This Week in Managed Care: October 19, 2018

This week, the top managed care news included the Trump administration unveiling plans to include drug prices in television ads; CMS touted Medicare Advantage at the beginning of open enrollment for Medicare; research found Medicare beneficiaries who live in housing with support services stay out of the hospital.

Drug prices could be in TV ads, CMS promotes Medicare Advantage, and having insurance isn’t the protection it should be.

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

Costs in TV Drug Ads

Those prescription drug ads you see on TV could have something new if Trump health officials have their way. On Monday, HHS Secretary Alex Azar unveiled plans for the wholesale acquisition cost to appear onscreen in TV ads for any drug covered by Medicare or Medicaid.

Said Azar, “Patients deserve to know what a given drug could cost when they’re being told about the benefits and risks it may have. They deserve to know if the drug company has pushed their prices to abusive levels. And they deserve to know this every time they see a drug advertised on TV.”

The Pharmaceutical Research and Manufacturers of America (PhRMA) is expected to challenge the plan on First Amendment grounds, and offered to direct consumers to a website with drug costs instead.

Said PhRMA president and CEO Stephen Ubl: “The president challenged us to provide this information, policy makers on a bipartisan basis have ... and you’ll see robust action in the coming months.”

Groups representing the nation’s health insurers and physicians both praised the move, saying greater transparency would help consumers.

CMS Promotes MA Growth

This week marked the start of open enrollment for Medicare for 2019, and CMS officials went on the road to tout the benefits of Medicare Advantage, which gives those age 65 and older access to the government healthcare program through private plans.

CMS Administrator Seema Verma said the plans offer more services at a lower cost, because competition drives up value.

She said, “Thirty-seven percent of Medicare beneficiaries now participate in Medicare Advantage, up from 15% just 2 decades ago.”

CMS has eased rules in Medicare Advantage that allow a larger number of plans, as well as step therapy to control costs. While Medicare Advantage premiums are down for 2019, traditional Medicare premiums rose, and the deductible for hospitalization will rise $24.

Medicare Part D is relying more on generics and biosimilars to bring down premiums, Verma said.

For more, visit AJMC®’s The Center for Biosimilars®.

Heavy Cost of Being Sick

A recent survey found that health insurance has failed a basic test of protecting people from financial ruin when they become very ill.

One-third of those in the United States facing major health issues spent all or most of their savings when they got sick, according to a survey by The New York Times, the Commonwealth Fund, and the Harvard T.H. Chan School of Public Health.

Respondents had been hospitalized twice in the past 2 years and had at least three doctors. More than 20% of people with health insurance had trouble paying for necessities, and 13% had to borrow money. These episodes affected family members, as well.

Supportive Housing for Seniors

Medicare beneficiaries who live in housing with support services stay out of the hospital, according to research by Rutgers School of Public Health.

The research team compared seniors in Queens, New York, who lived in facilities with supportive services with those in the same ZIP codes without services and found the hospital discharge rate was 32% lower among those in the supportive housing.

When they were patients, those from supportive housing tended to stay one fewer day than their peers from the neighborhood.

Said lead author Michael Gusmano, PhD, “These findings are consistent with the claim that housing programs of this sort help people stay healthy and, perhaps more importantly, help them receive health and social services that allow them to manage their chronic conditions.”

New Issue of EBO™

This month’s issue of Evidence-Based Oncology™ looks at changes in healthcare policy, from the effects of the federal sequester, to narrow networks, and even the growing discussion about medical marijuana in cancer care.

Our editor-in-chief, Joseph Alvarnas, MD, is interviewed in a story about balancing proposed changes from CMS with making the transition to value-based reimbursement. He said: “We are in the midst of a perfect storm, in which there is a constant down pressure on reimbursement while oncologists are being asked to immerse themselves in genomics, become effective stewards of emerging therapeutics, and magically lead efforts to control anticancer pricing.”

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

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