This Week in Managed Care: June 8, 2018

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This week, the top managed care stories include Medicare Part A will run out earlier than predicted; healthcare costs for families continue to rise; and thousands of women with a common form of early breast cancer can forgo chemotherapy.


Medicare’s financial health is declining, healthcare costs for families keep rising, and thousands of women with breast cancer may be able to skip chemotherapy.

Welcome to This Week in Managed Care, I’m Kelly Davio.

Medicare Part A Will Run Out 3 Years Earlier Than Predicted

Medicare trustees said this week that Medicare Part A, which covers hospital bills, will be insolvent by 2026, 3 years sooner than the last projection. Their trustees foresee lower payroll taxes from lower wages and less income, due to taxation of Social Security benefits under the new tax law.

Last year, income into Medicare Part A exceeded spending by $2.8 billion, but deficits are forecast after that, until the Hospital Insurance Trust Fund runs out of money in 2026. Republicans called for reforms, but Democrats said the forecast is proof the tax plan is harming Medicare.

Said Democratic Senator Ron Wyden, D-Oregon: “This report should eliminate any doubt that Trump’s tax law yanked Medicare closer to insolvency.”

Read more.

Healthcare Costs For Families Continue to Rise

Healthcare costs for a family of 4 on an employer plan will reach $28,000 this year, according to the Milliman Medical Index. The annual increase of 4.5% is one of the lowest since the index began in 2001. However, the report notes that pharmacy costs are rising much faster than other healthcare expenses, and now account for 17% of costs, up from 13% of healthcare spending in 2001.

Healthcare costs may feel higher to employees because they now pay 44% of the total, up from 40% a decade ago.

For more, visit

Majority of Women With Form of Early Breast Cancer Can Forgo Chemotherapy

Women with a common form of early breast cancer can skip chemotherapy, according to results presented at the American Society of Clinical Oncology. The TAILORx study showed that 70% of women with lymph node-negative, hormone-sensitive, HER-2 negative breast cancer can rely on hormone therapy, but the women who can take this approach must be identified through genomic testing.

The Oncotype DX test, which evaluated which women could avoid chemotherapy, could help thousands of women avoid chemotherapy, reducing side effects and healthcare costs. Medicare covers the $4500 test, but in some states Medicaid does not.

The TAILORx study was just one of several important results announced at ASCO:

  • Forty-seven percent of patients with metastatic cutaneous squamous carcinoma responded to treatment with cemiplimab, a PD-1 inhibitor
  • The Keynote-042 trial confirmed that pembrolizumab is a superior first-line treatment to chemotherapy for patients with advanced/metastatic non—small cell lung cancer.
  • More results from the ZUMA-1 trial show that a patient’s response at 3 months the CAR T-cell therapy axi-cell predicts remission in B-cell lymphoma.

During the conference, AJMC® also spoke with James Lin Chen, MD, of Ohio State University about the importance of technology in precision medicine.

For full coverage from ASCO, visit

FDA Approves Pegfilgrastim Biosimilar

Finally, the FDA this week approved Mylan and Biocon’s pegfilgrastim biosimilar, which will be sold under the brand name Fulphila. Like the reference drug Neulasta, the drug is approved to reduce the chances of infection from febrile neutropenia in patients receiving myelosuppressive chemotherapy.

FDA Commissioner Scott Gottlieb, MD, said, “Bringing biosimilars to patients is a top priority for the FDA, and a key part of our efforts to help promote competition that can reduce drug costs and promote access.”

To learn more about what’s happening in biosimilars, visit the Center for Biosimilars.

For all of us at the Managed Markets News Network, I’m Kelly Davio.