This Week in Managed Care: March 5, 2016

March 5, 2016

The top managed care stories this week include a cost-sharing roundtable, an AARP study on rising drug prices for seniors, research on waste in cancer drugs, and HHS released new rules for the health insurance marketplaces.

Hello, I’m Brian Haug, president of The American Journal of Managed Care. Welcome to This Week in Managed Care, from the Managed Markets News Network.

Cost-Sharing Roundtable

This week, AJMC and the Patient Access Network Foundation hosted a roundtable in Washington, DC, on the economic hardships that patients face as cost-sharing burdens increase in cancer and other therapeutic areas.

Economists, patient advocates, health policy experts and others joined the discussion which featured case studies that were part of the PAN Challenge, a project that seeks solutions for what rising out-of-pocket costs mean for patients.

This month, AJMC will publish 2 winning case studies in a special issue.

Read more about the discussion and the PAN Foundation.

Seniors Face Rising Drug Costs

There was more news this week on the high cost of drugs. On Tuesday, AARP issued a report that found retail prices for drugs commonly used in Medicare are rising at six times the rate of inflation, which is putting a heavy burden on seniors.

Seniors must pay more out of pocket for prescriptions, but because inflation has remained flat, their Social Security payments have not kept pace—in fact, there was no increase in 2016. AARP found the average annual cost of the 622 drugs commonly used in Medicare was $11,341 in 2013, more than twice the average cost from 2006. Most of that increase is due to skyrocketing costs in specialty pharmacy—which includes drugs for cancer and hepatitis C.

Wasting Cancer Drugs

Unfortunately, patients and health plans may be paying for cancer drugs that go to waste, according to Peter Bach, MD, of Memorial Sloan Kettering Cancer Center.

This week Dr Bach and authors from the University of Chicago published a study that found many doses of cancer therapy are much larger than necessary, and what is leftover is thrown away for safety reasons. It will cost the healthcare system $1.7 billion in 2016, the study found.

Dr Bach said: “This is due to decisions about how much drug companies decide to put in each dose vial. They almost certainly realize how these decisions translate into revenue.”

Insurance Marketplace Rules and Health IT Pledge

CMS this week issued final rules for the 2017 health insurance marketplaces, which include new provisions to limit “surprise bills” for consumers. However, some aggressive proposals to impose minimum provider network standards were left out. Open enrollment will begin November 1, 2016, and end January 31, 2017.

HHS Secretary Sylvia Burwell announced a pledge between major health IT developers and the federal government to improve the flow of information. The pledge, which covers companies that provide 90% of electronic health records used, includes 3 core commitments for better consumer access, improved transparency, and a plan to implement federal standards for electronic health records.

  • Better consumer access
  • Improved transparency
  • Standards for EHR

Tier Controversy

Next week, a New Jersey Senate committee will discuss 3 bills that would increase transparency in creating tiered rating systems, following the controversy over the creation of the Horizon OMNIA plan. Most of New Jersey’s Catholic hospitals have sued over being left out of OMNIA’s preferred tier.

Sister Patricia Codey, of the Catholic Healthcare Partnership of New Jersey, spoke with AJMC about the legislation.

Patient-Centered Diabetes Care 2016

New Jersey is the location of our upcoming meeting, Patient Centered Diabetes Care, which takes place April 7-8 in Teaneck. For more information and to register, click here.

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