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This Week in Managed Care: October 14, 2016


This week, the top stories in managed care included HHS releasing the final rule for the Medicare Access and CHIP Reauthorization Act, a commentary on the downside of drug coupons, and the World Health Organization called on countries to enact a soda tax.

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


This week, CMS released the final rule to implement the Medicare Access and CHIP Reauthorization Act, known as MACRA.

The rule will have a huge effect on how physicians are paid and on the transition from fee-for-service to value-based payment. For more on the rule, read our article.

Drug Coupons

This week, Doctors Peter Bach of Memorial Sloan Kettering and Peter Ubel of Duke University co-authored a commentary calling for stricter rules on prescription drug coupons, which they say actually drive up health care premiums by masking the true cost of drug prices.

In the Annals of Internal Medicine, Bach and Ubel point to the recent uproar over EpiPen prices, and the manufacturer’s use of a $300 coupon as an example of how this strategy keeps prices high until consumers meet deductibles and insurers pick up most of a drug’s costs.

Because discounts for Medicaid and Medicare are based on a percentage of costs, the system hurts taxpayers, too. Among their recommendations: “Pharmaceutical companies cannot discriminate against patients who cannot document their financial need, provide assistance for some medications but not others, or limit coupons to only a few prescription fills rather than the duration the patient needs the medication.”

Biosimilar Update

While the FDA has approved 4 biosimilars, there are still legal and regulatory gaps for their use in the United States, according to speakers who appeared recently at Academy of Managed Care Pharmacy 2016 Nexus.

Unlike Europe, where 20 biosimilars have been approved, roadblocks in this country have slowed their use. These include:

  • A clear path to show interchangeability
  • An end to lawsuits aimed at keeping products off the market
  • Resolution to naming and coding issues

Federal questions aren’t the only hurdles for biosimilars—about half the states have laws to regulate products.

Emerging Diabetes Therapies

The current issue of Evidence-Based Diabetes Management features coverage of new and emerging therapies, including 2 combinations that pair insulin with GLP-1 receptor agonists. Earlier this year, FDA extended reviews for competing combinations from both Sanofi and Novo Nordisk, which promise improved clinical benefits with fewer side effects.

John Buse, MD, PhD, of the University of North Carolina, told EBDM that he has participated in trials of Novo Nordisk’s combination, Xultophy, which combines Tresiba and Victoza, and the results have been impressive. “The percentage of patients who get A1C levels in the target range is high, while the risk of hypoglycemia or weight gain is low," he said.

Sponsored Content

Novo Nordisk and the Victoza team have developed a series of videos to explain cost challenges and the role of evidence in managing diabetes. The videos are part of a broader effort to improve the type 2 diabetes management landscape. Learn more at ReconsiderCosts.com.

Soda Tax

This week, the World Health Organization again called on countries to tax soda to curb the obesity epidemic, while the American Journal of Preventive Medicine published a study that found Coca-Cola and Pepsi funded 96 health-related groups over a five-year period.

The organizations included those that support limits on sugar consumption, like the American Heart Association and the American Diabetes Association. Both groups responded that grants from soda companies in no way affect their policy positions or their research.

While the soda industry is suing the City of Philadelphia to overturn a tax set to take effect in January, there are several ballot measures on soda taxes for November 8th, including three in the San Francisco Bay area and one in Boulder, Colorado.

For more, read the full article.

Patient-Centered Oncology Care

There’s still time to join us for the 5th annual meeting of Patient-Centered Oncology Care, which comes to Baltimore, Maryland November 17-18.

The conference will feature sessions on Immuno-oncology, patient-centered payment models, meeting the challenges of health IT, as well as our first poster session. For information and to register, click here.

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