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This Week in Managed Care: November 2, 2018


This week, the top managed care news included a proposal to allow Medicare to pay the same prices for certain drugs as what other countries pay; President Donald Trump signed a law to fight the opioid crisis; an FDA advisory panel voted narrowly to retain a 10-year-old guidance for safety trials for diabetes drugs.

Medicare drug prices may be tied to what other countries pay, President Donald Trump signs a law to fight the opioid crisis, and changes may be coming to safety trials for diabetes drugs.

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

Basing Medicare Prices on an International Index

President Trump wants to stop “global freeloading” by linking drug prices in Medicare Part B to an International Pricing Index.

The proposal, unveiled during a speech by the president at HHS, would create the index in 2020 and start by targeting single-source drugs and biologics. Officials estimate basing what Medicare pays on the index could trim drug spending by 30%.

Said Trump, “At long last drug companies and foreign countries will be held accountable for how they rigged the system against American consumers.”

But the idea found immediate resistance from physicians, pharmaceutical manufacturers, and other vendors in the drug supply chain.

According to Ted Okon, MBA, executive director of the Community Oncology Alliance, the proposal relies on middlemen, and Congress has had no input. He said,“What the administration is proposing is incredibly complex and extremely difficult to comprehend how it would be implemented in the real-world of medical practice. Their premise that oncologists use drugs based on financial incentives is simply not founded in fact and calls into question the need for this convoluted upheaval of the current cancer care delivery system.”

Bipartisan Opioid Law

President Trump also signed a wide-ranging law aimed at the nation’s opioid crisis. The SUPPORT for Patients and Communities Act includes several managed care provisions, including:

  • Certain controlled substances covered under Medicare must be transmitted with an electronic prescription drug program by January 2021.
  • HHS must create a standardized electronic prior authorization system for use in Medicare Part D.
  • HHS must clarify when pharmacists can deny an opioid prescription because fraud is suspected.
  • Medicare Part D and Medicare Advantage plans can suspend payments when fraud is suspected and must report this to HHS.

The law includes about $7 billion over 2 years to fight the problem. But implementation will be key, according to an expert who spoke with The American Journal of Managed Care® (AJMC®).

Said Arwen Podesta, MD, ABPN, FASAM, ABIHM, “How exactly will each state use the money? Will they actually improve access to quality treatment or just low-level treatment? Are we improving quality of life or just preventing overdoses? There needs to be much more education on the underlying reasons people get addicted in the first place.”

Vote Calls to Keep Diabetes Drug Safety Trials

An FDA advisory panel voted narrowly to retain a 10-year-old guidance for safety trials for diabetes drugs. But the discussion that led to the vote suggests that changes will be coming for these large studies, known as cardiovascular outcomes trials.

FDA required these studies after concerns that an earlier class of diabetes drugs might cause heart attacks. But since then, these studies have changed the field, led to new standards of care, and revealed cardiovascular benefits in 2 classes of drugs: SGLT2 inhibitors and GLP-1 receptor agonists.

Steve Nissen, MD, of the Cleveland Clinic, whose recommendations led to the guidance, told AJMC®: “We knew that if you did outcomes trials, you would learn things you didn’t otherwise know.”

Some tweaks are in order, however, to bring down the cost. FDA’s Dr. William Chong noted that the 8 trials have not found excess cardiovascular risk. Some steps may include more flexibility and different end points, with more focus on heart failure and kidney disease.

Suicide Among Head and Neck Cancer Survivors

Survival rates for patients who develop head and neck cancer are improving, but another risk is emerging: they are at higher risk for suicide.

A study published in the journal Cancer found that survivors of head and neck cancer were twice as likely to die of suicide than survivors of other cancers. Men were at higher risk than women, and white patients were at higher risk than those of other races.

The authors said the changes in physical appearance, pain, difficulty swallowing, and depression associated with head and neck cancer take a toll.

Said lead author Nosayaba Osazuwa-Peters, PhD, MPH, “Now, more than ever before, people are outliving their cancer diagnosis. This makes lifelong surveillance critical—being considered a ‘cancer survivor’ does not tell you how well the individual is doing. Some cancer survivors unfortunately decide that [it] is better that they are dead rather than being alive.”

Community Oncology Coverage

Regulatory and cultural roadblocks to value-based agreements received attention earlier this week at the Community Oncology Alliance Payer Exchange Summit, held in Tyson’s Corner, Virginia.

AJMC® provided full coverage of the meeting, which addressed the evolution of the Oncology Care Model, and the challenges that community practices still have with admission rates to the emergency department.

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

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