This Week in Managed Care: May 24, 2019

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This week, the top managed care news included a study questioning the Hospital Readmissions Reduction Program; FDA issuing a warning about do-it-yourself artificial pancreas systems; measles cases reach the highest level since 1994.


Another study questions the Hospital Readmissions Reduction Program, a do-it-yourself diabetes tools catch FDA’s attention, and measles cases reach the highest level in 25 years.

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

Hospital Readmissions Reduction Program Questioned

Fewer Medicare beneficiaries are readmitted to the hospital today due to the Hospital Readmissions Reduction Program. But new research in Annals of Internal Medicine adds to the argument that the program's assumptions about who influences readmissions may not be correct.

The new study suggests that readmission rates varied little among primary care physicians (PCPs), while the current CMS program calls for giving rewards and penalties based on their readmission rates.

The authors wrote, “Our finding of minimal variation in risk for readmission among PCPs calls into question any pay-for-performance program that aims to reduce readmissions and assumes variation by PCP.”

For more, visit

FDA Warns About Do-it-Yourself Artificial Pancreas

FDA this week issued it first-ever warning about do-it-yourself artificial pancreas systems, after a patient suffered an accidental insulin overdose. Do-it-yourself systems combine approved insulin pumps and continuous glucose monitors with open source software. They appeared in 2015, after patients and parents of children with type 1 diabetes grew tired of waiting for approval of a closed loop system to automatically dose insulin, often called an artificial pancreas.

The FDA statement said, “These devices were not designed to be used together and were combined in a way that had not been thoroughly tested for compatibility.”

Developers of the most popular systems made a statement on Twitter calling for do-it-yourself users to report adverse events. So far, FDA has never taken action against do-it-yourself developers.

For more, visit

Measles Cases Continue to Climb

The measles outbreak in the United States has reached 880 cases, the highest number since 1994. Forty-one new cases have been reported in the past week, including 30 in New York State. CDC officials say measles cases have reached 24 states, and they do not know if the outbreak has slowed. The agency issued the following recommendations on vaccinations:

  • The first dose should be given between 12 and 15 months of age
  • The second dose should be given between 4 and 6 years of age
  • Teens and adults should be up-to-date on the measles-mumps-rubella vaccination

Schizophrenia Drug Shows Less Weight Gain

At this week’s meeting of the American Psychiatric Association, Alkermes presented data on an experimental combination therapy that gives patients with schizophrenia the benefits of olanzapine with less weight gain. Adam Simmons, Alkermes’ Director of Clinical Program Management, told AJMC® that limiting weight gain is an important consideration for these patients.

For more coverage from the 175th Annual Meeting of APA, visit

Panelists Debate the Role of the Institute for Clinical and Economic Review

Finally, the rise of the Institute for Clinical and Economic Review has been an important development in the value discussion for therapies. Whether ICER has contributed to better decision-making or a loss of choice was a highlight of this week’s ISPOR annual meeting in New Orleans.

Said Michael Sherman, MD, MBA, MS, chief medical officer and senior vice president, Harvard Pilgrim Health Care, “It helps me look at drugs in the context of not ‘what is the price tag?’ but ‘what do you get for your money?’”

For all our coverage from ISPOR, visit

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