This Week in Managed Care: January 25, 2019

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This week, the top managed care news included the Institute for Clinical and Economic Review investigating rising drug prices; CMS expanding value-based insurance design; and researchers using a blood test to detect preclinical Alzheimer disease.


Rising drug prices continue to dominate healthcare news, CMS expands value-based insurance design (VBID), and a blood test could offer an early warning for Alzheimer disease.

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

ICER to Review Drug Price Increases

After nearly 30 drug makers announced price hikes in January, a study in Health Affairs found most cost growth in the United States comes not from new blockbusters but from increases for older drugs.

Now, the Institute for Clinical and Economic Review, known and ICER, will track those increases and report on those that can't be supported. Said ICER chief medical officer David Rind, MD: "By identifying drugs with substantial price increases despite no new evidence of added benefit, we hope to make an important first step in providing policy makers with information they can use to advance the public debate on drug price increases."

A draft protocol is available for comment. The first report is due October 8th. For more, visit

Drug Prices, Shortages Impacting Hospitals

Drug shortages and Medicare reimbursements that don't keep pace with drug costs are forcing some hospitals to cut staff, putting patient safety at risk.

That was the message from a report by 3 major healthcare groups, which found that drug spending rose more than 20% over a 2-year period form 2015 to 2017. Interviews with key hospital leaders found they questioned hte price hikes relative to the value of the drugs.

Outside the hospital, a research group found that insulin costs for people with type 1 diabetes doubled between 2012 and 2016. The Health Care Cost Institute analyzed 15,000 claims from large insurers and found the following:

  • Over the 4-year period, gross spending on insulin per person increased by $2841.
  • Spending on insulin accounted for 47% of the $6027 increase in overall healthcare spending per person during the period.

CMS Expands VBID Model, Creates More Risk Sharing in Part D

CMS this week expanded its value-based insurance design (VBID) model in Medicare Advantage and created more risk sharing in Medicare Part D. VBID interventions encourage low- or no-cost coverage for prescriptions or healthcare procedures that will prevent higher healthcare costs elsewhere.

Both plans are voluntary and expand a pilot that began in 2017 to all 50 states.

VBID inteventions can cover one or more areas:

  • VBID by condition, socioeconomic status, or both, including spcial determinants of health.
  • Programs Medicare Advantage and Part D rewards and incentives.
  • Increasing access to telehealth.
  • More coordination of wellness and healthcare planning.

CMS estimated the voluntary models will save $2 billion a year.

For more, visit

Blood Test to Detect Alzheimer Disease

Researchers have used a blood test to detect biomarkers for Alzheimer disease.

The findings, published in Nature Medicine, predicted differences about 16 years before patients with a genetic mutation would be expected to show symptoms.

While the test is years away from being used in clinical practice, the hope is that it could help identify brain disease not only for Alzheimer but for other neurodegenerative conditions, such as multiple sclerosis or stroke.

The test detects a structural protein that forms part of the internal skeleton of neurons. When brain neurons are damaged, the protein leaks into the bloodstream.

Said study author Brian Gordon, PhD: "This is something that would be easy to incorporate into a screening test in a neurology clinic. We validated it in people with Alzheimer's disease because we know their brains undergo lots of neurodegeneration, but this marker isn't specific for Alzheimer's. High levels could be a sign of many different neurologial diseases and injuries."

Medication Adherence in Metastatic Breast Cancer

Finally, a current Peer Exchange on addresses the challenge of medication adherence for patients with breast cancer being treated with CDK4/6 inhibitors.

Sara Tolaney, MD, MPH, appearing with Lindsay Shaw, NP, says that if physicians don't ask about adherence, they might not know there is a problem.

For our Peer Exchange series, visit

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