This Week in Managed Care: May 19, 2017

This week, the top managed care stories included the White House budget director hinting at mandatory drug rebates in Medicare; a global cyberattack locked physicians out of patient records; and the National Diabetes Prevention Program released promising data from the first 4 years.

Trump’s budget director hints that Medicare could require drug rebates, seniors face large out-of-pocket costs for healthcare, and a cyberattack hit hospitals around the globe.

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

Drug Rebates in Medicare

Could mandatory rebates be part of the answer to rising drug costs in Medicare?

While speaking last weekend at a conference at Stanford, Mick Mulvaney, President Donald Trump’s budget director, said rebates might be on the table. While mandatory discounts are required in Medicaid, they were left out of Medicare Part D as a condition of getting the program approved in 2006.

But that could change, as polls find both Democrats and Republicans are frustrated by rising drug costs.

According to The Washington Post, Mulvaney said, “We’ve floated the idea with the president, to be a little bit heavier-handed on the rebates they have to pay in order to drive the prices down.”

The Pharmaceutical Researchers and Manufacturers of America said mandatory rebates in Medicare would make it harder for seniors to have access to drugs and end up increasing costs for beneficiaries.

High Cost Burden in Medicare

Talk of price-fixing for Medicare drugs comes as a report from the Commonwealth Fund finds seniors are paying more than ever out-of-pocket for healthcare.

The report found that supplemental coverage can be expensive, and the lack of a cap on out-of-pocket costs means that 27 percent Medicare beneficiaries are spending at least 20 percent of their income on insurance premiums and other healthcare costs.

What’s more, those with both low incomes and poor health were most likely to have a high cost burden for healthcare. For example, dental care is not covered by traditional Medicare, which adds to the cost burden.

The study concluded: “As the single largest purchaser of healthcare in the country, Medicare policies directly influence insurance and care systems across the country. With a projected one-fifth of the population on Medicare by 2024, keeping beneficiaries healthy and financially independent is important to beneficiaries, their families, and the nation.”

Global Cyberattack

A cyberattack that hit Great Britain’s National Health Service and affected hospitals across the globe locked physicians out of patient records and caused cancellation of surgeries last week.

By Monday, more than 200,000 hospitals, corporations, and agencies in 150 countries had been affected by the attack, which involved a ransomware bug that asked affected parties to pay a $300 fee in Bitcoins to re-gain access to their computers.

The hackers used a vulnerability that had been developed by the National Security Agency, which had been stolen and posted online. While Microsoft had developed a patch to fix it, many hospitals had not installed the repair—something the hackers knew.


The vulnerability of health systems to cyberattacks was a topic of the recent meeting of the ACO & Emerging Healthcare Delivery Coalition.

Read coverage of our panel discussion about cybersecurity in healthcare.

Diabetes Prevention Results

The National Diabetes Prevention Program has produced promising results in its first 4 years, according to data reported this week in the journal Diabetes Care.

An analysis of results from nearly 15,000 adults who took part in the yearlong program between 2012 and 2016 found that the average person took part in 14 sessions over 172 days, with an average weight loss of 4.2%.

The study also found that 42% of the people met the exercise standard of 150 minutes per week.

Results showed that the greater the level of participation, the more weight people lost, and some programs made adjustments to the program design to keep people engaged after the first 16 weeks, before the maintenance period began.

Medicare is scheduled to start offering the Diabetes Prevention Program in January, after a pilot program showed a savings of $2650 over 15 months. Right now, diabetes accounts for $1 of every $3 spent in Medicare, and CMS is looking for ways to halt the number of people who progress to type 2 diabetes.

Special Issue of EBOTM

Richard Pazdur, MD, whose name is synonymous with breakthrough cancer therapies at FDA, has written a commentary on the new Oncology Center of Excellence for a special edition of Evidence-Based Oncology, which features coverage from the spring Oncology Stakeholders Summit.

Pazdur writes how the new Center of Excellence is a natural evolution of the FDA’s steps in recent years to bring life-saving therapies to patients as quickly as possible, and one made possible by former President Barack Obama’s National Cancer Moonshot Initiative, which was launched in his final State of the Union address.

Besides coverage of the Summit itself, the special issue features a perspective from the Institute for Clinical and Economic Review.

Read the special issue.

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

Thanks for joining us.