This Week in Managed Care: September 20, 2019

Purdue Pharma files for bankruptcy, data on HIV screening disappoint, and a report shows most US hospital markets are now highly concentrated.

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

Purdue Pharma Files for Bankruptcy

Oxycontin maker Purdue Pharma sought bankruptcy protection Sunday night, as the company offered a tentative agreement to resolve lawsuits with 24 states and more than 2000 other jurisdictions over the company’s role in the opioid epidemic. While the Sackler family agreed to give up control of Purdue Pharma, New York Attorney General Letitia James said her office had identified $1 billion in wire transfers that showed an attempt to shield assets from the settlement.

So far, several attorneys general have rejected the deal because Purdue has not admitted wrongdoing and because the payment would come from future drug sales. Said Massachusetts’ Attorney General Maura Healey in The Washington Post: “We have to ask ourselves, if we want real accountability for this wrongdoing, where should the money come from? Should it come from future sales of addictive and deadly drugs, as Purdue has proposed, or should it come from the Sacklers themselves? I rejected the

settlement because it doesn’t tell the truth about what happened.”

HIV Screening Rates

New findings suggest the number of people who get screened for HIV at least once falls far short of what CDC recommends. Using electronic health records from 40 million patents over a 20-year period, researchers reporting in the journal Cureus found that the share of adult Americans who have a prior HIV test may be as low as 6.4%.

That figure is far lower than survey estimates that about 42% of the public has been screened.

The researchers wrote: “While our estimates were significantly lower than those reported by the CDC, it should be noted that no study has yet determined whether single-item questions on national surveys of HIV screening corroborate with objective evidence of screening.”

The researchers acknowledged several limitations in their study:

• Some hospital systems do not report HIV data to the EHR or use anonymous screening
• Patients screening outside health systems may not be in the data
• Conversion from paper charts to EHRs may have caused missing data

For more, visit ajmc.com.

US Hospital Market Concentration

A new report shows that 75% of US hospital markets are now highly concentrated. The Health Care Cost Institute (HCCI) released its Healthy Marketplace Index, which uses inpatient hospital claims to assess competition among providers in a region.

The report found:

• Nearly 75% of 112 metropolitan areas were deemed highly concentrated by 2016, compared with 67% of 75 areas in 2012.
• 69% of the markets studied showed an increase in concentration.

Said HCCI president and chief executive officer Niall Brennan, “Increasingly concentrated hospital markets have been linked to the rising cost of hospital care by nearly every expert in the field.”

For more, visit ajmc.com.

Fast Track Designation for Dapagliflozin, Positive Carfilzomib Data

FDA has designed AstraZeneca’s dapagliflozin, sold as Farxiga, for fast track designation to reduce the risk of cardiovascular death or worsening of heart failure in adults with reduced or preserved ejection fraction. The decision was based on 2 phase 3 trials, DAPA-HF and DELIVER. Last month, FDA granted this designation to the drug to delay the progression of renal failure and prevent cardiovascular and renal death in patients with chronic kidney disease.

And Amgen has posted updates on triplet therapy involving carfilzomib, sold as Krypolis. The phase 3 CANDOR study, involving carfilzomib, dexamethasone, and daratumumab, sold as Darzalex, met its primary end point of progression-free survival in patients with relapsed or refractory multiple myeloma, with a 37% reduction in risk of progression or death.

Said Amgen’s David Reese, MD, executive vice president of Research and Development: "The potential to combine Kyprolis with Darzalex, 2 powerful targeted agents, represents an additional therapeutic approach for patients with relapsed or refractory multiple myeloma. The results from the CANDOR study confirm the potential for Kyprolis to be used in combination with an anti-CD38 monoclonal antibody."

Managed Care for Long-Stay Nursing Home Patients

Finally, a study in the new issue of The American Journal of Managed Care^® examines the performance of UnitedHealthcare’s at-risk model involving long-stay nursing home patients.

Authors led by Brian E. McGarry, PT, PhD, Department of Health Care Policy, Harvard Medical School, found that, compared with traditional fee for service institutionalized Medicare beneficiaries, patients in the models had:

• 51% lower emergency department use
• 38% fewer hospitalizations
• 45% fewer readmissions
• But skilled nursing facility use was 112% higher

For the full study, visit ajmc.com.

For all of us at AJMC, I’m Jaime Rosenberg. Thanks for joining us.