This Week in Managed Care: March 15, 2019

The White House budget proposal brings mixed results for healthcare, FDA approves the first immunotherapy regimen for breast cancer, and researchers reveal underlying mechanisms in sodium glucose co-transporter-2 (SGLT2) inhibitors.

Welcome to This Week in Managed Care, I’m Jaime Rosenberg.

White House Releases Proposed Budget for 2020

President Trump’s 2020 budget plan calls for a mix of healthcare spending cuts and increases, as well as policy changes that would expand rules in place in some states. Proposals include:

• A 12% cut to the HHS budget, to $87.1 billion
• Requiring states to create Medicaid work rules, which are now optional
• Replacing the ACA with grants to subsidize private insurance coverage
• Requiring prior authorization for Medicare fee-for-service
• Adjustments to the Medicare reimbursement schedule for new drugs, biologics, and biosimilars

The budget includes $291 million in funding for HIV efforts, after President Trump announced a goal of reducing the number of new infections by 75% within 5 years and 90% in 10 years. The budget emphasizes improving access to pre-exposure prophylaxis, or PrEP, which protects people at high risk of HIV from infection. While there are more than 1.2 million Americans who should be taking PrEP, only 10% are on the pill.

At the same time, the budget calls for a 12.6% drop in funding to the National Institutes of Health, including cuts to the National Institute for Allergy and Infectious Diseases, the agency most responsible for HIV research. The National Cancer Institute would lose 14.6% of its budget, dropping from $6.14 billion to $5.25 billion.

For more visit ajmc.com.

FDA Approves First Immunotherapy Regimen

FDA this week approved atezolizumab, a programmed death ligand-1 (PD-L1) inhibitor, to be used in combination with nab-paclitaxel to treat adults with unresectable locally advanced triple negative breast cancer. The treatment, sold as Tecentriq, is the first immunotherapy regimen for the treatment of breast cancer and offers a regimen for patients who had few treatment options.

Said Hayley Dinerman, executive director of the Triple Negative Breast Cancer Foundation: “The Tecentriq regimen is an exciting new treatment for certain people living with metastatic triple-negative breast cancer, a difficult-to-treat disease. Chemotherapy alone has been the mainstay of treatment for many years, so it’s encouraging to now have an immunotherapy combination available for people with PD-L1 positive disease.”

The FDA said that continued approval of the combination in this setting will require a confirmatory trial.

Scientists Uncover How SGLT2 Inhibitors Work

While scientists understand the basic outlines of how SGLT2 inhibitors lower blood glucose for patients with type 2 diabetes, some other aspects remained a mystery, including how patients lost weight. Researchers from Joslin Diabetes Center, reporting in JCI Insight, have reported on an animal study that sheds light on the mechanisms of this important drug class that is now being investigated for renal disease and heart failure.

SGLT2 inhibitors largely work by targeting a protein that normally reabsorbs glucose through the kidney. This causes patients to expel excess glucose through the urine. But they also induce a fasting state without requiring patients to sharply cut back on food intake. The Joslin team was able to demonstrate this mechanism in experiments with three groups of mice eating different types of diets and seeing the reaction to the drug.

For more, visit ajmc.com.

e-Cigarettes Boost Risk of Heart Attack, Coronary Artey Disease

A study released this week by the American College of Cardiology found that e-cigarette users were at higher risk for heart attacks or coronary artery disease and more likely to experience emotional distress, raising the question whether they are truly a healthier alternative to tobacco.

The study was released as prelude to the ACC Scientific Sessions, which will be held this weekend in New Orleans, Louisiana.

For full coverage of the meeting, visit our conference page.

For all of us at the Managed Markets News Network,

I’m Jaime Rosenberg. Thanks for joining us.