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This Week in Managed Care: October 20, 2017


This week, the top managed care news included the bipartisan deal to stabilize the Affordable Care Act's insurance markets; coverage from the Academy of Managed Care Pharmacy 2017 Nexus; and a plan to reduce clinician burnout at the computer.

The Senate brokers a short-term fix for healthcare subsidies, specialty pharmacy drugs consume a bigger share of the healthcare pie, and the American Medical Association kicks off an effort to make health data work for patients.

Welcome to This Week in Managed Care, I’m Kelly Davio.

Bipartisan ACA Deal

Members of the Senate struck a bipartisan deal Tuesday to bring order to the individual health insurance markets, which would restore cost-sharing reductions that President Donald Trump canceled last week.

While the package led by Republican Lamar Alexander of Tennessee and Patty Murray of Washington was touted as only a short-term fix, it faced resistance from House Republicans and from President Trump, even though he initially told reporters it could “get us over this intermediate hump” before the Affordable Care Act is replaced.

The plan would do the following:

  • Extend the cost-sharing reductions through 2019
  • Restore enrollment outreach funds
  • Make state waivers easier to obtain and give governors greater control
  • Allow waivers to last 6 years instead of 5
  • Ensure that people with pre-existing conditions and vulnerable populations are protected

Trump reversed course Wednesday, saying he couldn’t support a plan that would bail out insurance companies.

Alexander said he hoped the president and House members would reconsider the plan as insurers announced large premium increases for 2018. “My guess is that it will become law in some form by the end of the year because the American people will not want to create chaos in the health insurance market for millions of Americans who have skyrocketing premiums, and in some cases, can’t buy insurance at all.”

AMCP Nexus 2017

This has been a banner year for drug approvals, with specialty pharmacy leading the way. Healthcare industry leaders gathered in Dallas this week at the Academy of Managed Care Pharmacy 2017 Nexus to hear what’s coming next in specialty pharmacy.

As usual, Express Scripts’ Aimee Tharaldson, PharmD, drew a packed audience for an overview of the drug pipeline. She told attendees:

  • Competition from novel molecules and generics will increase
  • Barriers to biosimilars will fall
  • Dupilumab will be approved for more uses
  • Cancer care will see more activity in the CAR T cell space
  • FDA will approve many new drugs for inflammatory conditions

The outlook isn’t rosy for all specialty drugs, however. Market conditions have slowed progress for treatments for hepatitis C and multiple sclerosis.

See the full coverage of the AMCP 2017 Nexus.

FDA Approves Second CAR T Therapy

A day after Tharaldson predicted more CAR T cell activity, FDA approved a second treatment, this time for diffuse large B-cell lymphoma.

Approval for Yescarta, developed by Kite Pharma, comes 6 weeks after approval for the first CAR T-cell therapy for treatment of children with acute lymphoblastic leukemia. Yescarta’s customized gene therapy will be indicated when 2 other treatments have failed.

Read more.

Clinician Burnout

The promise of electronic health records has fallen short, and the time spent at the computer has been cited as a factor in clinician burnout.

The American Medical Association is taking a step to make health data work better for doctors and patients with the Integrated Health Model Initiative, which seeks to address poor interoperability, cumbersome data structures, and the sheer number of clicks that current systems require.

The AMA wants to create a new model that lets doctors easily extract what they need from data at the point of care.

Said CEO James Madara, MD, “We spend more than $3 trillion a year on healthcare in America and generate more health data than ever before. Yet some of the most meaningful data—data to unlock potential improvements in patient outcomes—is fragmented, inaccessible or incomplete.”

ACO Coalition

Clinician burnout is on the agenda next week at AJMC’s meeting of the ACO and Emerging Healthcare Delivery Coalition, which gathers in Nashville, Tennessee, Thursday and Friday.

Visit the ACO conference page to join us.

Diabetes Drug Update

An FDA advisory panel has recommended approval for semaglutide, a once-weekly GLP-1 receptor agonist that had superior results for glycemic control and weight loss against a competitor in a head-to-head trial.

Panel members had questions about whether the drug raises risks for retinopathy, or whether the increased risk seen in the drug’s cardiovascular outcomes trial were actually from rapid A1C reduction. Complications were seen mostly among patients with long duration diabetes and existing retinopathy.

An oral form of semaglutide is also under development, and phase 2 results that appeared this week in JAMA found it works just as well as the injectable version. A GLP-1 in a pill would set semaglutide apart from competitors.

FDA action on semaglutide is expected in early December.

Evidence-Based Oncology

Finally, the new issue of Evidence-Based Oncology explores the role of the pharmacist in cancer care. The current issue covers:

  • The pharmacists’ role in managing the growth of oral therapies in cancer care
  • A nationwide initiative to improve the quality of oncology dispensing practices
  • Challenges and opportunities with pharmacy benefit managers

See the full issue.

For all of us at the Managed Markets News Network, I’m Kelly Davio.

Thanks for joining us.

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