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This Week in Managed Care: September 28, 2018


This week, the top managed care news included comments to several proposals from CMS; Medicare advocates say voters will be motivated by healthcare cost concerns during the midterm elections; research showed diabetes drug dapagliflozin, an SGLT2 inhibitor, reduces risks of major cardiovascular events.

CMS gets strong reactions to several proposals, Congress acts on key healthcare bills, and Medicare advocates say voters will be motivated by healthcare cost concerns.

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

Responding to CMS Proposals

Hospitals and other groups are pushing back against a CMS proposal to change billing codes for complex patients and for 340B, while some surgical centers support certain changes.

CMS earlier this year changed its billing methodology in the 340B program for nonexempted off-campus hospital clinics, to address concerns that the program was being abused and forcing consolidation.

The Community Oncology Alliance was among the groups that had asked for a change, and CMS said that the move had already saved $320 million.

In comments due this week, the American Hospital Association said it is also concerned about changes in payment rates that would affect off-campus facilities that service large Medicare and Medicaid populations, especially in rural areas, which would see devastating funding cuts.

A Texas rheumatologist wrote: “The only way for my clinic to survive financially will be to only address 1 issue per visit and have [patients] come back repeatedly to address individual issues per visit. Obviously, this new system would clutter my schedule (which is already full with a several week wait), further limiting access to patients.”

Read more.

Congress Passes Healthcare Bills

With the midterm elections less than six weeks away, Congress has been busy on several key healthcare items:

  • A week after the Senate’s action, the House of Representatives passed a bill that lets pharmacists tell patients if their prescription drug would be cheaper without their insurance.
  • The Senate reached a deal on a bill to address the opioid crisis after scrapping a provision to benefit the pharmaceutical industry.
  • The Congressional Budget Office projected that the CREATES Act, designed to promote generics and biosimilars, will reduce federal spending on prescription drugs by $3.3 billion.

Bolstering Medicare

Concerns about healthcare and drug costs are on voters’ minds as the midterm elections draw near, according to a group of Medicare advocates.

The Center for Medicare Advocacy announced a campaign, called “SaveMedicareNow” along with polling results it says show the public is not on board with efforts to privatize the program.

Pollster Celinda Lake said the Republican Party is losing the advantage among older voters that it has enjoyed in recent elections, especially among women. Lake presented the following in a briefing for reporters:

  • 93% of all voters support the idea of letting Medicare negotiate drug prices.
  • 92% of voters agree that prescription drugs developed with taxpayer dollars should be affordable to Americans.
  • When asked to rank a list of healthcare issues in order of importance, 28% of all adults selected the cost of health insurance premiums, followed by out-of-pocket costs, hospital care, and prescription drugs.
  • Among those in Medicare, 24% listed out-of-pocket costs, followed by prescription drugs, and premiums.

Said the center’s Judith Stein: “We know healthcare matters to voters. We know Medicare is a nationally treasured program. But we fear current efforts to privatize Medicare, and longer-term plans to cut and change the program entirely, are flying way below the radar. Our goal is to remind media, voters, and candidates that Medicare matters—to voters of all persuasions throughout the country.”

Farxiga Cuts Heart Risks

The diabetes drug dapagliflozin reduces risks of major cardiovascular events, according to topline results of a trial to be presented at the American Heart Association in November.

Astra Zeneca made the announced this week for dapagliflozin, the SGLT2 inhibitor sold as Farxiga. Dapagliflozin is the last of the first wave of SGLT2 inhibitors to show a cardiovascular benefit, adding to the evidence that this is a class effect for these type 2 diabetes drugs, which reached the US market 5 years ago.

Competitor empagliflozin, which is sold as Jardiance by Eli Lilly, was the first of these drugs to show such a benefit in 2015, an event that was unexpected and a game changer in the market.

The results line up with findings from a large international claims-based study, CVD-REAL, which AstraZeneca has sponsored. That study evaluates data the United States, Canada, and countries in Europe and Asia to show that the drugs prevent hospitalization for heart failure and cardiovascular death across a range of populations.

Giant cardiovascular outcomes trials were first designed to show that diabetes and cardiovascular drugs did not cause heart attacks and strokes, and some question whether they are worth the high cost. The FDA has set a meeting in late October to revisit the value of the trials, which became requirements after concerns about rosiglitazone in the mid-2000s.

Oncology Meeting

Registration is open for Patient Centered Oncology Care, the annual multistakeholder meeting of providers, payers, technology experts, and patient advocates in cancer care.

Join us November 16 in Philadelphia with our keynote speaker, oncologist Dr. Barbara McAneny, who is the current 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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