This Week in Managed Care: May 7, 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.

Partnering With Retail Clinics

Express Scripts said last week that it’s looking for retail partners to fight diabetes. Unlike its rival, CVS Health, the nation’s largest pharmacy benefits manager (PBM) doesn’t have its own network of retail clinics, but it wants to change that by next year.

Express Scripts Chief Medical Officer Dr Steve Miller told a meeting of the PBM's largest clients that it’s working to create partnerships with existing retail outlets because that’s what consumers want. Said Dr Miller: “Right now, consumers don’t differentiate and don’t prefer retailers based on their quality; it’s usually a just a cost equation. We think this is going to be huge in the marketplace, because you’re going to be able to get millions of patients higher quality care and lower cost on diabetes.”

For more on the growth of retail clinics in diabetes care, see our recent coverage from our conference Patient-Centered Diabetes Care.

Oral Cancer Agents

A new study in JAMA Oncology found that oral agents to fight cancer are being launched at much higher prices compared with a decade ago, and this can affect patient access to care.

Claims data from TruvenHealth MarketScan showed that the cost of oral agents approved in the year 2000 were $1869 per month, but by 2014 the cost for new drugs had climbed to $11,325 per month. Older drugs, such as Gleevec, are becoming more costly as well. Between 2001 and 2014, the price increased from $3346 to $8479 per month.

Dr Peter Bach of Memorial Sloan Kettering Cancer Center said: “The rate of rise exceeds the health benefits from these drugs. This is a ginned-up pricing structure that isn’t a product of careful analysis.”

For cancer patients and others with serious illness, the sooner palliative care starts, the better. Dr Toby Campbell of the University of Wisconsin told AJMC recently how early palliative care leads to better outcomes. Watch the video interview.

Prescription Painkiller Addiction

One in 5 Americans has a family member addicted to prescription pain medication, a new poll has found.

The Kaiser Health Tracking Poll, taken in mid-April, found that 4 in 10 Americans knew someone addicted to opioids, and that most Americans thought both the federal government and their states were not doing enough to combat the epidemic.

While those who responded to the poll placed the greatest responsibility for the problem on addicts themselves, nearly two-thirds also said physicians bear responsibility for prescribing too many painkillers.

The CDC recently issued new guidelines to help primary care physicians reduce the number of painkiller prescriptions, which had increased 7.3% per person between 2007 and 2012.

Hepatitis C Special Issue

The moral and policy questions surrounding direct acting antivirals, which can cure hepatitis C, have been among the most challenging issues ever to confront managed care.

This week, The American Journal of Managed Care published a special issue of new research and commentary on treatment for hepatitis C, which discusses both the long-term health benefits and cost-effectiveness of this new class of therapy.

Edited by Dr Jay Bhattacharya of Stanford University, the issue presents evidence for payers who are trying to address what Dr Bhattacharya calls the “dismal arithmetic” of hepatitis C virus care. He wrote: “Although the medical prospects facing patients with hepatitis C virus have never been better, the prospect of gaining access to a cure is another matter for many patients.”

Read the full issue.

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