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This Week in Managed Care: October 25, 2019


This week, the top managed care news included the average Affordable Care Act premiums falling 4%; the FDA approving a triple combination treatment for cystic fibrosis; House Republicans releasing part 1 of their healthcare plan.

Average Affordable Care Act (ACA) premiums fall 4%, the FDA approves a triple combination treatment for cystic fibrosis, and House Republicans release part 1 of their healthcare plan.

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

2020 ACA Benchmark Plan Premiums Mostly Lower

This week, HHS announced that the 2020 average state premium for a benchmark silver plan sold on the federal ACA exchanges will fall 4%, compared with 2019 plans.

In addition, there are 20 more issuers offering qualified health plans in 2020 compared with 2019, making the new total 175.

HHS released the news as it also awaits an imminent decision from the federal 5th Circuit Court of Appeals about the constitutionality of the ACA, which the Trump administration refused to defend in a federal lawsuit. If the appeals court sides with the administration, HHS Secretary Alex Azar said his message is simple: Keep Calm and Carry on, since the decision will likely go to the Supreme Court.

Read more.

Landmark Cystic Fibrosis Approval

Calling it a “landmark approval,” the FDA cleared for sale a novel triple combination therapy for cystic fibrosis. The triple combination therapy of elexacaftor, ivacaftor, and tezacaftor treats the most common cystic fibrosis mutation.

Drug maker Vertex Pharmaceuticals will sell the therapy under the name Trikafta. It is approved for patients 12 years and older.

Said Acting FDA Commissioner Ned Sharpless, “MD, In the past few years, we have seen remarkable breakthroughs in therapies to treat cystic fibrosis and improve patients’ quality of life, yet many subgroups of cystic fibrosis patients did not have approved treatment options.”

Read more.

Republicans Release Healthcare Reform Plan

Conservative Republicans in the House of Representatives released their alternative to the Affordable Care Act. The blueprint is an effort to position the party for 2020 and counter various Democratic "Medicare for All" proposals.

It includes ideas such as undoing Medicaid expansion in favor of state block grants. It would also re-establish high-risk pools for those with costly health conditions, expand the role of health savings accounts, and put a focus on a delivery care model called direct primary care.

The report says: “Our RSC Health Care Plan introduces reforms that can: achieve a vibrant market with protections for all, including those with pre-existing conditions; encourage continuous coverage through true insurance portability; and ensure an appropriate and sustainable safety net for our most vulnerable citizens.”

Read more.

Blood Supply Needs

Most countries lack an adequate blood supply to meet their healthcare needs, according to a study published in Lancet Haematology.

The shortage is falling hardest on poor countries south of the equator. The gap is about 30 million units worldwide, but the burden is not evenly distributed. Denmark has the best blood supply and South Sudan has the worst.

The findings are a reminder that a safe, adequate blood supply cannot be an afterthought of the healthcare system

Thierry Burnouf, PhD, of Taipei Medical University in Taiwan, wrote in an accompanying editorial: “Substantial differences in the availability, safety, and quality of blood still exist around the world.”

Read more.

Hospital Readmission Risk for Black Patients With Diabetes

Black patients with diabetes may have a significantly higher risk of readmission to hospitals than other ethnic and racial minorities, according to new research.

Compared with whites, Hispanics, and Asians, black patients had the highest rates of 30-day all-cause readmissions, at 12.2%. The findings could not be explained by other factors, according to the authors.

They wrote: “These findings in readmission rates and outcomes are concerning, particularly as they likely underestimate the true impact of racial/ethnic differences in the United States, as our study comprised privately insured individuals with access to care."

Read more.

Patient-Centered Oncology Care®

Finally, there’s still time to register for Patient-Centered Oncology Care, which takes place November 8 at the Sofitel Hotel in Philadelphia.

Former FDA Commissioner Scott Gottlieb, MD, will join the meeting to address, “Innovation and Quality: New Directions in Oncology Value-Based Care,” and keynote speaker Joshua Ofman, MD, of Grail will discuss his company’s mission of early cancer detection.

Learn more and register.

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

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