  • Clinical trial results, including CAPTIVATE and CANDOR
  • Summaries of real-world evidence and patient-reported outcomes from poster presentations
  • The latest on biosimilars presented at ASH

For the full ASH recap issue, visit ajmc.com.

Paper of the Week:

Finally, we present “Paper of the Week,” which will look back at some of the most influential research articles and commentary that have appeared in The American Journal of Managed Care® over the past 25 years, and why they are important today.

There was great disappointment with this month’s results in the New England Journal of Medicine, which found that work by Dr Jeffrey Brenner and the Camden Coalition, called “hot spotting,” did not reduce hospital readmissions. But the results might not be a surprise to readers of our paper of the week.

This week’s Paper of the Week, from 2007, asked a question: “Evidence for the Effect of Disease Management: Is $1 Billion a Year a Good Investment?”

This review article examined data from disease management programs in diabetes and congestive heart failure, as well as large-scale population health studies over a 15-year period.

The authors found: “We found consistent evidence that disease management improves processes of care and disease control but no conclusive support for its effect on health outcomes. Overall, disease management does not seem to affect utilization except for a reduction in hospitalization rates among patients with congestive heart failure and an increase in outpatient care and prescription drug use among patients with depression.…

“…When the costs of the intervention were appropriately accounted for and subtracted from any savings, there was no conclusive evidence that disease management leads to a net reduction of direct medical costs.” Mattke, Seid, and Ma, The American Journal of Managed Care®, 2007.

Results in 2007 and today show that addressing social determinants of health is a complex process; and, as Dr Brenner said, “These patients are hard to treat.”

To read our Paper of the Week, visit ajmc.com.

For all of us at AJMC, I’m Gianna Melillo. Thanks for joining us.

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