This Week in Managed Care: March 19, 2016

This week, the top managed care stories include Humana announcing executive bonuses are now partially tied to value, Veterans Affairs has expanded access of hepatitis C drugs to all veterans in the system, and CDC releases guidelines on prescribing opioids.

Hello, I’m Justin Gallagher, associate publisher of The American Journal of Managed Care. Welcome to This Week in Managed Care, from the Managed Markets News Network.

Humana's Move to Value

The health insurer Humana is taking payment for value seriously—even its executives now have a stake in the health of the members.

Twenty percent of Humana’s 2015 executive bonuses were tied to metrics that asked whether the insurer was tracking down patients with chronic conditions, and getting them enrolled in preventive programs and its pharmacy.

Humana’s move comes as CMS is pushing for more of Medicare reimbursement to be tied to value-based payment models. It also comes as the insurer seeks regulatory approval for a merger with Aetna, a proposal that many doctors oppose.

Aetna-Humana Merger

In Florida this week, 3 physician groups asked Attorney General Pam Bondi to oppose the merger. The doctors argued that an Aetna-Humana merger will mean less competition, and that the bigger insurer will not be better for patients.

Robert Nesse, MD, senior director of policy and payment reform at the Mayo Clinic, told AJMC that when healthcare consolidation is done for the wrong reasons, it can have negative consequences for patients. Watch the interview.

VA Expands Access to HCV Drugs

Many payers have struggled with giving hepatitis C patients access to new, expensive drugs that cure the disease. This week, however, the Veterans Administration announced that it will expand treatment to all veterans in the system, thanks to funding that Congress provided late last year.

So far, the VA has cared for about 76,000 veterans with HCV and cured 60,000. There are 174,000 veterans in the system with the disease, most of whom served in the Vietnam era.

One factor that works in the VA’s favor: the laws governing its health system give it negotiating power with drug companies not seen in Medicare, something that leading presidential candidates want to change.

Opioid Prescribing Guidelines

This week, the CDC released a guideline for primary care doctors to help reduce the number of prescriptions for opioid painkillers.

The guideline, which has 12 specific recommendations, is based on 3 broad principles:

  • Non-opioid therapy is preferred for chronic pain outside of active cancer, palliative, or end-of-life care.
  • When opioids are used, the lowest effective dose should be tried first.
  • Providers must exercise caution and closely monitor patients when prescribing opioids.

The guideline was created to combat the nation’s growing opioid and heroin epidemic. In 2014, the United States recorded the highest number of deaths ever from drug overdoses, mostly from opioids and heroin.

CDC researchers found there were 259 million prescriptions for opioid painkillers in 2012, “enough for every adult in the United States to have a bottle of pills.”

Afrezza Relaunch

This week, MannKind Corp. named a new chief commercial officer to relaunch the inhaled insulin Afrezza, which has fallen well short of expected sales despite its popularity with a core group of diabetes patients.

Michael Castagna, PharmD, MBA, has a solid sales and marketing track record in the pharmaceutical industry, most recently with Amgen. Dr Castagna’s challenge will be winning over payers, who thus far have been reluctant to put Afrezza on formulary.

For an overview of Afrezza’s history and future plans, read the feature in the current issue of Evidence-Based Diabetes Management.

Diabetes Tweetchat

To learn more about diabetes care and performance measurement, join AJMC and Dr. Robert Gabbay of the Joslin Diabetes Center for a Tweetchat on March 22 from 1 to 2 pm Eastern time. Dr. Gabbay, Joslin’s chief medical officer and senior vice president, will answer questions through the Twitter handle @JoslinDiabetes, and you can follow the conversation with #AJMCchat. And don’t forget to follow us at @AJMC_Journal. We look forward to your questions.


For all of us at the Managed Markets News Networks, I’m Justin Gallagher. Thanks for joining us.

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