This Week in Managed Care: May 3, 2019

The head of CMS calls for more disruption to the healthcare system, the former FDA Commissioner reflects on the agency’s record of innovation, and liraglutide shows promise for youth with type 2 diabetes.

Welcome to This Week in Managed Care, I’m Samantha DiGrande.

Upend the Status Quo to Move to Value, Says Verma

CMS Administrator Seema Verma, MPH, last week said the shift to value-based care isn’t happening fast enough, and the Trump administration will make changes to further disrupt the status quo and bring down costs. Verma told attendees at the National Association of Accountable Care Organizations (NAACOS) that calls for Medicare for All are misguided, because more government control under the Affordable Care Act has not brought savings for consumers. She said reform must come at a faster pace.

Said Verma: “Value-based care means upending the current paradigm and, in my view, it’s not happening fast enough.”

Verma said CMS will focus on the following:

• Payment reform that aligns with the Triple Aim
• Giving clinicians flexibility to innovate
• Amending the Stark Law to allow better coordination of care

For more from Verma’s address and for full coverage of the NAACOS meeting, visit ajmc.com.

Gottlieb Highlights FDA's Push for Innovation

In his first speech since stepping down as FDA Commissioner, Scott Gottlieb, MD, put a spotlight on the agency’s push for innovation during his tenure. Speaking at the World Health Care Congress in Washington, DC, Gottlieb said boosting innovation called for the agency to think differently because the old rules did not apply.

Among the issues he discussed:

• How to address market exclusivity for different therapies that target the same gene but through different vectors.
• How new guidance documents will shape the regulation of regenerative medicine.
• How tissue agnostic approvals will speed innovation in oncology.
• How new regulatory tools are needed for the rise of artificial intelligence.

For more on Gottlieb’s speech and full coverage from the World Health Care Congress, visit ajmc.com.

Liraglutide Lowers A1C in Type 2 Diabetes

Youth who took liraglutide, the glucagon-like peptide-1 receptor agonist sold as Victoza, had significantly lower A1C after a year than those who took a placebo, according to a study published last weekend. Phase 3 results from the Ellipse trial, funded by Novo Nordisk, could lead to a new treatment option for teens under age 18 with type 2 diabetes, who today have only 2 FDA-approved therapies: metformin and insulin.

A 2017 study from the National Institutes of Health found rising rates of type 2 diabetes among US youth aged 10 to 19, especially in minority groups. This is driven by the increase in childhood obesity. Novo Nordisk said it is already seeking approval from US and European regulators to market liraglutide for pediatric use.

Said Mads Krogsgaard Thomsen, executive vice president and chief science officer at Novo Nordisk, “These data add to the extensive evidence for the use of Victoza and further cement Novo Nordisk's commitment to addressing a considerable and growing unmet medical need across the full spectrum of the type 2 diabetes patient population.”

Personalized Breast Cancer Treatment Can Significantly Lower Costs

Sparing certain women with breast cancer from chemotherapy based on the genomic profile of the tumor could trim $50 million in US healthcare costs in the first year of care. That’s what researchers from Georgetown’s Lombardi Cancer Center have concluded in an analysis based on results from last year’s landmark TAILORx trial, which found that the Oncotype DX test demonstrated that 70% of women with the most common type of breast cancer could be treated with endocrine therapy alone.

Said study author Jeanne Mandelblatt, MD, MPH, professor of oncology and medicine at Georgetown Lombardi Comprehensive Cancer Ceneter, “Individual women's decisions should not be about dollars and cents, but what is right for them based on consideration of the best evidence and personal preferences.”

Why Patients Seek Out Medical Marijuana

Finally, in this week’s Managed Care Cast, we speak with Dr. Kevin Boehnke, a researcher in anesthesiology, about the findings that chronic pain is the most common reason patients qualify for medical marijuana. You can listen to the podcast through iTunes, TuneIn, Stitcher, Spotify, or find it online at ajmc.com.

For all of us at the Managed Markets News Network, I’m Samantha DiGrande. Thanks for joining us.