This Week in Managed Care: November 13, 2020

This week, the top managed care news included the Supreme Court signaling willingness to uphold the Affordable Care Act; Pfizer’s coronavirus disease 2019 vaccine shows 90% efficacy; racial disparities in lung cancer screenings and prescribing biologics.

Supreme Court signals willingness to uphold the Affordable Care Act, Pfizer says its COVID-19 vaccine shows 90% efficacy, and a look into racial disparities in lung cancer screenings and prescribing biologics.

Welcome to This Week in Managed Care, I’m Matthew Gavidia.

Supreme Court Signals Willingness to Uphold ACA

This week, the Supreme Court heard oral arguments in California v Texas, the case brought by Republican attorneys general in 18 states to repeal the Affordable Care Act, or ACA.

During the arguments conducted via teleconference, Chief Justice John Roberts and conservative Justice Brett Kavanaugh called into question Republican arguments claiming that if one provision of the ACA falls, the entire act must be invalidated and found unconstitutional.

“It’s hard for you to argue that Congress intended the entire act to fall if the mandate was struck down,” Roberts said. He continued, “We ask ourselves whether Congress would want the rest of the law to survive if an unconstitutional provision were severed,” while noting that Congress opted to leave the rest of the law intact in 2017. “That seems to be compelling evidence.”

In 2017, Trump eliminated the individual mandate—the heart of the ACA that requires everyone to have health coverage and lays the groundwork for a risk pool that is more balanced between the sick and the healthy, the young and the old. Subsequently, in 2019 the Fifth Circuit of the United States Court of Appeals ruled the mandate unconstitutional.

The filing accuses the ACA of inflicting “classic pocketbook injuries on the states,” in addition to preventing states from enforcing their own laws and policies.

The 3 liberal justices on the court will most likely vote to uphold the ACA in its entirety, while more conservative Justices Kavanaugh and Roberts seem to be leaning toward upholding the bulk of the ACA. Kavanaugh stated that recent court decisions suggest “the proper remedy would be to sever the mandate and leave the rest of the act in place.”

However, some conservative justices also indicated Republican challengers did have the proper standing to bring the legal challenge. They described instances where an individual may be able to file a suit over a government mandate in the absence of a penalty.

For more, visit

Pfizer Says Vaccine 90% Effective; Biden Team Announces COVID-19 Transition Panel

This past Monday, Pfizer said interim data on its COVID-19 vaccine show 90% efficacy; meanwhile, the transition team for President-elect Joe Biden and Vice President–elect Kamala Harris released the names of the scientific, medical, and public health professionals who will serve on its Transition COVID-19 Advisory Board.

Led by cochairs Dr David Kessler; Dr Vivek Murthy; and Dr Marcella Nunez-Smith, the advisory board met with Biden, who said his administration “will follow the science” in fighting the virus.

Worldwide, COVID-19 has killed more than 1.2 million people and more than 240,000 in the United States. While promising, the Pfizer announcement doesn’t mean a vaccine against SARS-CoV-2, the virus that causes COVID-19, is imminent.

“More data on safety is also needed, and we are continuing to accumulate that safety data as part of our ongoing clinical study,” said Pfizer CEO Albert Bourla in a statement.

Authorities have stressed it’s unlikely any vaccine will be available before the end of the year, with initial supplies expected to go to health care workers and vulnerable populations. These sentiments were shared by Biden, as he said that production and capacity for any vaccine would take months.

Both announcements came less than 48 hours after the race was called for Biden by the Associated Press and all news networks after incumbent President Donald Trump failed to reach the 270 Electoral College vote threshold.

Speaking on this past Sunday’s “Face the Nation,” former FDA Commissioner Dr Scott Gottlieb predicted that Biden would be taking office at the “apex” of the pandemic and then it would hopefully start to decline, but said the virus would not be conquered in 2021.

“And the only question is going to be how many people have died in the course of this and how many people have been infected. And we have to keep those numbers down as much as possible," said Gottlieb.

For more, visit

Lung Cancer Screening Criteria Miss Young, High-Risk Black Smokers

In assessing racial disparities across health care, an abstract presented at the CHEST 2020 annual meeting suggests that the current US Preventive Services Task Force, or USPSTF, lung cancer screening recommendations may be failing young, Black smokers.

Screenings are a crucial step in catching cancer in its early stages and have been shown to lower cancer mortality. Because lung cancer is the deadliest type of cancer worldwide, much focus has been placed on improving screening for the disease, including analyzing the USPSTF guidelines’ inclusivity. Researchers aimed to find out if the general screening guidelines are sufficient in communities with many young, Black smokers.

About 33% of lung cancer patients in the study were diagnosed before the age of 55 and were therefore ineligible for yearly screenings based on the USPSTF guidelines. Close to 50% of patients in that group were African American, 95% of whom had a known smoking history. Of those patients, 80% were in advanced stages of cancer by the time they were diagnosed.

The authors consider more individual risk-based low-dose CT screening guidelines to be a possible solution.

In another study examining the presence of racial disparities among patients with rheumatoid arthritis, findings show that Black patients are less likely to be prescribed a biologic than White patients.

Historically, the impact of racial disparities on access to care and effective treatment options have been poorly understood, although previous research has indicated that non-White patients are less likely to use a biologic than White patients, even when accounting for comparable disease activity and access to treatment.

The study, drawing on data from over 1800 patients from 2010 to 2018, also found that Black patients with rheumatoid arthritis were more likely to be prescribed glucocorticoids, which come with a risk of serious long-term adverse effects.

“With the explosion of effective therapies for rheumatoid arthritis, it is particularly important to make sure that we are treating patients in the best way possible,” said Dr Michael George, assistant professor of medicine at the Hospital of the University of Pennsylvania, and co-author of the study, in a statement. “Variability in practice, and disparities in treatment, suggest that there is room for significant improvement.”

For more, visit

Bang for the Buck: How Health Care Innovation Affects Life Expectancy and Patient Well-Being

During a 60-minute discussion, the speakers on The American Journal of Managed Care® webinar "Bang for the Buck: How Health Care Innovation Affects Life Expectancy and Patient Well-Being" highlighted where health care has improved life expectancy and which areas, such as public health, drugs, and hospital care, have contributed the most.

Dr Robert Dubois, interim president and CEO of the National Pharmaceutical Council, moderated the discussion with:

  • Mariam Alboustani, clinical pharmacy manager of Medicare Pharmacy Services at Blue Cross Blue Shield of Michigan
  • Jason Buxbaum, PhD candidate in health policy at Harvard University
  • Michael Ciarametaro, vice president of research at the National Pharmaceutical Council
  • And Dr David Cutler, Otto Eckstein Professor of Applied Economics at Harvard University

The speakers framed the discussion around 3 papers published in the last year about the connection between health care spending and value creation.

For more, visit

Paper of the Week

And, now our paper of the week, which looks back at some of the most important papers over the past 25 years of The American Journal of Managed Care® and why they matter today.

The COVID-19 pandemic has brought increased attention to health care disparities, but this has been a rich area of study for years.

A 2014 paper, “Beyond Black and White: Race/Ethnicity and Health Status Among Older Adults,” drew attention to the fact that seniors from racial or ethnic minority backgrounds are at higher risk than white seniors for a range of poor health and functional outcomes.

Except for some Asian groups, older adults from minority populations were significantly more likely than whites to report poor mental health status, sensory limitations, multiple symptoms, and the inability to complete activities of daily living.

One challenge, the paper noted, was the fact that older adults from minority groups are less frequently seen in clinical trials.

For the paper, visit

For all of us at AJMC®, I’m Matthew Gavidia. Thanks for joining us!