This Week in Managed Care: October 10, 2015

Top managed care stories this week include how much waiting to see the doctor costs patients, Express Scripts announced it will cover both PCSK9 inhibitors, and HHS proposed simplifying rules for providers using electronic health record.

Transcript (slightly modified for readability)

Hello, I’m Justin Gallagher, associate publisher of The American Journal of Managed Care.

Welcome to This Week in Managed Care, from the Managed Markets News Network.

The Cost of Seeing a Doctor

A study in The American Journal of Managed Care has put a price tag on the cost of waiting to see the doctor. Research led by Dr Kristin Ray found that the cost of waiting for the typical doctor’s visit is $43, when calculating travel and time lost from work. That’s higher than the average co-payment of $32. Nationwide, all that lost time adds up—the study found that the annual opportunity cost of waiting for healthcare was $52 billion.

The study’s senior author, Dr. Ateev Mehrotra, said, “The Time spent per year by employed adults seeking medical care exceeded the number of annual hours worked by more than half a million full-time employees.”

Read the full study.

Formulary Coverage of PCSK9 Inhibitors

Express Scripts announced this week it will add both new cholesterol-fighting therapies to its formulary, after negotiating steep discounts with the drug makers.

Praluent, made by Sanofi-Regeneron, and Repatha, by Amgen, received FDA approval this summer for patients at high risk of heart attacks or strokes who have uncontrolled cholesterol even after trying the most powerful statins available.

Both drugs have whole prices above $14,000 a year, which prompted Express Scripts and CVS to leave them off the formulary until they secured discounts.

Express Script won’t say how much they trimmed from the prices, but they estimate the new class, called PCSK9 inhibitors, will cost the pharmacy manager $750 million in 2016, well below projections.

Obesity and Endometrial Cancer

A study from the Virginia Cancer Center has found that between 40% and 50% of all endometrial cancers are caused by obesity, and that if more obese women were able to have bariatric surgery, many of these cancers could be prevented.

The study followed 71 women who had surgery and lost an average of 100 pounds. Before their surgery, 10% of the women had precancerous uterine changes, which seemed to have been resolved by the surgery and the weight loss. The authors said the study adds to the evidence that bariatric surgery produces health benefits and cost savings, in addition to better quality of life.

EHR Rules Simplified

The Department of Health and Human Services this week announced a proposal to simplify rules for providers who use electronic health records. HHS also finalized a rule setting standards for the creators of Health Information Technology, which will allow systems to share more information and create more competition in the market.

Dr Patrick Conway, the chief medical officer at HHS, said the new proposal is based on feedback from physicians, who asked that electronic health records be easier to use.

Both proposals are designed to get the healthcare community ready for the 2018 goals for Medicare reimbursement, which call for 50 percent of all payments to be tied to value-based models.

Price Transparency

Lack of transparency in healthcare creates wide variation in what patients or their insurers pay for basic services. A study published this week focused on the variation in the cost of mammograms, a basic service for women.

Researchers from Castlight Health found that the cost of a mammogram can range from $43 in Sarasota Florida, to $1898 in the New York metro area—a 44-fold variation in cost. The study’s authors said their findings underscore complaints that the lack of transparency in healthcare pricing falls harder on women than men, because women use more healthcare.

Patient-Centered Oncology Care

Finally, it’s not too late to register for our upcoming meeting, Patient Centered Oncology Care, which takes place November 19-20 in Baltimore, Maryland.

We’ll hear new findings on the effectiveness of requiring genetic counseling with testing, and we’ll learn about the impact of the FDA’s increased oversight in molecular diagnostics.

To learn more about the agenda and to register, visit our conference page.

For the Managed Markets News Network, I’m Justin Gallagher. Thank you for joining us.