5 Hot Healthcare Topics of 2018

As the US healthcare system continues to go through major shifts in policy and care delivery, 2018 saw several trends that remained prevalent throughout the year and will likely have significant implications for 2019.

Here are 5 hot topics from the year:

1. Social determinants of health

More and more, healthcare stakeholders are recognizing the impact that housing, transportation, and other social determinants have on a person’s health. A survey at the beginning of the year found that the majority of executives are increasingly adopting social determinants of health (SDOH) into their programs. Major health organizations are also getting involved, with Kaiser Permanente investing $200 million to address housing instability and CareMore Health using Lyft to transport Medicare beneficiaries to appointments.

However, while there is a general consensus that population health is impacted more by what happens outside the walls of a doctor’s office or hospital, rather than inside of it, and some organizations have taken initiative, there’s less of a consensus on who is responsible for addressing them. In a survey of physicians, the majority indicated that while SDOH matter for their patients, they do not believe that it is their responsibility to address them, and they do not feel well positioned to do so.

2. Mergers and acquisitions

This year saw 2 megamergers finalized: CVS—Aetna, and Cigna—Express Scripts. In November, CVS Health officially acquired Aetna after New York and New Jersey provided the last 2 state approvals needed for the merger to close. The deal required the sale of Aetna’s Medicare Part D plans to WellCare health plans. The merger will let CVS transform its stores into one-stop shops for a variety of medical needs and services.

Last week, Cigna finalized its purchase of Express Scripts, which puts the insurance company in direct competition with Aetna and UnitedHealth Group. The announcement was first announced in March, and the 2 companies say that the acquisition will drive greater affordability and connectivity with customers and their healthcare providers, while making healthcare simpler.

Also during the year, Amazon purchased PillPack, an online pharmacy, and Walmart has been in talks of buying insurer Humana.

3. Medicaid work requirements

In January, the Trump administration released a guidance for states that want to require able-bodied Medicaid recipients to work or participate in volunteer or job-training activities. Just a day later, Kentucky became the first state to get approval for its Medicaid work requirements program. Since then, the requirements have been blocked by a federal judge and reapproved by CMS. Five other states have also seen their requirements approved.

In June, Arkansas became the first state to actually implement its work requirements and since then has had nearly 17,000 beneficiaries locked out of coverage for the rest of the year for failing to comply with the requirements. The program has faced criticism, with the Medicaid and CHIP Payment and Access Commission asking the administration to pause the program to make proper adjustments. Arkansas has since announced a change to the program and will now allow recipients to report their hours over telephone, not just online.

Ten other states are awaiting approval for their Medicaid work requirements.

4. Biosimilars

In 2018, the number of FDA-approved biosimilars nearly doubled. Throughout the year, the biosimilar market saw approvals for trastuzumab, pegfilgrastim, and adalimumab biosimilars, among others. In addition to the multiple approvals, Mylan launched its pegfilgrastim biosimilar, Fulphila, which marked the first opportunity for patients to receive a lower cost treatment for neutropenia.

Despite these approvals and launches, just 15 biosimilar products have been approved to date and only 5 are commercially available. In order to address the lagging price competition, the FDA released the Biosimilar Action Plan. In the plan, the agency said that it will create review templates specifically for biosimilars and the data needed to meet approval standard and that it is willing to work more closely to the Federal Trade Commission to address any practices that businesses are using to thwart competition.

5. CAR T-cell therapy

In January, chimeric antigen receptor (CAR) T-cell therapy was named the American Society of Clinical Oncology's Advance of the Year, with the organization saying that the therapy is “poised to transform the outlook for children and adults with certain otherwise incurable cancers.”

Although the 2 approved therapies—tisagenlecleucel (Kymriah) and axicabtagene ciloleucel (Yescarta)—come with hefty price tags, a report from the Institute for Clinical and Economic Review confirmed that the cost-effectiveness of the therapies fall below or within commonly cited thresholds of $50,000 to $150,000 per quality-adjusted life year.

In August, CMS approved Medicare technology add-on payments for the treatments, saying it will pay a maximum of $186,500 per case, starting in 2019. A few weeks later, during a meeting of the Medicare Evidence Development and Coverage Advisory Committee, panelists mostly endorsed including patient-reported outcomes in its final national coverage analysis decision, which is expected in the coming year.