This Week in Managed Care: October 21, 2016

Hello, I’m Justin Gallagher, associate publisher of The American Journal of Managed Care. Welcome to This Week in Managed Care from the Managed Markets News Network.

Cancer Moonshot

Vice President Biden presented his report on the Cancer Moonshot initiative this week, which calls for increased information sharing and a $700 million investment from Congress. Biden said he has witnessed more collaboration since the project began, but that much more needs to be done.

The report calls for:

• More incentives to reward collaboration
• Better recruitment for clinical trials
• Faster sharing of both patient information and discoveries

Several research efforts have started under the Moonshot initiative, including a partnership at the National Institutes of Health to bring together cancer research centers, foundations, philanthropies, and drug companies to share data.

For more on the Cancer Moonshot, click here.

MACRA Final Rule

Physicians and healthcare experts around the country spent this week reading the details of the final rule for MACRA, the Medicare Access and CHIP Reauthorization Act.

Many praised CMS for listening to concerns that the rule as first proposed would have threatened the survival of small and rural physician practices. As the final rule was announced, Kate Goodrich, MD, director of Quality Measurement and Value-Based Incentives at CMS, explained the approach that regulators took in protecting these providers from too much upheaval as they transition away from fee-for-service.

Watch the interview.

Health Plan Discrimination

Complaints filed with HHS charge that 7 health insurers are discriminating against people with HIV and other serious illnesses by making the drugs they need unaffordable.

Harvard Law School’s Center for Health Law and Policy filed complaints with HHS’ Office of Civil Rights, saying the insurers are trying to avoid parts of the Affordable Care Act that bar marketplace plans from creating benefit designs that discriminate based on age, race, gender, sexual orientation, or illness. While regulators don’t define such designs, they’ve suggested that pricing single tablet regimens that are standard of care out of reach would meet the test.

The center filed complaints against Humana plans in six states, against Cigna plans in 3 states, and against 5 other insurers in Pennsylvania, Wisconsin, and Texas.

Remicade Biosimilar

Pfizer said this week that its biosimilar Inflectra, similar to Johnson & Johnson’s TNF blocking agent Remicade, will cost 15% less when it reaches the US wholesale market in November. Said Pfizer’s Diem Nguyen, “By introducing Inflectra to the US marketplace, Pfizer is helping customers access an additional high-quality treatment option that promises greater savings for the healthcare system.”

Inflectra was approved this year to treat rheumatoid arthritis, Crohn’s disease, psoriatric arthritis, and plaque psoriasis. Without insurance or discounts, a single dose of Remicade can cost $1300 to $2500, depending on a patient’s weight and the disease being treated. Johnson & Johnson said Pfizer’s move would be an “at-risk launch” given ongoing litigation but that it would compete with discounts, rebates to payers and pharmacy benefit managers, and other options.

Negotiating Out-of-Network Bills

There’s a lot in the news these days about the “surprise” bills that patients receive if they venture outside narrow networks for care. A new study in the current issue of The American Journal of Managed Care shows that few patients try to negotiate bills, and they’re not too successful when they do.

The Internet survey found that only 19% of patients tried to negotiate out-of-network bills and succeeded only 56% of the time. If there’s a lesson in the findings, patients had more luck working straight with the provider than the insurer. Read the full study.

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