This Week in Managed Care: May 21, 2016

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The top stories in managed care included the Supreme Court declining to rule on the contraception case Zubik v Burwell, Oklahoma and Louisiana both move toward expanding Medicaid, and the price of the opioid overdose drug naloxone has increased 17-fold over 2 years.


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.

SCOTUS Punts Contraception Case

The Supreme Court this week declined to rule in a challenge to the Affordable Care Act’s contraception mandate. In Zubik v Burwell, the Little Sisters of the Poor objected to a notification requirement that would let nursing home staff have access to birth control without the sisters’ direct involvement.

Still operating with a vacancy because of the death of Justice Antonin Scalia, the justices sent the case back to a lower court, and asked the parties to work out a compromise. Because the case consolidates seven others, and because religious nonprofits employ thousands of people, the case could still have a far-reaching impact.

2 More States Move to Expand Medicaid

Governors from both ends of the political spectrum are moving to expand Medicaid to the working poor.

In Louisiana, Governor John Bel Edwards is using the state’s food stamp program to identify those who will automatically qualify for coverage starting July 1. Up to 375,000 people could be newly eligible for coverage. Edwards a Democrat, made Medicaid expansion a centerpiece of his campaign for governor last fall.

Meanwhile, in Oklahoma, Republican Governor Mary Fallin is reversing her longtime opposition to expansion because of a state budget shortfall. Oklahoma has a $1.3 billion budget deficit due to falling oil prices, and without expansion, the state would be forced to cut doctors’ fees 25%.

Healthcare experts believe that fee cut would cripple rural clinics and leave 33,000 residents without access to coverage. Under the proposal, Medicaid could enroll more than 600,000 new participants. Fallin calls for paying the state’s 10% share of expansion by raising cigarette taxes $1.50 per pack.

Overdose Drug's Price Rises

Prices for the drug naloxone, sold as Narcan, have increased 17-fold in the past 2 years, just when it’s most needed.

Naloxone reverses opioid overdoses and prevents accidental deaths. Even though it’s 45 years old, its cost is soaring as more local governments and emergency responders have started keeping it on hand.

While the Obama Administration has tried to help local governments pool their purchasing power to save money, it hasn’t stop complaints about the greed of the pharmaceutical industry.

According to Eliza Wheeler, who runs an overdose prevention program in California: “You have increased demand and few people who control the pricing, so they can charge whatever they want.”

Cancer Prevention and Detection

A report from the American Cancer Society (ACS) found that prevention and early detection programs are saving lives—but only in cancer types that have screening tools available.

Tests are now available for lung, breast, colorectal, and prostate cancer, along with recommendations on who should be screened. These tests, along with tobacco control efforts, have allowed ACS to get halfway to its goal of reducing cancer mortality by 50% from 1990 levels.

ACS’ chief medical officer, Dr Otis Brawley, and cancer control officer, Dr Richard Wender, wrote that for more lives to be saved, more Americans will need access to new screening tools. The next big target will be to screen more Americans for hepatitis C, which can lead to liver cancer. Death rates for living cancer have doubled since 1990.

Hepatitis C Treatment and Cost

The need for improved screening of hepatitis C, and better access to therapy, will be the topic of a Capitol Hill briefing this Monday. “Ending Hepatitis C: The Value of Curing the Nation’s Deadliest Blood-Borne Disease,” will feature authors from the recent special issue of The American Journal of Managed Care.

The briefing will be held from noon to 1:30 pm in the Dirksen Senate Office Building. For information and to register, click here.

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