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This Week in Managed Care: March 2, 2018


This week, the top managed care stories included a bipartisan group of governors releasing an outline for health reform; a report finds value-based contracts brings down prescription drug co-pays; 20 states file a lawsuit over the constitutionality of the Affordable Care Act.

A bipartisan group of governors takes on health reform, value-based contracts help bring down prescription co-pays, and more states sue to overturn the Affordable Care Act (ACA).

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

Bipartisan Group of Governors on Healthcare Reform

Five governors unveiled an outline for the US healthcare system that they said would bring better outcomes at a lower cost for individuals, employers, and the government.

Republicans John Kasich of Ohio and Brian Sandoval of Nevada, Democrats John Hickenlooper of Colorado and Tom Wolf of Pennsylvania, and Independent Bill Walker of Alaska, said reorienting the health system toward value must be the top priority. Their recommendations include:

  • Making information transparent to all stakeholders
  • Using information and incentives to end fragmented care and hold providers accountable
  • Letting states use Medicaid and state employee benefit funds to create the “critical mass” to overcome inertia
  • Ensuring all Americans have access to care
  • Requiring that everyone contribute to their healthcare costs based on ability to pay
  • Getting rid of regulations that stifle competition and innovation

The plan also seeks to align consumer incentives, take steps to reduce the volatility of the individual market, and rethink the relationship between states and federal government in Medicare and Medicaid.

Learn more.

Decreasing Co-Pays of Medicines

Value-based contracts have helped bring down cost-sharing in commercial plans for key prescription drugs, according to a report from the Pharmaceutical Research and Manufacturers of America, known as PhRMA.

Treatments for diabetes, high cholesterol, and HIV saw cost-sharing drop 28% between 2015 and 2017, according to the report, which was based on an analysis by Avalere Health.

Said PhRMA President Stephen Ubl, “Results-based or value-based contracts can reduce healthcare system costs and can make medicines more affordable and accessible for patients. The healthcare market is starting to move in this direction, but we need public policy reforms that allow greater flexibility for innovative payment arrangements that lower out-of-pocket costs and enable patients to access the right treatments the first time.”

States Sue Over ACA

Many parts of the Affordable Care Act have been stripped away in the past year, but that hasn’t stopped some states from trying to get rid of what’s left.

Twenty states sued the federal government this week, saying the ACA is unconstitutional now that the individual mandate has been abolished with the new tax law signed by President Donald Trump. The Tax Cuts and Jobs Act eliminated a key penalty of the ACA under the tax code, without technically eliminating the requirement to buy coverage.

The lawsuit, filed in the US District Court in North Texas, states: “Following the enactment of the Tax Cuts and Jobs Act of 2017, the country is left with an individual mandate to buy health insurance that lacks any constitutional basis. Once the heart of the ACA—the individual mandate—is declared unconstitutional, the remainder of the ACA must also fall.”

Attorneys general for 20 states, mostly in the South and Midwest, filed the suit.

Cancer in Patients With HIV

Those with HIV are 50% more likely to be diagnosed with cancer compared with the rest of the US population and have a harder time getting safe and appropriate care. To address this, the National Comprehensive Cancer Network has released guidelines for cancer care for people with HIV.

Common cancers in this group include:

  • Non-Hodgkin lymphoma
  • Kaposi sarcoma
  • Lung, anal, prostate, and liver cancers
  • Oral/pharyngeal cancer
  • Female breast cancer
  • Cervical cancer

Cancer rates are higher among people with HIV today because anti-retroviral therapy has allowed them to live longer, and many of these cancers are common with aging.

Said Gita Suneja, MD, of Duke Cancer Center, “The disparity in cancer is large and significant. For most cancers, people living with HIV are 2 to 3 times more likely to receive no cancer treatment compared to uninfected people.”

Modifications of treatment should not depend on HIV status alone, the guidelines say.

Patient-Centered Oncology Care® Recap

Finally, if you could not attend our fall conference, Patient-Centered Oncology Care®, our recap issue is now available. This special issue of Evidence-Based Oncology, featuring coverage of our sixth annual conference from Philadelphia, is available here.

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

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