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This week's paper from our editors-in-chief presented the idea of tying a prescription drug's cost-sharing to its clinical value to the patient.

Medicare beneficiaries with untreated obstructive sleep apnea (OSA) have increased healthcare utilization (HCU) and costs across all points of service, according to results of a recent study published by the Journal of Clinical Sleep Medicine.

“The course of history shows that as government grows, liberty decreases.” --Thomas Jefferson

This week, top managed care stories included a new plan for Medicaid block grants; federal officials’ response to the novel coronavirus; FDA offers guidance for gene therapies.

Coverage of our peer-reviewed research and news reporting in the healthcare and mainstream press.

The incidence of open globe injuries decreased in the US from 2006 to 2014, according to a recent study published in JAMA Ophthalmology.

Results come at the decision point for practices: Will it be 1-sided or 2-sided risk?

A. Mark Fendrick, MD, director of the Center for Value-Based Insurance Design (V-BID) at the University of Michigan and co-editor-in-chief of The American Journal of Managed Care®, and Suzanne F. Delbanco, PhD, executive director of Catalyst for Payment Reform, discuss V-BID X for employers, a plan constructed through benefit-design and payment reform that works to promote high-value services and deter low-value care.

Three proteasome inhibitors (PIs) are approved for patients with multiple myeloma (MM): Bortezomib, a first-in class PI, fights both newly diagnosed and relapsed/refractory MM (RRMM); carfilzomib, a next-generation PI, treats RRMM as both a monotherapy and in combination; and ixazomib, the first oral PI, treats RRMM in combination. PIs work by preventing the proteasomes in cancerous plasma cells from “recycling” what is essentially garbage protein.

The World Health Organization issued a global health emergency over coronavirus; a judge orders Johnson & Johnson to pay hundreds of millions in a pelvic mesh suit; the House of Representatives passes a ban on fentanyl look-alikes.

For the first time since 2007, the National Center for Health Statistics (NCHS) issued a report on maternal mortality, which they define as any death that occurs while a woman is pregnant or within 42 days following the termination of the pregnancy. NCHS also released reports on life expectancy and mortality for 2018.

The drug-shock strategy was more effective for patients experiencing atrial fibrillation for the first time and for patients younger than 70 years, the researchers said.

CMS Administrator Seema Verma announced Medicaid structural reforms, rebranding what was previously known as block grant funding as the “Healthy Adult Opportunity.”

Tara Vail is the Chief Operating Officer of HST Pathways and serves on the Board of the California Ambulatory Surgery Association.

Chimeric antigen receptor (CAR) T cells are a patient’s own, harvested and reengineered to attack specific malignant cells. They were initially developed using knowledge gleaned from allogeneic stem cell transplants: that donor mature immune cells can attack healthy cells in the recipient patient.

The newly sworn in FDA commissioner faces tobacco regulation challenges; CMS announces changes in hospital quality ratings; soldiers with traumatic brain injuries are more likely to develop mental health disorders.

Researchers from the Employee Benefit Research Institute (EBRI) estimate that if hospital unit prices matched physician office (PO) prices of cancer drugs, holding drug mix and treatment intensity constant, commercial insurers would have saved $9766 (45%) per user of these medicines in 2016, with statistically significant relative differences ranging from 128.3% (nivolumab) to 428% (fluorouracil).

Researchers in Canada determined that a treat-and-extend regimen of administering ranibizumab to patients with neovascular age-related macular disease produced comparable results to a monthly dosing administration, according to a study published in JAMA Ophthalmology.

Key features of the lung microbiome (bacterial burden, enrichment with gut-associated bacteria) were found to predict outcomes in critically ill patients, representing a potential therapeutic target for the prevention and treatment of acute respiratory failure, according to study findings.

Body mass index (BMI) and low vitamin D are causal factors for multiple sclerosis (MS), according to a recent study published in Neurology Neuroimmunology & Neuroinflammation.

HHS will announce its Medicaid fixed-payment block grant proposal on Thursday; the United States reiterates its offer to send a team to China to help with the coronavirus outbreak; Maryland legislators renew their fight over medically assisted suicide.

Researchers exhibit recent advances in the basic characteristics of interleukin (IL)-24, a member of the IL-20 family of cytokines associated with pro-inflammatory autoimmune disorders such as psoriasis, arthritis, and inflammatory bowel diseases, as a catalyst in the pathogenesis of allergic skin inflammation.

Medical cannabis was found to exhibit an overall positive effect on maintaining nightime sleep in patients with chronic pain, but frequent use was associated with problems of both waking up at night and falling asleep, according to study findings.

In a press conference, HHS secretary Alex Azar provided updates on the US government’s response to the 2019 novel coronavirus. He was joined by the director of the CDC, Robert Redfield, MD; the director of CDC’s National Center for Immunization and Respiratory Diseases, Nancy Messonnier, MD; and the director of the National Institutes of Health’s National Institute of Allergy and Infectious Diseases, Anthony Fauci, MD.

Participants in Last Gift, an end-of-life HIV research program from UC San Diego, donate their blood and their bodies so researchers can uncover all the places that HIV hides, to both fight the disease and stop it. Before each autopsy, the following is read: “From our first breath to our last, each of us tells a unique story. Here, we honor our Last Gift participants for their altruism to further research into HIV and the human condition. We take this moment of silence to honor their gifts and express our gratitude for all the discoveries their selfless donations will yield.”

The American Medical Association Foundation announced a national fellowship program to promote best practices and shared outcomes for the LGBTQ community; the FDA issued guidances promoting development of gene therapy products; the CDC announces 110 possible cases of coronavirus in the United States.

Ipsen, a French pharmaceutical company based in Paris, announced it has paused studies conducted on a drug used to treat Fibrodysplasia ossificans progressive (FOP).

New York Attorney General Letitia James announced a lawsuit filed against 2 former chief executive officers of Turing Pharmaceuticals, now known as Vyera Pharmaceuticals: “Pharma Bro” Martin Shkreli, currently serving a 7-year sentence in federal prison for securities fraud, a crime that took place before the launch of Vyera, and his business partner Kevin Mulleady.

CMS said it is expanding coverage of next generation sequencing (NGS) for use as a diagnostic for patients with germline breast and ovarian cancer, paving the way for Medicare beneficiaries to receive more personalized medicine. However, an advocate said the wording of CMS' decision could actually limit testing access for some women with breast or ovarian cancer.

Heart failure (HF) taxes the American healthcare system by a total of $39.2 billion to $60 billion each year. This amount is expected to increase up to 20% by 2030 and total $70 billion. Worldwide, HF has been diagnosed in 26 million individuals, and this number is rising.