This Week in Managed Care: September 6, 2019

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This week, the top managed care news included a diabetes drug showing positive results in treating heart failure; new lipid guidelines promoting the use of proprotein convertase subtilisin/kexin type 9 inhibitors; and a study finding doctors are more likely to prescribe opioids if they are in a hurry.


A diabetes drug may double as a way to treat heart failure, New European lipid guidelines promote the use of proprotein convertase subtilisin/kexin type 9 (PCSK9) inhibitors, and a study finds doctors are more likely to prescribe opioids if they are in a hurry.

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

Dapagliflozin Cuts Risk of Cardiovascular Death, Worsening of Heart Failure

The sodium glucose co-transporter 2 (SGLT2) inhibitor dapagliflozin, already approved to treat type 2 diabetes, may become a treatment for the nation’s 5.7 million heart failure patients, based on new findings. In a late-breaking session at last week’s European Society of Cardiology (ESC) meeting in Paris, investigators for the DAPA-HF trial reported a large reduction in the risk of cardiovascular death or worsening heart failure. Of special interest to health plans:

  • Dapagliflozin produced the same results in patients with or without type 2 diabetes
  • Patients saw a 30% drop in the risk of their first heart failure event, such as a trip to the hospital
  • Those who had a heart failure event before the trial saw a 33% reduced risk of a future event or cardiovascular death
  • Patients who were obese saw a 31% reduced risk of a heart failure event or cardiovascular death

Heart failure is one of the most expensive conditions in the health system. CDC reports that it costs the United States more than $30 billion a year. For more, visit

New Guidelines Support Benefit of PCSK9 Inhibitors

During the ESC Congress, the ESC and the European Atherosclerosis Society presented updated lipid guidelines that increased the emphasis on using PCSK9 inhibitors to reduce elevated cholesterol in high-risk patients, along with statins and ezetimibe. This drug class, once seen as a blockbuster, took longer to penetrate the market because payers felt the early $14,000-a-year price tag was too high. Today, price cuts put both drugs on the market around $6000 a year. Key changes in the guidelines include:

  • Changing language to “recommend” PCSK9 inhibitors for high-risk patients, instead of asking physicians to consider them.
  • Using ApoB for lipid analysis for cardiovascular disease risk instead of alternatives
  • Recommending a 50% reduction in low-density lipoprotein cholesterol in dyslipidemia for patients with type 2 diabetes and certain genetic conditions
  • Starting statins is not recommended for patients older than 75 or for premenopausal women if they have diabetes or are considering pregnancy

For more results on PCSK9 inhibitors from last week’s Congress, visit

Opioid Prescribing Influenced by Time of Day

Does the time of day influence how a doctor prescribes opioids? A new study says yes. Findings in JAMA Network Open show that providers are more likely to prescribe opioids later in the day or if they are running late. As the day progressed, there was a 33% relative increase in opioid prescribing among 5600 primary care doctors seeing more than 600,000 patients complaining of pain who had never taken opioids.

Said lead author Hannah Neprash, PhD, assistant professor, School of Public Health, University of Minnesota: “These findings support the widespread perception among providers that time pressure to provide a ‘quick fix’ is one reason why opioids are frequently prescribed in the United States. If similar patterns exist in other clinical scenarios, such as managing challenging chronic illness, this phenomenon could have relevance for public health and quality improvement efforts.”

For more, visit

Soda Consumption and Mortality Risk

A large, population-based study across 10 countries in Europe finds that soft drinks were linked to a greater risk of death, including a chance of dying from Parkinson disease. Researchers reporting in JAMA Internal Medicine aren’t sure what the link is to Parkinson—and it could mean nothing. But they say it will merit further study.

The study included more than 450,000 people and compared those who drank 2 or more glasses of soda per day with those who drank less than 1 glass per month. The average follow-up was 16 years. Researchers found:

  • Higher all-cause mortality was seen among those who drank at least 2 glasses per day of sugar-sweetened soft drinks, as well as those who drank artificially sweetened drinks.
  • The risk of death from drinking artificially sweetened drinks was higher than it was among those drinking the sweetened beverages.
  • For digestive diseases, all-cause death was higher for drinking 1 sugar sweetened beverage per day but not the artificially sweetened ones.
  • No link was found between soft drink consumption and overall cancer death.

The findings lend support to initiatives such as Philadelphia’s decision to pass a soda tax, which has led to a 38% drop in sales.

Institute for Value-Based Medicine Registration

Finally, registration is now open for our October regional meeting of the Institute for Value-Based Medicine, which will travel to Nashville, Tennessee. Join us October 24 at the Hutton Hotel for an evening of discussion on value-based care, led by our co-chairs, Aaron Lyss, director of value-based care for Tennessee Oncology, and Stephen Schleicher, MD, MBA, medical oncologist, Tennessee Oncology.

And it’s not too late to register for our meeting September 19th in Philadelphia, featuring faculty from Penn Medicine, Sidney Kimmel Cancer Center, Fox Chase Cancer Center, and Independence Blue Cross. For information and to register, visit

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