This Week in Managed Care: September 27, 2019

This week, the top managed care news included state and federal crackdowns on vaping that forced out the president of Juul; FDA approved a groundbreaking diabetes treatment; Medicare Advantage premiums will decline for 2020.

State and federal crackdowns on vaping force out the president of Juul, FDA approves a groundbreaking diabetes treatment, and Medicare Advantage premiums decline for 2020.

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

Pushback Against Vaping

Amid reports of illnesses and deaths tied to vaping, the Trump administration has proposed banning vape flavors it says are aimed at children. This week, The Wall Street Journal reported that the Federal Trade Commission has opened a criminal investigation into Juul’s marketing to minors, while both federal and state prosecutors have started their own probes.

Massachusetts Governor Charlie Baker declared a public health emergency and banned sales of vapes for 4 months, in the toughest state crackdown. In Washington, CDC’s Principal Deputy Director Anne Schucat, MD, told the House Oversight Committee that the new generation of vapes is more addictive, leading to the rise of illnesses. She said, "We are seeing more and more cases each day.…We don't know enough about the aerosol that vaping produces in terms of the short- and longer-term health impacts.”

Walmart announced it would stop selling electronic cigarettes, and by Wednesday Juul’s chief executive officer Kevin Burns had stepped down as the company said it would halt advertising and not fight the proposed flavor ban.

Last week, a study in the journal Scientific Reports found that different flavors in e-cigarettes without nicotine had varied asthma outcomes in mice depending on the flavor.

For coverage of the study, visit

FDA Approves Oral Semaglutide

Novo Nordisk received approval last week for the first glucagon-like peptide-1 (GLP-1) receptor agonist in a pill form. Oral semaglutide, which will be sold as Rybelsus, will be taken once a day to treat type 2 diabetes. The other formulation is injected once a week. FDA approved two doses of the drug, at 7 and 14 mg, under the priority review process, because it serves an unmet need. Some patients who would benefit from a GLP-1 therapy have been unwilling to use an injectable drug.

Said Novo Nordisk’s Todd Hobbs, MD, vice president and chief medical officer, "People living with type 2 diabetes deserve more innovation, research and support to help them achieve their individual [glycated hemoglobin] goals.”

Novo Nordisk is separately seeking cardiovascular indications for its injectable and oral formulations of semaglutide, but FDA is not expected to take action on those applications until January 2020.

For more, visit

Medicare Advantage Premiums to Decline

Medicare Advantage premiums will drop 14% next year, with the average monthly premium reaching its lowest level in 13 years, CMS said this week. Officials said the average monthly plan will cost $23. CMS officials have adjusted requirements on Medicare Advantage plans, allowing for more options, and say this has led to more plan choices. The average number of plans per county will be 39 in 2020, up from 33 in 2019.

In a speech to America's Health Insurance Plans, CMS Administrator Seema Verma touted the Trump administration’s changes to Medicare Advantage, which she said included:

  • Telehealth benefits for primary and mental health care
  • Flexibility around supplemental health benefits to address social determinants of health
  • The ability of plans to tailor benefits for patients with conditions like asthma or heart disease

Verma said she expects a 10% increase in Medicare Advantage enrollment, to 24 million, as well as premium savings in Medicare Part D.

For more, visit

OB/GYN Shortage Expected

Maternity care is one of the specialties that will be hard hit by the growing physician shortage in the United States, according to a leading professional society. The American Congress of Obstetricians and Gynecologists expects a gap of 9000 specialists in the field by next year, and that shortage will grow to 22,000 by 2050.

Research from Doximity highlights which metropolitan areas will be especially hard hit. The report reveals troubling demographics for the obstetricians and gynecologists (OB/GYNs) who will remain: They will be older, and so will their patients.

Said Amit Phill, MD, vice president of streategy and insights, Doximity: “The projected OB-GYN shortages across the nation pose serious concerns for women’s reproductive care. This is particularly concerning for millennials, who are already waiting longer to start a family due to a variety of economic and social factors.”

Rising Cost of Insulin

Finally, the current issue of Evidence-Based Diabetes Management offers several perspectives on the crisis of rising insulin prices:

  • We hear from a leading advocate, Aaron Kowalski, PhD, of JDRF, about pricing reform efforts
  • A leading provider, Kasia Lipska, MD, MHS, of Yale, who led a research project on the frequency of insulin rationing
  • A leading health system, CareMore, whose pharmacists discuss the return of older insulins for seniors with type 2 diabetes
  • And we hear from a group of young adults with type 1 diabetes, who told AJMC’s Jaime Rosenberg what they gave up in the quest for insurance coverage just to stay alive.

In addition, reports from AJMC’s The Center for Biosimilars® offers perspectives on how follow-on products could provide new options for patients.

For the full issue, visit

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

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