This Week in Managed Care: November 1, 2019

This week, the top managed care stories included a report from the FDA considering how to avoid drug shortages; a white paper finds rising comfort with telehealth even as use of digital health tools stagnates; data show a spike in the number of uninsured children.

FDA asks how to avoid drug shortages, a report finds rising comfort with telehealth, and data show a spike in the number of uninsured children.

Welcome to This Week in Managed Care, I’m Christina Mattina.

Preventing Drug Shortages

In the wake of recent drug shortages, FDA this week identified 3 factors that contribute to the problem—including few incentives to make less profitable drugs.

A report from the FDA-led Interagency Drug Shortage Task Force asks Congress for more power to avoid shortages, such as a recent disruption of vincristine, a key pediatric chemotherapy that now has only one supplier.

In a joint statement, FDA’s Ned Sharpless, MD, and Janet Woodcock, MD, said, “Despite public- and private-sector efforts to prevent and mitigate drug shortages, they continue to occur and persist. These results suggest a broken marketplace, where scarcity of drugs in shortage or at risk for shortage does not result in the price increases predicted by basic economic principles.”

The report calls for 3 policy solutions:

  • Create a “shared understanding” of how drug shortages affect patients and how contracting practices give rise to them, with better data on the costs and outcomes.
  • Create a rating system to prod manufacturers to invest in facilities. Ratings would have to be disclosed in purchasing contracts.
  • Promote “sustainable” private sector contracts to ensure reliable supplies of key drugs through financial incentives for manufacturing or quality management.

A new draft guidance and language for FDA’s 2020 budget are expected to address this issue.

Read more.

Digital Health Tool Utilization Stagnates

Use of digital health tools has leveled off in 2019, but not all groups are using technology at the same rate, according to a new white paper. The paper from Rock Health and Stanford Medicine found that digital health tracking was the only tool with increased use from 2018 to 2019.

Wearable ownership remained at 33%, while online provider reviews also held steady at 64%. Use of Live video telemedicine and online health medicine both fell slightly.

The paper identified three trends:

  • Patient-generated health data create both opportunities and challenges.
  • Online health information is changing the patient-physician relationship, and
  • Willingness to share health data depends on who will see it.

Meanwhile, people are happier with telehealth as more consumers try it. JD Power findings show the sector is poised for growth, with 65% of users saying they tried it because it was recommended by someone they knew or their health plan.

Said Greg Truex of JD Power, “Telehealth offers an alternative avenue to receive quality care that is cost efficient and accessible. Once providers and payers refine the formula for awareness and adoption, telehealth will change the landscape of how affordable and quality care is delivered.”

More Uninsured Children

The number of uninsured children in the United States rose by 400,000 between 2016 and 2018 and is above 4 million, a new report finds.

The Georgetown University Center for Children and Families finds that policies from the Trump administration affecting Medicaid and families that may include immigrants are wiping out gains in coverage that took place during the early years of the Affordable Care Act. Children in states that did not expand Medicaid are twice as likely to be uninsured as those who live in states that did expand Medicaid.

The report cited the long delay in renewing funding for the Children’s Health Insurance Program and cuts to the navigator program, which helps people shop for coverage.

Said Georgetown’s Joan Alker, ”The decline in health coverage occurred at a time when children should have been gaining coverage in the private market and is a red flag for policy makers, as even more children would likely lose coverage in an economic downturn.”

Diabetes Prevention

Reports that CMS’ faulty roll out of the Medicare Diabetes Prevention Program (MDPP) has caused the number of enrollees to fall short of expectations prompted a bipartisan group of senators to ask the agency to reconsider allowing online providers to offer the program for reimbursement.

Led by Senators Tim Scott, a South Carolina Republican, and Mark Warner, a Virginia Democrat, the 19 lawmakers appear prompted by report in Politico that only a few hundred seniors enrolled in the Medicare benefit the first year.

Information provided to The American Journal of Managed Care® (AJMC®) said the report was inaccurate and that a full enrollment report will come this fall.

The senators wrote: “Virtual delivery of MDPP has the ability to empower beneficiaries to access MDPP regardless of where they live, and in the format of their choosing. Because of the outcome-focused reimbursement structure, CMS is insulated from reimbursing for ineffective treatment. Medicare Advantage plans have also been vocal in their desire to deploy virtual DPP for their beneficiaries.”

Read more.

Data Drives Value

The need for data was a major theme at 2 conferences AJMC attended this week.

Pharmaceutical leaders at the Community Oncology Alliance’s Payer Exchange Summit, held in Tyson’s Corner, Virginia, discussed the need for data to propel value-based contracts in the era of 2-sided risk.

In National Harbor, Maryland, pharmaceutical leaders at AMCP Nexus discussed how real-world evidence will be increasingly important in drug approvals.

For coverage from both meetings:

COA Payer Exchange Summit

AMCP Nexus 2019

For all of us at AJMC®, I’m Christina Mattina,

Thanks for joining us.

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