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This Week in Managed Care: March 24, 2017


This week, the top stories in managed care included last-minute changes to Republicans' bill to repeal the Affordable Care Act; a lack of votes to pass the GOP health bill; and promising study results on PCSK9 inhibitors and SGLT2 inhibitors.

The plan to repeal Obamacare stalls, and an expensive cholesterol drug reduces cardiac events, but is it enough for insurers?

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

ACA Repeal Vote

House Speaker Paul Ryan pulled the plug on Thursday’s planned vote to replace the Affordable Care Act, after he and President Donald Trump could not find enough votes to support their plan, the American Health Care Act. (Editor note: After filming, Ryan visited the White House to tell Trump that there were not enough votes to pass the bill. The House was scheduled to beginning voting at 3:30 pm on Friday, but instead GOP leadership pulled the bill of the table.)

Ryan scheduled the vote on the 7th anniversary of the passage of President Obama’s signature law, but he could not bridge a gap between conservatives who thought his plan left too many ACA regulations intact, and moderates who feared their constituents would lose coverage.

Obamacare supporters have flooded Congressional offices with phone calls and protested at Town Hall meetings, and polls show support for the ACA is higher than ever.

Yet amendments to the House Republican plan, designed to win over conservatives, might have cost the plan votes if it reached the Senate.

These included:

  • Changes to let states add work requirements for Medicaid recipients.
  • An option to let states receive a true block grant for Medicaid, instead of a per capita cap.
  • A change added late Thursday that strips the ACA of its 10 essential health benefits, and lets states decide what health plans must cover.

An update from the Congressional Budget Office Thursday found that the changes would have still cost 24 million people coverage, but cut the deficit by $150 billion, less than half the original bill.

As This Week in Managed Care taped Friday morning, a vote in the House was expected later in the day.

PCKS9 Results

Evolocumab, the cholesterol drug sold as Repatha, significantly reduces cardiac events after the first year without any cognitive side effects, according to separate studies presented last week at the American College of Cardiology Scientific Session.

But while many physicians were impressed with results of the FOURIER trial, some payers thought they were not enough to justify the drug’s $14,000 annual price tag.

Two separate studies presented at ACC showed that payers are refusing to approve evolocumab and another drug in the class called PCSK9 inhibitors. The studies found:

  • More than three-quarters of the initial prescriptions are rejected, although many decisions are later reversed
  • Commercial payers are more likely to reject prescriptions than Medicare, and
  • Cardiologists have an easier time getting prescriptions approved than primary care physicians

SGLT2 Results

AstraZeneca, the maker of dapagliflozin, funded a study that found the diabetes drug class SGLT2 inhibitors may prevent heart failure in patients who have not been diagnosed with the condition.

The study, called CVD-REAL, used health registries to examine questions raised by the EMPA-REG clinical trial, which found that another SGLT2 inhibitor, empagliflozin, reduced cardiovascular deaths and heart failure hospitalization in high-risk patients.

AstraZeneca’s Jim McDermott, PhD, explains the purpose of the study. Watch the interview.

Read all our coverage from the American College of Cardiology.

NCCN logo

The American Journal of Managed Care® is on the road again this weekend, bringing you coverage from the 22nd annual conference of the National Comprehensive Cancer Network in Orlando, Florida. The meeting is an opportunity to discuss new findings that result in updates to the NCCN guidelines, which payers use for reimbursement decisions.

Follow our coverage.

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

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