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This Week in Managed Care: September 21, 2018


This week, the top managed care news included the Senate overwhelmingly voting to ban pharmacist gag clauses; a study found the current vaccine pipeline for HIV, tuberculosis, and malaria may fall short; an expert noted a trend of healthcare cost data seeping into nonhealthcare companies’ earnings calls.

The Senate overwhelmingly votes to ban pharmacist gag clauses; a study finds the current vaccine pipeline for HIV, tuberculosis, and malaria may fall short; and an expert notes a trend of healthcare cost data seeping into nonhealthcare companies’ earnings calls.

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

Ending Pharmacy Gag Clauses

Late Monday, the Senate passed a bill that is part of the American Patients First drug pricing blueprint. Voting 98 to 2, senators approved to end a gag clause that prevents pharmacists from telling patients if a prescription drug would be cheaper if they paid entirely out-of-pocket.

The bill was sponsored by Democratic Senators Claire McCaskill, of Missouri, and Debbie Stabenow, of Michigan; as well as Republican Senator Susan Collins, of Maine. It was opposed by Republican Senators Rand Paul, of Kentucky, and Mike Lee, of Utah.

The National Community Pharmacists Association (NCPA) is happy with outcome of the Senate vote. “NCPA cheers the Senate’s passage of S. 2554, the Patient Right to Know Drug Prices Act, legislation that will prohibit so-called ‘gag clauses’ in private health plans," said B. Douglas Hoey, chief executive office, NCPA.

In a testimony before the House Energy and Commerce Subcommittee on Health earlier this month, NCPA board member Hugh M. Chancy narrated how his community pharmacy received a verbal warning from a pharmacy benefit manager for telling a customer that a medication could be obtained less expensively if paid for off insurance.

He said, “The PBM stated we were in violation of our contract for disparaging the plan when we discussed the cost of a drug off insurance. We were told that if our pharmacy were to do so again, there would be consequences, including exclusion from PBM networks.”

In a statement, America’s Health Insurance Plans said that drug prices remain too high and removing the gag rule won’t solve the problem of patients being unable to afford their medications.

Vaccine Development for HIV, Malaria, Tuberculosis

A study that analyzed the research and development pipeline for vaccine candidates has concluded that the existing pipeline is unlikely to produce highly effective vaccines for HIV, tuberculosis, or malaria, which could be important for controlling the spread of these diseases.

The authors, led by Gavin Yamey, MD, MPH, MA, believe a lack of funding sources has led to this development. While annual funding for vaccine development hovers around 3 billion dollars, it falls short of what is needed by between 1.5 billion dollars and 2.8 billion dollars.

While 128 products would make it to launch, per the study, actual product launches of vaccines for the 3 diseases would be unlikely.

Said Yamey, “The model shows us where the current pipeline is most robust and where it is lacking. For global health advocates, this is a broad picture of what pieces we are likely to still be missing, and where we can direct priorities in funding and product development.”

Healthcare Costs in Corporate America

According to AJMC.com contributor Joseph Andelin, healthcare costs in America have found a place in earnings calls of nonhealthcare companies, including manufacturers of sports goods and food products, and flower delivery companies.

Andelin shares healthcare-related statements from earnings calls of several companies, including Hibbert Sports, Footlocker, and 1-800-Flowers.

Oil and gas company Enservco Corporation reported that since the company is partially self-insured, it makes a relatively large upfront payment on each claim.

Treating Ovarian Cancer

To mark National Ovarian Cancer Awareness Month, The American Journal of Managed Care spoke with an ovarian cancer survivor and her gynecologist about the complexities associated with treating the disease in the presence of comorbidities, and the vital role of a multidisciplinary care team.

Listen to the interview.

Register for PCOC

AJMC®’s 7th Patient-Centered Oncology Care® meeting will be held in Philadelphia on November 16, where panelists will discuss learnings from the oncology care model data reporting, highlight the pharmacist’s role in patient care, and provide insight on the future of value-based payment models.

This year, the keynote address will be presented by Barbara McAneny, MD, president of the American Medical Association.

Learn more and register.

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

Thanks for joining us.

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