This Week in Managed Care: May 29, 2020

Seniors enrolled in Medicare Advantage and certain Part D plans to see insulin costs capped in 2021, details on why the BPCIA should stay even if the Affordable Care Act falls, and AJMC^® learns nationwide and state-level takeaways from Sharecare’s Flatten the Curve Survey.

Welcome to This Week in Managed Care, I’m Matthew Gavidia.

Seniors in Certain Plans to See Insulin Costs Capped in 2021

This week, CMS said that senior citizens who use insulin for diabetes and are enrolled in Medicare Advantage and certain Part D pharmaceutical plans will see co-pays drop by 66% in 2021 and capped at $35.

President Trump announced the plan at the White House on Tuesday, which would allow manufacturers to continue paying their full coverage gap discount for their products even when a plan offers lower cost sharing.

In a call with the media, CMS Administrator Seema Verma and Kellyanne Conway, assistant to the president and senior counselor, said 88 Part D sponsors applied to the Part D Senior Savings Model to offer “enhanced” plans for a 1-month supply of insulin from the beginning of the year through the Part D coverage gap.

Moreover, the plan would require participating Part D sponsors’ plans, in part through applying manufacturer rebates, to lower cost sharing to no more than $35 for a month’s supply.

Dr Sachin H. Jain, the just-departed leader of CareMore Health who took steps to deal with insurance affordability among low-income seniors, called the move "disruptive" and said it would force conversations about the use of copays for essential medicines.

For more, visit ajmc.com.

Association Details Why BPCIA Should Stay Even if ACA Falls

This month, briefs were due in the Supreme Court, which in March agreed to review the decision of the Fifth Court of Appeals in California v Texas, originally Texas v Azar, over the constitutionality of the Affordable Care Act.

One of those briefs, filed by the Association of Accessible Medicines, or AAM, which supports biosimilar development, argues that even if the ACA is deemed unconstitutional, the Biologics Price Competition and Innovation Act, or BPCIA, is severable and should survive, noting it has strong bipartisan support.

In its brief, the organization says that biosimilars are expected to save at least $54 billion for patients and health care systems over the next 7 years. Throwing the BPCIA out with the ACA would mean that the FDA would lose its approval to streamline biosimilar approvals and corporations would lose the investments they have made in this industry.

In a statement, Jeff Francer, interim CEO and general counsel at AAM, said, “FDA-approved biosimilars offer patients and taxpayers enormous cost savings on life-saving treatments.…If a constitutional challenge to some provisions of the ACA resulted in the invalidation of the entire ACA, including the BPCIA, a decade of progress by AAM and its members would be lost—and at a crucial moment.”

For more, visit ajmc.com.

Takeaways From Sharecare’s Flatten the Curve Survey

In a 2-part interview with AJMC^®, Elizabeth Colyer, senior vice president of Community Well-Being Index at Sharecare, shared nationwide and state-level takeaways from the organization’s Flatten the Curve Survey.

As indicated by Colyer, the survey’s question set was based around 3 core categories:

• Habits and behaviors related with flattening the curve of COVID-19
• Up-to-date information on COVID-19 transmission
• And well-being or potential well-being changes caused by the pandemic

Based on a nationwide perspective, the greatest takeaways from the survey were mental well-being, the connection between health and wealth, and access to health care.

At the state-level, Colyer highlighted the negative impact of COVID-19 on survey respondents in states with typically high mental and financial well-being, as well as the lack of change in those within states already known for these negative tendencies.

For the interview on nationwide takeaways, visit ajmc.com.

For the interview on state-level takeaways, visit ajmc.com.

Amid COVID-19, New Ways to Fight Cancer

A new survey from the American Society for Radiation Oncology, or ASTRO, reports shortages of personal protective equipment and a drop in the number of patients due to the COVID-19 pandemic.

Notable findings from the nation’s radiation oncologists highlight the growing financial strain at freestanding clinics, including those that say they will lose half their annual revenue.

Furthermore, the ASTRO report also shows the ability of radiation oncologists to adapt, whether through telehealth or other care delivery models, which could prove crucial as some freestanding clinics are the only location for radiotherapy in their area.

During an interview with AJMC^®, ASTRO President Dr Thomas Eichler said that an overlooked aspect of the pandemic on cancer patients is the “huge psychological impact,” warranting recommendations to ensure safe and timely care.

“I’m hopeful that we’re doing an adequate job of meeting the needs of not only the patients and the staff, but the membership as a whole. And I will say that we are a long way from this being over.”

For more, visit ajmc.com.

Paper of the Week

And, now our paper of the week, which looks back at some of the most important papers over the past 25 years of The American Journal of Managed Care^® and why they matter today.

Over the years, The American Journal of Managed Care^® has published several studies on drug affordability and out of pocket costs. But this week, we will feature a very recent paper:

A March 2020 study led by Patrick Liu found that Medicare beneficiaries often paid more out of pocket in their health plans than they would spend if they bought drugs at Walmart.

For the paper, visit ajmc.com.

For all of us at AJMC^®, I’m Matthew Gavidia.