This Week in Managed Care: January 11, 2019

This week, the top managed care news included the FDA commissioner discussing boosting drug competition; BMS offering details on its acquisition of Celgene; and cancer mortality rates declining for the 25th consecutive year.

The FDA Commissioner looks to boost drug competition, Bristol-Myers Squibb's (BMS’) big purchase kicks off JP Morgan’s healthcare conference, and cancer survival increases, but the news isn’t all good.

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

Gottlieb Discusses Promoting Drug Competition in 2019

FDA Commissioner Scott Gottlieb, MD, promised more steps to promote competition in 2019, as he addressed the JP Morgan Health Care conference in San Francisco. Gottlieb took questions remotely due to the government shutdown. He said the FDA will issue more guidance documents that will close the gap between product approvals and products that actually reach the market.

Said Gottleib: “If we bring more products to the market, that will promote price competition.”

Biosimilars and generic drugs can expect plenty of attention, and Gottlieb promised several items for these manufacturers:

A long-awaited interchangeability guidance
A policy on carving back indications
An updated Purple Book, which is the list of licensed biological products

For more, see AJMC’s sister site, the Center for Biosimilars.

BMS and Celgene Discuss Merger

The JP Morgan meeting kicked off with a joint session for BMS and Celgene, where they announced their $74 billion merger. With stakes in similar fields and drugs that include Opdivo, Yervoy, and Eliquis, the marriage will drive more value in oncology, cardiology, and autoimmune diseases, according to BMS Chairman and chief executive officer (CEO) Giovanni Caforio. Pipeline products include five in Celgene’s portfolio, notably liso-cel, which would be the third CAR T-cell therapy.

Said Celgene CEO Mark J. Alles: “This is a scientific powerhouse; when you put together the innovation and the scientists who are at BMS with what we’ve built through our network of partners and our standalone company, the scientific prowess of this company is unparalleled.”

The JP Morgan meeting also brought news that Eli Lilly is buying LOXO Oncology for $8 billion. LOXO’s medicines target genetic mutations regardless of where they are in the body.

For more on the BMS acquisition, visit ajmc.com.

Cancer Mortality Rates Continue to Decline

For the 25th year in a row, the American Cancer Society reported a drop in the cancer mortality rate. That’s the good news. The bad news is that socioeconomic disparities are getting worse. The annual report, published in CA: A Journal for Clinicians draws on data from the National Center for Health Statistics and the National Cancer Institute. Thanks to decades of public health efforts to get people to quit smoking and earlier detection, much of the news is good:

From its peak in 1991, the cancer death rate has dropped steadily about 1.5% a year.
Death from lung cancer dropped 48% among men from 1990 to 2016, and 23% from 2002 to 2016 among women.
Prostate cancer deaths dropped 51% from 1993 to 2016, and breast cancer deaths dropped 40% from 1989 to 2016.

Changes in diet are working against this good news, however. Overall, colorectal cancer death rates have dropped 53% since the 1970s. But the gap in rates for men in the richest and poorest counties was 20% 40 years ago; today, it’s 35%. Lack of access to care is an issue.

The authors wrote: “These [poor] counties are low-hanging fruit for locally focused cancer control efforts, including increased access to basic healthcare and interventions for smoking cessation, healthy living, and cancer screening programs. A broader application of existing cancer control knowledge with an emphasis on disadvantaged groups would undoubtedly accelerate progress against cancer.”

Medical and Recreational Marijuana

This week, Annals of Internal Medicine, the leading journal for physicians in primary care for adults, published a series of perspectives on medical and recreational marijuana. Collectively, while the authors say the opioid crisis has created interest among physicians in finding alternatives to treat pain, regulatory and research gaps create challenges. Authors from the University of Pittsburg Medical Center Health Plan said marijuana’s status as a Schedule 1 drug prevents research and payer coverage.

Lead author Chester B. Good, MD, told The American Journal of Managed Care^®: “It is my personal belief that insurers will need to consider nontraditional data, and eventually (assuming removal of legal constraints) can use these data for coverage decisions.”

CVS Discusses Aetna Acquisition

Finally, the JP Morgan conference offered both breaking news and updates on news from the past year. CVS Health CEO Larry Merlo told attendees that the integration with Aetna is offering new care coordination opportunities for patients. A concept store will open in Houston, Texas, and CVS will roll out programs to help patients manage chronic diseases, including: