The top stories in managed care included Vice President Joe Biden's released his report on the Cancer Moonshot initiative, complaints were filed against 7 insurers for discriminating against people with HIV, and Pfizer announced it plans to launch its Remicade biosimilar in November.
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.
Cancer Moonshot
Vice President Biden presented his report on the Cancer Moonshot initiative this week, which calls for increased information sharing and a $700 million investment from Congress. Biden said he has witnessed more collaboration since the project began, but that much more needs to be done.
The report calls for:
Several research efforts have started under the Moonshot initiative, including a partnership at the National Institutes of Health to bring together cancer research centers, foundations, philanthropies, and drug companies to share data.
For more on the Cancer Moonshot, click here.
MACRA Final Rule
Physicians and healthcare experts around the country spent this week reading the details of the final rule for MACRA, the Medicare Access and CHIP Reauthorization Act.
Many praised CMS for listening to concerns that the rule as first proposed would have threatened the survival of small and rural physician practices. As the final rule was announced, Kate Goodrich, MD, director of Quality Measurement and Value-Based Incentives at CMS, explained the approach that regulators took in protecting these providers from too much upheaval as they transition away from fee-for-service.
Health Plan Discrimination
Complaints filed with HHS charge that 7 health insurers are discriminating against people with HIV and other serious illnesses by making the drugs they need unaffordable.
Harvard Law School’s Center for Health Law and Policy filed complaints with HHS’ Office of Civil Rights, saying the insurers are trying to avoid parts of the Affordable Care Act that bar marketplace plans from creating benefit designs that discriminate based on age, race, gender, sexual orientation, or illness. While regulators don’t define such designs, they’ve suggested that pricing single tablet regimens that are standard of care out of reach would meet the test.
The center filed complaints against Humana plans in six states, against Cigna plans in 3 states, and against 5 other insurers in Pennsylvania, Wisconsin, and Texas.
Remicade Biosimilar
Pfizer said this week that its biosimilar Inflectra, similar to Johnson & Johnson’s TNF blocking agent Remicade, will cost 15% less when it reaches the US wholesale market in November. Said Pfizer’s Diem Nguyen, “By introducing Inflectra to the US marketplace, Pfizer is helping customers access an additional high-quality treatment option that promises greater savings for the healthcare system.”
Inflectra was approved this year to treat rheumatoid arthritis, Crohn’s disease, psoriatric arthritis, and plaque psoriasis. Without insurance or discounts, a single dose of Remicade can cost $1300 to $2500, depending on a patient’s weight and the disease being treated. Johnson & Johnson said Pfizer’s move would be an “at-risk launch” given ongoing litigation but that it would compete with discounts, rebates to payers and pharmacy benefit managers, and other options.
Negotiating Out-of-Network Bills
There’s a lot in the news these days about the “surprise” bills that patients receive if they venture outside narrow networks for care. A new study in the current issue of The American Journal of Managed Care shows that few patients try to negotiate bills, and they’re not too successful when they do.
The Internet survey found that only 19% of patients tried to negotiate out-of-network bills and succeeded only 56% of the time. If there’s a lesson in the findings, patients had more luck working straight with the provider than the insurer. Read the full study.
For all of us at the Managed Markets News Network, I’m Justin Gallagher. Thanks for joining us.
The Supreme Court seems likely to reject a challenge to the abortion pill mifepristone; the FDA is inspecting far fewer pharmaceutical companies conducting clinical research; AstraZeneca has sued to block an Arkansas law that it said would unlawfully expand the 340B program to include for profit-pharmacy chains.
Read More
Exploring Medicare Advantage Prior Authorization Variations
March 26th 2024On this episode of Managed Care Cast, we're talking with the authors of a study published in the March 2024 issue of The American Journal of Managed Care® about their findings on variations in prior authorization use across Medicare Advantage plans.
Listen
What We’re Reading: HHS' Funding Flat; Mifepristone Safety; Insulin Shortage
March 25th 2024Flat funding for Health and Human Services (HHS) leaves critical health initiatives stagnant; Supreme Court weighs tightening regulations on abortion pill; manufacturing delay sparks access concerns for insulin medication.
Read More
Navigating Health Literacy, Social Determinants, and Discrimination in National Health Plans
February 13th 2024On this episode of Managed Care Cast, we're talking with the authors of a study published in the February 2024 issue of The American Journal of Managed Care® about their findings on how health plans can screen for health literacy, social determinants of health, and perceived health care discrimination.
Listen
CMS is highly likely to negotiate the price of the obesity medication semaglutide in the coming years; many health care providers are trying to determine whether their cyberattack insurance will help cover their losses after the Change Healthcare hack; the US life expectancy increased for the first time in 2 years.
Read More