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This Week in Managed Care: March 30, 2018


This week, the top managed care stories included another insurer announcing it would pass on drug rebates to consumers; FDA approved a new continuous glucose monitor and created a new medical device class; new guidelines address how to treat people with both HIV and cancer.

Aetna joins UnitedHealthcare in passing on drug rebates, a Medicare milestone comes on Sunday, and new guidelines are created for people with HIV and cancer

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

Passing on Drug Rebates

As the public demands answers on drug prices, Aetna this week said it would pass on drug rebates to consumers, following a similar move earlier this month from UnitedHealthcare. However, only a small share of Aetna’s customers will see the effect.

Unlike UnitedHealthcare, which owns the OptumRx pharmacy benefit manager, Aetna wants to merge with CVS, a move that must be approved by federal regulators.

FDA Commissioner Dr. Scott Gottlieb criticized rebates and their lack of transparency in a recent speech before America’s Health Insurance Plans, where he called them, “Kabuki drug-pricing constructs” that lead to higher out-of-pocket costs for consumers.

Rebating is at the heart of a current lawsuit over insulin prices, and the 2 sides will interpret the Aetna and UnitedHealthcare decisions differently.

Medicare DPP to Start

Starting Sunday, up to 22 million Medicare beneficiaries will be eligible for the Diabetes Prevention Program (DPP), a 16-session program designed to keep those over age 65 from progressing to type 2 diabetes if they meet criteria showing they are at risk.

This is the first time in the history of Medicare that at-risk patients can get access to a preventive service at no cost. If current trends continued, diabetes is projected to increase 2-fold among adults age 18 to 79 by 2050, with unsustainable costs.

In 2016, Medicare spent an extra 42 billion dollars on beneficiaries with diabetes, which includes:

  • An extra $1500 on each person with diabetes for Medicare Part D for medication
  • An extra $3100 for each person on hospital and facility services
  • An extra $2700 for each person on clinical services

Solera Health, which provides regulatory and technical support services for DPP providers, will launch a website April 1 to help beneficiaries determine their type 2 diabetes risk, verify their eligibility, and find a program.

MedicareDPP.org will match all eligible beneficiaries with Medicare DPP suppliers that need CDC and CMS requirements. Watch the video.

Integrated Continuous Glucose Monitor System

People with diabetes learned this week that FDA approved a new continuous glucose monitor and created a new medical device class that should make future medical device approvals go more smoothly, as diabetes technology evolves at a rapid pace. The Dexcom G6 represents a major advance, and creates competition with recently approved devices from Medtronic and Abbott.

The patch device, about the size of a quarter, can send blood glucose readings to a mobile app on a cell phone. The device is factory calibrated and does not require users to take finger stick measurements to calibrate the sensor.

FDA said the new review process would let manufacturers bring products to market in the “least burdensome manner possible.”

Read more.

Treating Patients With HIV and Cancer

Cancer has been part of the story of HIV from the dawn of the disease, with Kaposi sarcoma identified as one of its early distinguishing conditions. Only now, however, has the National Comprehensive Cancer Network created a distinct set of guidelines for treating people with HIV and cancer, which were presented last weekend at the annual conference in Orlando, Florida.

Gita Suneja, MD, of Duke Cancer Institute said people with HIV have both AIDS-defining cancers and higher rates of cancer overall. This is due to higher rates of viruses that lead to cancer and higher rates of smoking in the HIV population. Among the new recommendations:

  • HIV status alone should not be used for cancer treatment decision making
  • Because many lesions may be noncancerous, the threshold for a biopsy is lower
  • Drug—drug interactions are possible, so consults between HIV specialists and pharmacists are needed
  • Anti-retroviral therapy is the backbone of treatment for Kaposi sarcoma
  • Lung cancer is the most common non-AIDS defining cancer for people with HIV
  • Autologous stem cell transplant has been shown to be effective for patients with HIV and recurrent or relapsing Hodgkin lymphoma

Institute for Value-Based Medicine Dinner

There is still time to register for the AJMC® live event, “Advancing Quality in Oncology Care,” a presentation of the Institute for Value-Based Medicine. The April 5 event at Rosen Shingle Creek in Orlando, Florida, will feature oncology and pharmacy experts:

  • Lucio Gordan, MD
  • Don Champlain, RN
  • Aaron Lyss, MBA
  • Chris Kepinski, PharmD

For more information and to register, visit the meeting page.

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

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