This Week in Managed Care: May 14, 2016

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This week, the top managed care stories included an exclusivity deal that has patients with type 1 diabetes unhappy, a report found the healthcare system could have saved $73 billion from greater use of generics, and The American Journal of Managed Care seeks your nominations for an emerging leader award.


Hello, I’m Justin Gallagher, associate publisher of The American Journal of Managed Care. Welcome to This Week in Managed Care, from the Managed Markets News Network.

Future of Healthcare

Will the Affordable Care Act survive the Obama administration? Despite what you hear in the presidential elections, experts who took part in the recent meeting of the ACO & Emerging Healthcare Delivery Coalition think repealing the federal healthcare law won’t be easy.

That was just one of the takeaways from the meeting in Scottsdale, Arizona, where a panel that included AJMC co-Editor-in-Chief Michael E. Chernew, PhD, said no matter who is elected president, Medicaid expansion at the state level will be hard to reverse. Said Dr Chernew: “If it looks like (the ACA) is really here to stay, you’ll see more states expanding.”

Other key points at the meeting included:

  • the need to integrate primary care and behavioral health
  • ACO accreditation is voluntary—for now
  • Technology is connecting providers to patients and to each other
  • The future will be about precision medicine.

To learn more about AJMC’s ACO Coalition, or to register for our October meeting in Philadelphia, visit the ACO Coalition page.

UnitedHealthcare-Medtronic Deal

It’s been common for health plans or pharmacy benefit managers to arrange exclusive contracts with one manufacturer when a new drug class reaches the market. But UnitedHealthcare took this practice a step further when it announced a plan to transition most of its type 1 diabetes members to Medtronic insulin pumps, starting July 1.

A UnitedHealthcare spokeswoman told AJMC this week that the primary criterion for selecting Medtronic was safety, and a company bulletin said patients would have access to the MiniMed 530-G, which has a feature that stops insulin delivery if blood sugar levels fall below a preset level.

While UnitedHealthcare will have a process for medical exceptions, influential bloggers in the type 1 community said that’s not the point.

Kerri Sparling, who writes the blog Six-Until-Me, said those with type 1 diabetes have an “intimate” relationship with a device they wear around the clock. Sparling wrote on her blog: “We’re not talking about T-shirts here; this is a medical device that is part of every moment of every day, and you’d better believe that access to have a choice matters.”

Elsewhere in healthcare, patient engagement is a huge challenge. Recently, Dr Karen Van Caulil of the Florida Health Care Coalition spoke with AJMC about the difficulty of educating consumers about how to shop for value in healthcare, when basic issues like medication adherence are still an uphill climb. Watch the video here.

Savings With Generic Drugs

Greater use of generic drugs could mean savings for patients and the healthcare system, according to a new study in JAMA Internal Medicine. Researchers who looked at the years 2010 to 2012 found that patients could have saved $25 billion, and the healthcare system $73 billion, if more patients used generics in major categories such as statins, atypical antipsychotics, and proton pump inhibitors.

But one problem that has emerged since 2012 is the rising cost of generics. A report from HHS found that last year, 22% of generic drugs had price hikes that exceeded the levels that are allowed for branded drugs in Medicaid.

Emerging Leader Award

Do you know a rising star in managed care? If so, nominate that person for AJMC’s Seema S. Sonnad Emerging Leader in Managed Care Research Award.

The prize recognizes a scholar within 5 years of a terminal degree who is showing the potential to make lasting contributions to the field. Nominations are due July 11th and the award will be presented during our ACO Coalition meeting in October.

For more information, click here.

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