Biggest Healthcare Story of 2016: Readers Weigh In

As 2016 drew to a close, The American Journal of Managed Care (AJMC)® polled readers on what was, in their opinion, the biggest healthcare story of the year. Runners-up included drug pricing drama, Medicare policy announcements, and more, but the top answer by far was the news story that sent shockwaves throughout the healthcare industry and around the world.

Here is a look back at the top 5 healthcare stories of 2016.

5. (tie) Aetna, UnitedHealth, Humana to reduce Obamacare participation in 2017

An April announcement from UnitedHealth Group declaring its intention to withdraw from the Affordable Care Act exchanges in Georgia and Arkansas in 2017 was soon followed by the news that the insurer would pull back even further, sending ripples through the insurance world.

In announcing the decision to withdraw from all but a handful of states’ exchanges in the following year, UnitedHealth blamed the roll-back on the heavy financial losses from the exchange plans. In January 2016, UnitedHealth said it expected to lose around $1 billion from the exchanges in 2015 and 2016.

After these announcements, Aetna attempted to signal its faith in the exchanges, vowing to maintain its exchanges in all 15 of the states where it offered coverage and possibly expand to more states.

However, this was followed by a sharp turnaround in August, when the insurer announced it would withdraw from the exchanges in most states, remaining in just 242 of the prior 778 counties where it had offered coverage. The regretful press statement accompanying the announcement cited the unsustainable financial burdens associated with the exchanges.

Humana, which was part of an intended merger with Aetna currently blocked by a federal lawsuit, also announced it would “make changes” to its exchange offerings in 2017.

4. (tie) CDC releases guideline for primary care providers prescribing opioids

As the opioid epidemic continued to claim thousands of lives, the CDC attempted to quell the crisis by issuing guidelines for primary care physicians prescribing opioids for chronic pain. The report issued this March claimed that 20% of patients with pain symptoms or disorders received an opioid prescription from their physician.

“In 2012, healthcare providers wrote 259 million prescriptions for opioid pain medication, enough for every adult in the United States to have a bottle of pills,” according to the report.

The guideline contained 12 specific recommendations shaped by 3 broad principles:

• Nonopioid therapy is preferred for chronic pain outside of active cancer, palliative, or end-of-life care.
• When opioids are used, the lowest effective dose should be prescribed to reduce risk of opioid use disorder or overdose.
• Providers must exercise caution and closely monitor patients when prescribing opioids.

The report also included materials for physicians, including a prescribing checklist and guides for conversations with patients.

3. Medicare decides to fund the Diabetes Prevention Program

In March, HHS secretary Sylvia Mathews Burwell announced that Medicare would begin to cover the Diabetes Prevention Program, a model tested by the CMS Innovation Center. The pilot program saw savings of $2650 per person over 15 months, as well as encouraging weight loss results among participants.

The program involves 16 weekly sessions and monthly maintenance sessions thereafter that are designed to get participants to exercise and lose weight, hopefully heading off the advance of diabetes. The test program’s cost savings represented an attractive opportunity for Medicaid, which currently spends $1 of every $3 on diabetes care.

In November, CMS announced that it had finalized the eligibility criteria for the program, outlining the diabetes risk factors that would allow beneficiaries to participate. CMS also said it would only reimburse CDC-recognized programs, meaning “some community-based programs might not be eligible for Medicare reimbursement when it begins January 1, 2018.”

Supporters of the Diabetes Prevention Program included the American Diabetes Association, the American Medical Association, and the YMCA, as well as several bipartisan lawmakers.

2. EpiPen price saga

The drama surrounding the price of Mylan’s EpiPen captured the attention of millions nationwide, drawing outrage from those who accused the company of unfair price hikes. The epinephrine injectors for allergic reactions cost less than $100 for a 2-pack when Mylan purchased the product from Merck in 2007, but by this summer the price had skyrocketed to over $600.

Mylan’s claims that it had made EpiPens affordable via savings cards and patient assistance programs were not received kindly, as a group of 20 senators demonstrated in an angry letter to Mylan CEO Heather Bresch, who later had to testify before a Congressional committee.

“Your discount programs … represent a well-defined industry tactic to keep costs high through a complex shell game,” they wrote.

Mylan paid $465 million in October to settle a lawsuit alleging that it had not paid enough in EpiPen rebates to Medicaid, but the saga did not end there. STAT news reported in November that the Federal Trade Commission would investigate whether Mylan violated antitrust measures by encouraging school districts to purchase the EpiPen.

1. Donald J. Trump is elected president

In the biggest news story of the year, Donald J. Trump was elected president of the United States on November 8, 2016. The Republican candidate’s unexpected defeat of Democrat Hillary Clinton after a contentious campaign left even the most seasoned observers reeling from “the chaos of uncertainty.”

Repealing and replacing the Affordable Care Act (ACA) was one of Trump’s major campaign platforms, as he frequently cited rising premiums and deductibles as examples of the law’s failure. In the second presidential debate, Trump vowed to repeal the ACA, introduce block grants, and increase competition in the insurance industry.

Experts predicted a Trump-led administration would move to repeal the ACA, but after Trump’s sometimes contradictory statements, it was unclear exactly how he would approach this goal. In interviews after the election, he hinted he might keep some popular provisions of the law.

Another avenue of uncertainty surrounded Trump’s campaign promises to lower the price of prescription drugs by allowing imports from overseas, among other steps. Visitors to his transition website after the election noted that there was no mention of drug pricing on his list of intended healthcare reforms.

Some insights into Trump’s plans for renovating the healthcare system can be gleaned from his initial picks to fill his administration. His nominee for HHS Secretary, Representative Tom Price, has emphatically criticized the ACA and will likely play a major role in its repeal, while Seema Verma, tapped for the position of CMS Administrator, is known for her efforts in redesigning Medicaid programs. As the year drew to a close, Trump had not revealed his selections for various other healthcare posts, including the heads of the NIH, the CDC, and the FDA.