This Week in Managed Care: October 11, 2019

This week, the top managed care news included an effort by the Trump administration to bolster Medicare Advantage; an abortion case from Louisiana reached the Supreme Court; the study of adapting to changing oxygen levels wins the Nobel Prize.

The Trump administration moves to bolster Medicare Advantage, an abortion case from Louisiana reaches the Supreme Court, and the study of adapting to changing oxygen levels wins the Nobel Prize.

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

Trump Executive Order Bolsters Medicare, Medicare Advantage

President Trump last week issued an executive order to protect Medicare and give Medicare Advantage a competitive edge, as Democrats continue to promote the idea of "Medicare for All" on the campaign trail. The order directs the secretary of HHS to allow Medicare to offer more diverse and affordable choices, including removing barriers to Medicare Savings Accounts.

Said HHS Secretary Alex Azar: “President Trump’s executive order delivers on the clear promise he’s made to Americans about their healthcare: protect what works in our system and fix what’s broken.”

Among other provisions, the order calls for:

  • Ending regulations that limit licensed professionals from practicing at the top of their license
  • Ensuring that fee-for-service Medicare is not promoted over Medicare Advantage
  • Promoting wider use of telehealth

Trump officials have said that most Americans do not want to give up the health insurance plan under a Medicare for All plan promoted by Senator Bernie Sanders, I-Vermont, but some Democrats accused the Republicans of scare tactics.

Senate Finance Committee members Ron Wyden, D-Oregon, and Sheldon Whitehouse, D-Rhode Island, said after Trump’s speech that Americans do favor allowing people to buy into Medicare if they choose.

“The American people aren’t buying Donald Trump’s scare tactics on healthcare. Democrats want people to have choices for their healthcare—whether that’s Medicare Advantage or allowing Americans under 65 to join the program if they choose. Trump and Republicans in Congress are creating a smokescreen to keep pushing junk insurance and manipulating the courts to take away protections for preexisting conditions.”

For more, visit

US Supreme Court to Hear Appeals for Abortion Access in Louisiana

The US Supreme Court will hear a case that challenges a law that imposes limits on doctors who perform abortions. Hope Medical Group for Women filed an appeal after a failed attempt to block the Louisiana law, which was upheld in a lower court ruling. The law requires that doctors who perform procedures have hospital admitting privileges. The plaintiff says the law would force 2 of the state’s 3 remaining clinics to close.

This will be the first major abortion case since Justices Neil Gorsuch and Brett Kavanaugh joined the Supreme Court.

Nobel Prize Honorees Announced

This year’s Nobel Prize in Physiology or Medicine honors three scientists who showed how cells adapt to oxygen levels: William G. Kaelin, Jr, MD, of Dana Farber Cancer Institute; Sir Peter J. Ratcliff, MD, of Oxford University; and Gregg Semenza, MD, PhD, of Johns Hopkins University. Each played a role in the discovery of hypoxia-inducible factor (HIF), a complex that is both essential to the function of cells and tissues but can also fuel the growth of cancer tumors.

Said Randall Johnson of the Karolinska Institute, “That may be difficult to conceptualize that something can be both bad and good.”

The discovery is being applied in clinical practice for everything from cures for anemia to therapies that block the HIF-1-alpha protein to stop tumor growth.

For more, visit

California Expands Access to HIV Prevention Medication

California Governor Gavin Newsom this week signed a bill that will make HIV prevention drugs available without a prescription. The new law will allow pharmacists to dispense pre- and post-exposure prophylaxis in a way similar to birth control and emergency contraception. Insurance companies cannot require prior authorization.

Said bill sponsor state Senator Scott Wiener, D-San Francisco, “By allowing pharmacists to furnish these revolutionary medicines without a prescription, we will help more people—especially low-income people and people of color—stay negative.”

2019 US Psychiatric and Mental Health Congress

This weekend, The American Journal of Managed Care® (AJMC®) covered the 2019 US Psychiatric and Mental Health Congress in San Diego, California.

Headlines from the meeting included:

  • A survey showing that patients with bipolar I disorder will tolerate symptoms rather than live with side effects of antipsychotics
  • Mental health professionals are seeing more patients who are treating themselves with cannabidoil
  • Genetics are increasingly playing a role in the diagnosis and treatment of mental health disorders

For full meeting coverage, visit

For all of us at AJMC®, I’m Laura Joszt. Thanks for joining us.

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