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This Week in Managed Care: March 13, 2020


This week, top managed care news included WHO declaring coronavirus a pandemic; CMS’ creation of an insulin savings plan for seniors; racial bias from professionals as a factor in low minority participation in clinical trials.

WHO declares coronavirus a pandemic, CMS creates an insulin savings plan for seniors, and racial bias from professionals could be a factor in low minority participation in clinical trials.

Welcome to This Week in Managed Care, I’m Christina Mattina.

WHO Declares Novel Coronavirus a Pandemic

The World Health Organization has declared the novel coronavirus, COVID-19, a pandemic and urged all countries to take action.

The word came Wednesday that officials in Geneva were concerned by “alarming levels of inaction.” Said WHO Chief Tedros Adhanom Ghebreyesus: “All countries can still change the course of this pandemic. If countries detect, test, treat, isolate, trace, and mobilize their people in the response, those with a handful of cases can prevent those cases becoming clusters, and those clusters becoming community transmission.”

In the United States, the number of cases soared past 1000, with California, New York, and Washington State the hardest hit.

Vice President Mike Pence, the administration’s point person on the response, said after a meeting with US health insurers that they will waive co-pays for testing and cover treatment costs. Medicaid and Medicare will also cover costs and co-pays.

Said Pence, “As the testing is expanding, we wanted to make sure the American people knew that testing was available to them and that cost would not be a barrier.”

For updates, visit ajmc.com.

CMS Model Aims to Lower Insulin Costs

CMS this week announced a new Part D Senior Savings Model for insulin, which will allow prescription drug plans to offer beneficiaries the life-saving hormone at a maximum co-pay of $35 for a 30-day supply.

The model is voluntary and targeted to enhanced Part D plans, which offer richer coverage at higher premiums. Those enrolled in these plans could save $446 in annual out-of-pocket costs, according to the administration.

Said CMS in a statement: “Participating pharmaceutical manufacturers will pay the 70% discount in the coverage gap for the insulins that are included in the model, but those manufacturer discount payments would now be calculated before the application of supplemental benefits under the model.”

CMS will offer incentives to encourage companies to participate. Savings are estimated at $250 million over 5 years. Some advocates were not impressed, noting the plan is limited to seniors and does nothing for those outside Medicare.

For more, visit ajmc.com.

Racial Bias Impacts Minority Participation in Clinical Trials

Racial and ethnic bias by researchers can lead to low participation rates among minorities in clinical trials, according to a new study.

Appearing in Cancer, a journal of the American Cancer Society, the findings are based on qualitative interviews with clinical trial professionals, including research staff.

Lead author Soumya Niranjan reported: “Examples of the stereotypes we observed included perceptions that African Americans were less knowledgeable about cancer research studies, less likely to participate due to altruism, or simply less likely to complete all facets of the research study.”

According to the paper, the share of racial and ethnic minorities taking part in cancer trials is 15% to 20%. The minority population in the United States is 36%.

For more, visit ajmc.com.

Conference Coverage Continues Despite Travel Bans

With concerns over coronavirus rising, many medical meetings are being canceled or postponed, as institutions impose travel bans.

Before travel bans were imposed, AJMC® was able to cover the Association of Community Cancer Centers annual meeting, which was held last weekend in Washington DC.

For full coverage, visit ajmc.com.

The American Academy of Allergy, Asthma, and Immunology has canceled its planned meeting this weekend in Philadelphia. But AJMC® will bring you virtual coverage of the abstracts and more, starting this weekend. Look for coverage on our AAAAI page at ajmc.com.

Paper of the Week

Now we bring you Paper of the Week, which looks back at some of the most important research and commentary of the past 25 years in The American Journal of Managed Care® and why they matter today.

This week’s paper was among our top papers of 2015, and concerns care among the chronically ill. “Care Fragmentation, Quality, and Costs Among Chronically Ill Patients,” led by Dr Ashish Jha, found that those patients whose care was least coordinated were most likely to have poor quality care with the highest costs.

For the full paper, visit ajmc.com.

For all of us at AJMC®, I’m Christina Mattina. Thanks for joining us.

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