This Week in Managed Care: September 25, 2020

Supreme Court vacancy may shape the fate of the Affordable Care Act and reproductive rights, access to care for patients with Parkinson disease and rheumatoid arthritis is affected by the pandemic, and a look at the opportunities presented by the virtual format of Patient-Centered Oncology Care^® 2020.

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

How a Supreme Court Vacancy Can Shape the Fate of the ACA, Reproductive Rights

This past week, the passing of Supreme Court Justice Ruth Bader Ginsburg threw an already contentious election season into greater limbo, as her death and potential replacement could result in substantial changes to the future of the Affordable Care Act, or ACA, and women’s reproductive rights.

Throughout her tenure, Ginsburg consistently voted to uphold the tenets of the ACA and protect reproductive rights, including access to birth control and the right of a woman to have an abortion, stances largely opposed by the Trump administration and conservative justices and senators alike.

In 2017, President Donald Trump eliminated the individual mandate—the heart of the ACA that requires everyone to have health coverage, with the Fifth Circuit of the United States Court of Appeals also ruling the mandate unconstitutional in 2019.

Arguments on the case are scheduled for the week after the 2020 November election. Without Justice Ginsburg on the bench, the case may end up in a 4-4 tie, meaning the lower-court ruling would stand.

In addition to the possibility of women losing birth control coverage should the ACA be repealed, a vacancy on the Supreme Court creates an opportunity for the erosion or complete reversal of other landmark cases instrumental in ensuring female reproductive rights.

Trump plans to name a female Supreme Court nominee to replace Justice Ginsburg by the week’s end—a move contested by those arguing a replacement should not be instated until after the 2020 presidential election.

As the week drew to a close, the Trump administration planned to have the president sign 2 executive orders about preexisting conditions and surprise medical billing at a campaign event in in North Carolina, but it is unclear if the orders will have any impact or carry any authority. One declares that it is US policy to protect people with preexisting conditions no matter what happens to the ACA, and the other directs HHS Secretary Alex Azar to work with Congress to get legislation about surprise medical billing passed by January 1, 2021, or else he can investigate other options.

For more, visit ajmc.com.

Access to Parkinson Disease Medication Affected in Low-Income Countries

In a recent global study published in the journal Movement Disorders, health professionals reported difficulty in patients gaining access to Parkinson disease medications amid the COVID-19 pandemic, particularly in low-income countries.

Worldwide, COVID-19 has caused many government bodies to implement drastic measures to curb viral spread and limit human movement both within and between countries.

Although Parkinson disease is not a comorbidity associated with adverse events due to COVID-19, researchers of the study note that these restrictions and potential lack of resources may have negatively affected patients with the disease.

Moreover, if shortages of antiparkinsonian medications like levodopa were to occur, patients with Parkinson Disease could be at greater risk of OFF periods, which is the recurrence of symptoms after a period of symptom control.

Led by researchers from Queen Mary University of London, the study polled 346 health professionals from 76 countries across Asia, Africa, Latin America, and South America at the height of the pandemic in June 2020.

In assessing survey responses, a larger portion of respondents disagreed than those who agreed on whether COVID-19 had affected access to Parkinson disease medication. However, after stratifying for income, 88.9% of low-income countries’ respondents agreed that access to Parkinson disease medication was affected by COVID-19, compared with 22.8% of high-income providers.

“The results provide further evidence of inequity in routine PD care by region and wealth, which has been worsened by COVID-19," said corresponding author Dr Alastair Noyce of Queen Mary University of London.

For more, visit ajmc.com.

ACR Survey Reveals Patients Struggle to Maintain Access to Care During COVID-19 Pandemic

Remaining on the topic of access to care, a national survey of individuals with rheumatic diseases found that many face difficulties in obtaining access to care, with many forgoing physician care completely.

The survey, conducted in June by Rheumatic Disease Awareness Month 2020 and the American College of Rheumatology, revealed that there has been a 52% decline in patients currently seeing a rheumatologist between 2019 and 2020:

• In 2020, 33.5% of patients said they were currently receiving care, compared with 57.4% of respondents in 2019 who said they were being treated by a rheumatologist.
• Of those in 2020 who reported that they were no longer being treated by a rheumatology provider, 38.23% said that they used to be.

Affordability has also become an issue in 2020, with annual median out-of-pocket expenses more than doubling over the past year.

“It is critical for patients, clinicians, and policymakers to work together to improve rheumatology care so that those living with these diseases can live longer, healthier, and more fulfilling lives,” wrote the authors.

For more, visit ajmc.com.

Patient-Centered Oncology Care® 2020

Leading up to Patient-Centered Oncology Care^®, or PCOC^® 2020, The American Journal of Managed Care^® interviewed several key opinion leaders who will take part in Friday’s virtual conference.

Chief among them, co-chairs of PCOC® 2020 Drs Joseph Alvarnas and Kashyap Patel spoke with AJMC^® on opportunities presented by the virtual format, and how the COVID-19 pandemic will factor into discussions.

“The technology we have here allows us to have the kind of immediacy that we get under the best of circumstances in small sessions, to allow individuals in the audience to get questions to the speaker in a really efficient way, and to really foster the kinds of communities that we've seen develop online, through everything from Facebook, through Twitter, and Instagram,” stated Dr Alvarnas.

Dr Patel, who spoke on a wide array of issues regarding the pandemic’s effect on cancer care delivery, noted that for this year’s PCOC^® 2020, “the first thing I want to hear from my fellow colleagues on the panel is how they are navigating their own operations, how they are trying to minimize the risk of exposure, and how they’re incorporating telehealth to minimize inpatient visits for patients coming and getting exposed to another patient.”

For all the conference coverage, visit ajmc.com.

FDA Accepts Anti-BCMA Ide-cel for MM for Priority Review

This week, Bristol Myers Squibb and bluebird bio said the FDA accepted and granted priority review for the Biologics License Application for idecabtagene vicleucel, or ide-cel, the companies’ B-cell maturation antigen, or BCMA-directed CAR T-cell immunotherapy.

“We are pleased by the significant progress that is being made in partnership with patients and the multiple myeloma community to bring ide-cel to adults with relapsed and refractory multiple myeloma who are triple-class exposed and may benefit from an important new therapeutic option,” said Dr Stanley Frankel, senior vice president of Cellular Therapy Development at Bristol Myers Squibb.

The application is based on data from the pivotal phase 2 KarMMa study, which exhibited an overall response rate of 73% across all dose levels, including 33% of patients who had a complete response or stringent complete response.

If approved, it would be first CAR T-cell immunotherapy for the treatment of multiple myeloma in adult patients who have not responded or have relapsed after at least 3 other targeted therapies.

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.

This week, The American Journal of Managed Care^® will select its 2020 winner of the Seema Sonnad Emerging Leader in Managed Care Research Award. For our paper, we look back at work by the 2016 winner, Dr Zirui Song, who at the time was a resident at Massachusetts General Hospital and a clinical fellow at Harvard Medical School.

Dr Song later published a paper in our March 2018 issue with Drs Amol Navathe, Ezekiel Emanuel, and Kevin Volpp, “Incorporating Value Into Physician Payment and Patient Cost Sharing,” which presented the idea of an appropriateness modifier. Dr. Song’s work was supported by the National Institutes of Health Early Independence Award.

Good luck to this year’s Seema Sonnad winner!

For the paper, visit ajmc.com.

For all of us at AJMC^®, I’m Matthew Gavidia. Thanks for joining us!