This Week in Managed Care: May 28, 2016

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This week in managed care, the top stories included new guidelines for treating obesity, updated guidelines for heart failure, and a study shed light on a shift in payment for opioids.


Hello, I’m Brian Haug, president of The American Journal of Managed Care. Welcome to This Week in Managed Care, from the Managed Markets News Network.

New Guidelines for Treating Obesity

The world’s largest group of endocrinologists this week issued a comprehensive set of clinical guidelines for treating obesity.

The American Association of Clinical Endocrinologists issued a set of 9 clinical questions and 160 statements built around a new framework for looking at obesity: The priority, the authors said, should be to reduce weight-related complications, not weight loss per se.

With that in mind, the AACE Scientific Committee laid out conditions when obesity therapy and bariatric surgery are called for, including to eliminate conditions like gastric reflux and incontinence, and, in the case of surgery, to reverse type 2 diabetes.

AACE was one of the first professional societies to declare obesity a disease in 2012. Like other physician groups, it has been frustrated by ongoing stigma and resistance to payer coverage for therapy, as discussed at our recent conference, Patient-Centered Diabetes Care.

Said AACE Scientific Committee chair Dr Timothy Garvey: “Our rationale for creating these guidelines was the fact that obesity medicine lacks comprehensive and evidence-based guidelines that are translatable to real-world clinical care of patients with obesity.”

Heart Failure Guidelines

Updated heart failure guidelines issued this week are expected to give a boost to Novartis’ Entresto, the angiotensin receptor-neprilysin inhibitor approved last July. The American College of Cardiology, the American Heart Association, and the European Society of Cardiology jointly timed statements that call for replacing using Entresto in place of older ACE inhibitors or ARBs in stable heart failure patients with adequate blood pressure and good drug tolerance.

Separately, the 3 groups said Amgen’s Corlanor may be beneficial in reducing heart failure hospitalization in certain patients with stable, chronic disease.

An editorial in the Journal of the American College of Cardiology said the coordinated statements were designed to: “...promote optimal care for all patients with all forms of cardiovascular disease, to improve outcomes and enhance quality of life around the world.”

Who Paid for the Opioid Epidemic?

The rapid rise in opioid deaths is troubling enough—but now a new study shows that a sizeable share of the epidemic was funded by taxpayers. Researchers from CDC, reporting in Health Affairs found that between 1999 and 2012, more of the cost of opioids shifted to private and public payers, especially after the arrival of Medicare Part D in 2006.

During this same period, deaths from opioids quadrupled, and death rates rose fastest among those ages 55 to 64. Researchers noted that Medicare spending on opioids was actually higher among those younger than 65, because Part D also covers prescription drug spending on disabled persons in Medicaid. In fact, since 2006, Medicare has become the largest payer for opioid medication in the country, covering between 20% and 30% of the cost.

ASCO Annual Meeting

The annual meeting of the American Society of Clinical Oncology is next week in Chicago. To sign up for coverage that will appear June 4-6, click here. More and more, discussions about value in cancer care are taking place at ASCO, including how each patient views value differently. Dr Alan Balch of the Patient Advocate Foundation discussed this at our recent Oncology Stakeholders Summit. See what he had to say.

And watch the entire Spring 2016 Oncology Stakeholders’ Summit.

Latest EBDM Issue

One of every $ 3dollars in Medicare is spent on diabetes. With that in mind, the new issue of Evidence-Based Diabetes Management is devoted to the best ways to prevent and treat diabetes among seniors. The new issue includes commentary on:

  • Scaling the Diabetes Prevention Program in Medicare
  • Quality measures for senior diabetes care
  • A case study in medication management
  • A patient’s appeal to Medicare for CGM coverage
  • A payer perspective from Florida Blue

Read the full issue.

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