This Week in Managed Care: June 29, 2018

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This week in managed care, the top stories included HHS Secretary Alex Azar appearing before the Senate Committee on Finance to discuss the administration's plan to drive down prescription drug prices; FDA Commissioner Scott Gottlieb, MD, calling on payers to share data to aid drug innovation; and CMS calling for stricter oversight of Medicaid.


Senators grill a top Trump administration official on the drug pricing plan, the FDA Commissioner says payers should share data to aid drug innovation, and CMS calls for stricter oversight of Medicaid,

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

Azar Appears Before Senate Committee on Finance

HHS Secretary Alex Azar took questions this week on President Donald Trump’s plan to drive down prescription drug prices. Members of the Senate Committee on Finance wanted details about the blueprint, American Patients First, which calls for things like publicizing drug prices and merging Medicare Part B into Part D.

Democrats on the committee, including Senator Ron Wyden, D-Oregon, dismissed the administration’s idea to get other countries to raise drug prices so they can be lowered in the United States. He released his own report on why drug prices are so high in Medicare, saying: “The report shows how the broken drug system delivers massive profits to drug manufacturers, middlemen, and insurance companies while sending costs skyrocketing for families and taxpayers. The report comes as the Trump administration continues to fall short on the president’s promise to deliver lower drug prices.”

Senator Robert Menendez, D-New Jersey, pressed Azar about support for the Creating and Restoring Equal Access to Equivalent Samples (CREATES) Act, which would promote price competition and increase the availability of drug samples to manufacture generics and biosimilars. Azar called for more information sharing between drug makers and health insurers, saying: “We believe it’s the future of how we need to pay for drugs, pay for outcomes, [and] pay for healthcare.”

Gottlieb Calls on Payers to Share Data

FDA Commissioner Scott Gottlieb, MD, also called for better information sharing by payers to aid the drug development process, when he addressed cancer care leaders at the policy summit of the National Comprehensive Cancer Network this week. Sharing data will ultimately benefit payers because they will know if therapies help keep patients out of the hospital or have fewer side effects.

Gottlieb said better data is needed to modernize the drug development process and lower costs. He said, “If FDA-approved drugs are priced out of reach of patients, then the full benefits of innovation won’t be realized.”

For more, visit

CMS Unveiling Stricter Oversight of Medicaid

Medicaid expansion means there is a greater need for oversight, CMS said this week, as the agency announced several steps to fight fraud. The steps come in response to a report from the Government Accountability Office that found $89 billion in improper payments within Medicaid and Medicare.

CMS said due to Medicaid expansion in 33 states, spending rose from $456 billion in 2013 to $576 billion in 2016. Steps to prevent abuse will include:

  • Expanded audits of state claims for federal matching funds and medical loss ratios
  • New audits to make sure states are properly determining who is eligible for Medicaid
  • Advanced analytics that predict provider fraud based on state claims

High-Deductible Health Plans Continue to Grow in Use

Half of all American workers have health insurance with a deductible of at least $1000, according to a report from Bloomberg. That share is up from 22% in 2009 and reflects the rising popularity of high-deductible plans after the financial crisis. The share of large employers that offer only a high-deductible plan rose from 7% to 39% over the same period.

These plans are often cited as a reason why consumers avoid some preventive healthcare or can’t afford prescription drugs, and some companies are moving away from them as the labor market tightens.

Joslin Clinical Guidelines for Diabetes

Finally, AJMC® and Joslin Diabetes Center have collaborated to publish core chapters of the Joslin Clinical Guidelines, which appear in the current issue of Evidence-Based Diabetes Management™ (EBDM™).

Chapters in the issue cover the following:

  • Care for adults with diabetes
  • Nutrition
  • Pregnancy
  • Care for older adults
  • Pharmacological management for type 2 diabetes

Robert Gabbay, MD, chief medical officer at Joslin and editor in chief of EBDM™, explained that the guidelines developed at Joslin have been used internally and at affiliates over several years, but this partnership offers an opportunity to reach a wider audience.

For a link to the document, visit

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