This Week in Managed Care: July 21, 2017

This week, the top managed care stories included more twists in Senate Republicans' efforts to repeal the Affordable Care Act; a Medicare fraud sweep targeted opioid distribution; and the CDC reported 30 million Americans now have diabetes.

Repealing Obamacare is on hold for now, a Medicare fraud sweep charges hundreds with diverting opioids, and biosimilars for two blockbuster cancer drugs are closer to reaching patients.

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

Repeal and Replace on Hold

Efforts to repeal and replace the Affordable Care Act (ACA) are on hold after several twists earlier this week.

First, Senate Majority Leader Mitch McConnell acknowledged he did not have the votes to pass the Better Care Reconciliation Act after two more Republicans, Mike Lee of Utah and Jerry Moran of Kansas, said Monday they would not vote for the bill.

McConnell announced he would instead repeal the ACA with a 2-year delay to replace it. But the Senate’s 3 Republican women—Maine’s Susan Collins, Alaska’s Lisa Murkowski, and West Virginia’s Shelley Moore Capito—announced this idea was unacceptable, putting repeal on hold again.

Collins said in a statement: “I do not think that it’s constructive to repeal a law that is so interwoven within our healthcare system without having a replacement in place.”

Fraud Sweep Targets Opioids

A Medicare fraud crackdown last week arrested 412 people across the country in a sting that focused on diverting opioids and illegally charging Medicare or Medicaid for drugs that sometimes were not even received by patients.

While the Departments of Justice and Health and Human Services have collaborated on these summertime stings for several years, this is the first time the crackdown has focused on opioid distribution.

Attorney General Jeff Sessions and HHS Secretary Tom Price, MD, announced the arrests in a joint appearance, which featured tales of offering addicts gift cards and visits to strip clubs to get them to enroll so owners of rehab centers could bill their insurance.

Attorney General Sessions had harsh words for the health professionals charged: “They seem oblivious to the disastrous consequences of their greed. Their actions not only enrich themselves often at the expense of taxpayers, but also feed addictions and cause addictions to start. The consequences are real: emergency rooms, jail cells, futures lost, and graveyards.”

For more, read the article.

Biosimilars Update

Biosimilar candidates for 2 blockbuster cancer drugs are a step closer to the market after the FDA’s Oncologic Drugs Advisory Committee gave them unanimous approval this week.

The panel approved Amgen’s ABP-215, which is referenced on Avastin, and Mylan and Biocon’s MYL-1401o, referenced on Herceptin. The United States spent more than $5 billion on the 2 cancer drugs in 2016, and use of the 2 biosimilars is expected to bring significant savings to health plans and patients.

To keep up with news about the emerging biosimilars market, visit our Center for Biosimilars.

30 Million Americans Have Diabetes

The number of Americans with diabetes has passed the 30 million mark, according to a new report from the CDC. Public health officials release new data on diabetes every two years, and this year’s report reflects figures that are current as of 2015.

On the bright side, the number of Americans with prediabetes has gone down slightly to 84.1 million, following a massive public health campaign to identify those at risk of type 2 diabetes and intervene before these people develop the disease.

Said Ann Albright, PhD, RD, of the CDC: “If there’s good news, it’s that the rate of increase seems to be slowing. Diabetes is a contributing factor to so many other serious health conditions.”

Diabetes Prevention Program

Albright’s division has been a force in advancing the Diabetes Prevention Program, and this week CMS proposed the rules that Medicare will follow when it offers the program to seniors starting in April 2018.

While many are pleased that Medicare will finally pay for DPP, digital health providers were surprised to learn that the launch will limit them to offering makeup classes instead of a full program.

Adam Fawer, the chief operating officer of the digital health provider Noom, which was the first online provider to get full CDC recognition, published an editorial on saying the proposed rule puts seniors at risk.

“Only the virtual implementation of the DPP will lead to a widespread adoption among seniors. … Time and again, through peer-reviewed studies, virtual DPP providers have been proven to help prediabetics lose weight and change their behavior to lower their risk of developing diabetes.”

EBOTM ASCO Recap Issue

Finally, if you couldn’t attend this year’s meeting of the American Society of Clinical Oncology, be sure to read the special recap issue of Evidence-Based Oncology.

Highlights of this special issue include:

  • How doctors are catching some cancers earlier since the start of the ACA
  • Studies in support of new biosimilars
  • The connections between diet, exercise, and colorectal cancer
  • How patients are using the web to report symptoms and improve survival.

Check out the full issue.

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

Thanks for joining us.

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