This Week in Managed Care: June 7, 2019

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This week, the top managed care news included the American Society of Clinical Oncology discussing drug pricing; community oncologists seeking a delay in taking on downside risk in the Oncology Care Model; CDC finding a drop in new diabetes cases in the United States.


The American Society of Clinical Oncology (ASCO) takes on rising drug prices, community oncologists seek a delay in taking on risk, and the CDC finds a drop in new cases of diabetes.

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

ASCO Town Hall Brings Tense Conversation About Drug Pricing

Reducing drug prices has been a top priority for the Trump administration, and it was on the agenda this weekend at the annual meeting of ASCO in Chicago. Moderator Jeffrey Ward, MD, FASCO, hematologist at the Swedish Cancer Institute, and Rodney Whitlock, PhD, of McDermott+Consulting, discussed the finger pointing that happens when drug makers and pharmacy benefit managers cast blame for high prices at other parties.

But Whitlock said the real problem is that neither the FDA, which regulates safety and efficacy, nor CMS, which buys drugs for seniors and the poor, is equipped to regulate pricing.

According to Whitlock, stakeholders must champion their own solutions. He said, “Don’t wait on the federal government. If you, as an organization, want to drive that conversation, you’re better equipped than waiting for someone else at the ‘mothership’ in Baltimore, where CMS is located, to come up with the idea.”

In other ASCO coverage, presenters at a packed session called for more research into using cannabis for pain relief in cancer care, and findings that olaparib extends progression-free survival in pancreatic cancer.

For full coverage, visit

The Community Oncology Alliance Urges Delay in Downside Risk Deadline for the Oncology Care Model

October is the deadline for practices taking part in the Oncology Care Model (OCM) to let CMS’ Innovation Center know if they wish to move forward with two-sided risk, which would mean practices would lose money if they failed to achieve certain benchmarks. This week, the Community Oncology Alliance wrote to the Innovation Center and asked that the deadline be delayed until April 2020, to give practices another round of data and additional information to guide their decision.

The letter to CMMI Deputy Administrator Adam Boehler states: “Making the decision on whether to accept downside risk based on only 2 sets of reconciliation results/data after these key corrections to the methodology were made exposes practices to significant uncertainty rather than quantifiable risk.”

A recent report from Avalere Health estimates that 70% of OCM practices will owe payments if they transition to two-sided risk.

Reports from the past two performance periods have shed little light on the reasons why some practices do well and some don’t, COA’s Bo Gamble, director of Strategic Practice Initiatives, told AJMC® in an interview. He said, “You can’t change behavior that’s a year old, and therefore, you’re always chasing yourself trying to figure out how to improve. That’s what’s frustrating for people. They want to improve, but they want to know, ‘what did I do last month that I can address this month?’”

Beside the challenge of the lag time with performance reports, COA asked CMMI to address the following:

  • Price prediction
  • Risk adjustment
  • Attribution and recoupment of monthly enhanced oncology services payments

New Cases of Diabetes Are Dropping

After increasing for 20 years, the number of new cases of diabetes in the United States is falling, and the number of existing cases is remaining flat, according to an analysis published last week in BMJ Open Diabetes Research & Care. Authors from the CDC’s Division of Diabetes Translation reviewed data from 2 national health surveys from 1980 through 2017, and found that the number of new cases has peaked, and has fallen slightly each year since about 2008.

The researchers also found:

  • Most of the decline has come among non-Hispanic whites, so disparities between ethnic groups remain.
  • Among adults, the largest decline has come among those over age 65.
  • Findings are consistent with declining rates of cardiovascular death, which suggests that people with diabetes are living longer due to better care.

The authors said the decline coincided with efforts to encourage more diabetes screening and less sugar intake, as well as promotion of the National Diabetes Prevention Program. However, data alone cannot prove a cause and effect.

They wrote: “We caution that trends are likely affected by changing awareness, detection, and diagnostic practices. Even in the event of true reductions in incidence, the high prevalence and declining mortality signifies a continuing overall burden of diabetes. For these reasons, we urge a continued emphasis on multilevel, multidisciplinary prevention to reduce both type 2 diabetes and diabetes complications.”

For more, visit

American Diabetes Association 2019

The diabetes community will descend on San Francisco this weekend at the 79th Annual Scientific Sessions of the American Diabetes Association (ADA), which will feature several trials that focus on how newer diabetes drugs affect renal outcomes. Another highlight will be the presentation of results of cardiovascular outcomes for Novo Nordisk’s oral semaglutide, the first non-injectable glucagon-like peptide-1 receptor agonist. The drug for type 2 diabetes has been shown in clinical trials to help patients to lose weight, and has a pending new drug application at FDA.

For full coverage of the ADA sessions, visit

Seema Verma Envisions a Health System That Shares Data, Is Truly Value-Based

Finally, this week AJMC® published an interview with CMS Administrator Seema Verma, who discussed several challenges currently plaguing the US health system.

In written responses, Verma addressed the system’s lack of flexibility and transparency, saying, “Our current healthcare system is complex, opaque, and difficult to navigate for patients. Empowering patients starts with giving them better access to their own personal health data.”

For the full article, visit

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