This Week in Managed Care: April 7, 2017

This week, the top stories in managed care included the president's pick to lead the FDA testified before a Senate committee; Mylan recalls EpiPen batches and faces a class action lawsuit; and a study ties being a night owl to increased depression in patients with diabetes.

A Senate panel weighs the nomination of Dr. Scott Gottlieb for FDA; EpiPen faces a global recall and a lawsuit; and value-based contracts face challenges.

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

Gottlieb's Hearing for FDA

Scott Gottlieb, MD, President Donald Trump’s nominee for FDA commissioner, withstood tough questions about his ties to the drug industry at a hearing before a Senate panel this week.

Gottlieb, a former regulator at both FDA and CMS, has more recently advised companies on the drug approval process, and promised to recuse himself from decisions involving those firms. He’s been a guest for AJMC panel discussions on oncology therapies and testified about the effect of regulation on the cost of drugs.

“We need to make sure we’re getting the most bang for our regulatory buck. That means being cognizant of risks and being sure that we’re not adding to consumer costs without improving consumer safety.”

Mylan's Troubles

It’s been a tough week for Mylan, the maker of the EpiPen, which rescues people having severe allergic reactions. The company issued a global recall for 13 batches of the EpiPen and EpiPen Jr after two reports that the auto-injectors failed to work.

Then, Mylan was sued in federal court in Washington State, with the class action lawsuit claiming the company was in a scheme with pharmacy benefit managers to control the market and keep consumer prices high. PBM giants CVS Caremark, Express Scripts, and Optum Rx were discussed in the lawsuit but not named as defendants.

For more, read the story

Challenges of Value-Based Contracts

There’s plenty of interest in shifting to value-based contracting, but there are still many challenges, according to panelists at last week’s annual meeting of the Academy of Managed Care Pharmacy. Tomas Philipson, PhD, of the University of Chicago outlined 5 issues that value-based contracting faces, which are:

A need for stronger incentives
A need for measures that matter to patients
A way to address patient preferences
A need to avoid complex contracts, and
A need to reward innovation

Jeremy Schafer, PharmD, MBA, said more payers are using value-based contracts for expensive new drugs.

“Value frameworks are increasingly being used by payers. And this is, for many of them, creating almost a foundation or benchmark they can rest upon when going out there and working with manufacturers on potential value-based arrangements.”

Depression and Late Nights

Being a “night owl” can be harmful to those who have diabetes, according to a study reported at the annual meeting of the Endocrine Society. The study finds that patients with diabetes who stay up late—and wake up later—are more likely to suffer from depression than early risers.

The authors note that depression is known to be more common among patients with type 2 diabetes, and that scientists are learning more about the importance of regulating sleep, along with diet and exercise.

Depression can make diabetes management difficult, according to the study’s lead investigator: “Previous studies show that untreated depression is related to worse patient outcomes, including diabetes self-care, blood glucose control and diabetes complications.”

Attitudes Toward ACA

Finally, a poll by the patient network PatientsLikeMe finds that cancer patients share the general public’s concerns about healthcare costs, but see benefits in the Affordable Care Act that others may miss.

Cancer patients in the survey reported: