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This Week in Managed Care: May 10, 2019


This week, the top managed care news included HHS announcing a finalized rule requiring the disclosure of drug prices in television ads; a report finding high satisfaction with employer health coverage despite the cost; a study finding heart failure is surging among young adults.

Drug prices will be in TV ads starting this summer, a report finds workers like their employer health coverage despite the cost, and a new study finds rising heart failure among young adults, despite new drugs that can prevent it.

Welcome to This Week in Managed Care, I’m Jaime Rosenberg.

HHS Finalize Rule to Include Drug Prices in TV Ads

A plan to put drug prices in TV ads will take effect later this summer, after HHS finalized a rule this week.

HHS Secretary Alex Azar, JD, outlined the plan in a call with reporters, and said TV drug ads must meet the following tests:

  • They must include wholesale acquisition costs for drugs that cost more than $35
  • They must state that patients with insurance may pay less
  • They cannot direct people to a website to find prices
  • The rules apply for drugs sold in Medicare and Medicaid

Said Azar, “Requiring the inclusion of drugs’ list prices in TV ads is the single most significant step any administration has taken toward a simple commitment: American patients deserve to know the prices of the healthcare they receive.”

The move is part of American Patients First, the Trump Administration’s plan to cut drug prices.

For more visit ajmc.com.

High Satisfaction With Employer Coverage, but Challenges Persist

Most people with health coverage from their employer are happy with the plan, a new survey has found. But results from Kaiser Family Foundation and the Los Angeles Times show that worker attitudes differ greatly based on whether they are in a high-deductible or low-deductible plan.

The authors found: “The higher the deductible, the more likely an individual is to have negative views of their health plan, and the more likely they are to experience problems affording care or to put off care due to cost.”

Low incomes, high deductibles, and having chronic conditions were all linked with having trouble affording healthcare. The survey found:

  • 49% of workers with the highest deductibles reported having trouble paying for care.
  • Only 27% of workers with no deductible had trouble paying for care.
  • 49% of those who had someone on the plan with a chronic condition reported affordability issues compared with 29% who had no one on the plan with a chronic condition.

Amgen and Syapse Partner for Precision Medicine in Oncology

Biotech giant Amgen and data integrator Syapse have announced a partnership to create observational research analytics, in which Syapse will use its network and analytics tools to help Amgen find patients who could be eligible for its clinical trials. Last year, FDA announced a strategic framework for expanding the use of real-world evidence in drug approvals. Under the collaboration, Amgen and Syapse will work together on standards for using real-world evidence to speed therapies to market.

Said Mike Nohaile, senior vice president of Strategy, Commercialization, and Innovation at Amgen: “As cancer remains one of the leading causes of death around the world, emerging software and data analytic tools are creating exciting opportunities to more rapidly develop and deliver targeted treatment options to patients. Our collaboration with Syapse supports this effort by leveraging real-world evidence to accelerate bringing new oncology treatments to market and empowers healthcare providers with more robust insights and decision-making tools to improve patient care.”

Heart Failure—Related Deaths Surge in Young Adults

Heart failure is surging among young adults, according to new data reported in The Journal of the American College of Cardiology. The paper suggested that rising rates of obesity and diabetes could be behind the increase. The report comes even though new classes of therapy, sodium glucose co-transporter 2 inhibitors and glucagon-like peptide-1 receptor agonists, have been shown to reduce hospitalization for heart failure.

The classes were featured in recent primary prevention guidelines from the American College of Cardiology (ACC) as well as the ACC Expert Consensus Decision Pathway, which was the subject of the recent AJMC®-sponsored session of the Institute for Value-Based Medicine.

To read more about the session in Los Angeles featuring Peter Butler, MD, professor of medicine at the David Geffen School of Medicine at UCLA and director of the Larry L. Hillblom Islet Research Center; Anne Peters, MD, professor of medicine at the Keck School of Medicine at the University of Southern California and director of the USC Clinical Diabetes Programs; Karol E. Watson, MD, PhD, FACC, director of the UCLA Barbra Streisand Women’s Heart Health Program, co-director of the UCLA Program in Preventive Cardiology, and director of the UCLA Cardiology Fellowship; and Sachin H. Jain, MD, MBA, president and chief executive officer for CareMore Health, visit ajmc.com.

Louisiana's Subscription Payment Model for Hepatitis C Drugs

Finally, our latest podcast features Rebekah Gee, MD, the Commissioner of Health for Louisiana, who negotiated a subscription or “Netflix” style agreement for antiviral therapy for her state’s Medicaid patients and Corrections patients with hepatitis C virus. The agreement with Asegua Therapeutics, a division of Gilead, will last for 5 years.

​​​You can hear our podcast on these services: iTunes, TuneIn, Stitcher, and Spotify.

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

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