This Week in Managed Care: July 20, 2018

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This week, the top managed care stories included patient advocates, providers, payers, and pharma commenting on the Trump administration's drug pricing plan; a survey that found physicians and payers believe progress toward value-based care is slowing; a study that questions the standards of evidence for breakthrough therapy approvals.


Stakeholders have questions on Trump’s drug pricing plan, a survey finds progress toward value-based care is slowing, and a study questions the standards for breakthrough therapies.

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

Commenting on Trump's Drug Pricing Plan

Patient advocates, providers, payers, and pharma have all weighed in this week on American Patients First, President Donald Trump’s plan to cut drug prices.

Monday was the deadline to comment on a Request for Information about the blueprint, which was released in May. A group of 53 patient groups led by the Patient Access Network Foundation called for smoothing out the seasonal bumps in consumer out-of-pocket costs that are caused by benefit designs.

Their letter said: “When patients cannot afford their therapies, they cannot be adherent to their treatment plans, which can increase the total cost of care for these patients over time. Such an outcome hurts patients, their families, and taxpayers—all who bear the burden of the higher cost of care.”

America’s Health Insurance Plans, which represents payers, supported policies to promote generic drugs and biosimilars, and to make Medicare Part D more flexible. AHIP called on policy makers to designate an independent group to objectively define value and to require more data sharing to make negotiations fair.

Pharmaceutical Research and Manufacturers of America, known as PhRMA, took aim at pharmacy benefit managers and the practice of rebates, which they pay to secure formulary positions.

Said PhRMA President Stephen Ubl: “Delinking supply chain payments from the list price will be disruptive and requires our companies and others to adapt, but it is necessary to improve patient affordability. We hope realigning these incentives will result in a greater shift toward value and lower costs for patients.”

Novartis Halts Price Increases

The effort to rein in drug prices and out-of-pocket costs caused a second pharmaceutical leader, Novartis, to announce plans to halt price increases through the end of 2018.

Novartis CEO Vasant Narasimhan called the move prudent while the company talks to HHS about the Trump blueprint, and said: “We have voluntarily pulled back on any further price increases this year.”

340B Lawsuit Rejected

A judge ruled that hospitals trying to restore $1.6 billion in proposed cuts to the 340B program must wait until a claim is denied. The American Hospital Association vowed to refile its suit.

Said CMS Administrator Seema Verma: “The court’s ruling is a big win for patients, who this year alone are expected to save $320 million in out-of-pocket expenses for medicines in their doctors’ offices.”

Meanwhile, House Ways and Means Committee Chair Kevin Brady is in talks with HHS to restart payments that insurers are due under the Affordable Care Act. Earlier this month, CMS stopped $10.4 billion in risk adjustment transfers, which compensate payers that take on high numbers of sick patients.

Transition to Value-Based Care Slows

And Quest Diagnostics reports that progress toward value-based care has stalled. Quest’s survey of 451 primary care doctors and healthcare executives found that:

  • 72% felt that physicians don’t have enough information about their patients
  • 57% of payers said they believe physicians do not have tools to succeed under value-based care

Read more.

Evidence Behind Breakthrough Therapies

FDA’s Breakthrough Therapy designation has sped approval for dozens of drugs since 2012. But a new study in JAMA finds that in many cases, evidence supporting the approvals lacks key features, such as studies with randomization, double-blinding, and control groups.

The researchers found that many physicians assume the evidence behind these approvals is stronger than what’s required under the law. Of the 46 drugs that received the designation between 2012 and 2017, 25 were cancer therapies.

Learn more about the study.

EBO ASCO Coverage

Finally, if you could not attend last month’s meeting of the American Society of Clinical Oncology, you can still catch up on the news.

A special issue of Evidence-Based Oncology™ that recaps the ASCO meeting is now available online.

Check out the full issue.

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