This Week in Managed Care: November 6, 2020

Top health care takeaways from the 2020 general election, a Q&A with Dr William Shrank on connecting Medicare Advantage providers and patients, and Managed Care Cast discusses balancing evidence with action amid the COVID-19 pandemic.

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

Top 5 Health Care Takeaways From the 2020 General Election

As of 11 AM Eastern on Friday, it appears likely that former Vice President Joe Biden will be the next president of United States, as he leads in Pennsylvania, although ballots are still being counted.

In addition, voters weighed in on several ballot measures and state level races that yielded results with major implications in the health care field.

This week, over 60% of Louisiana voters approved an amendment proposing adding language to the state’s constitution ensuring it does not protect abortion as a right. The language also mandates abortion is not to be funded except in cases of life endangerment.

Specifically, a vote for Amendment 1 added this sentence to the Louisiana Declaration of Rights: “To protect human life, nothing in this constitution shall be construed to secure or protect a right to abortion or require the funding of abortion."

Conversely, voters in Colorado rejected Proposition 115, which aimed to outlaw abortions after 22 weeks of pregnancy with exceptions for life-threatening situations. The American College of Obstetricians & Gynecologists also opposed the proposition, claiming it would interfere with the doctor-patient relationship and complicate medical decisions.

In another notable health care–related outcome of the 2020 elections, Oregon became the first state to decriminalize the possession of small amounts of street drugs, including cocaine, methamphetamine, and heroin.

The new drug initiative will permit individuals arrested with small amounts of these drugs to avoid going to trial and possible jail time. Instead, individuals will pay a $100 fine and attend an addiction recovery program, while centers will be funded by revenue gained from sales of recreational marijuana.

For more, visit ajmc.com.

Medicare Advantage Providers, Patients Connect Without a Playbook

To mark the 25th anniversary of The American Journal of Managed Care®, we spoke with Dr William H. Shrank, chief medical officer of Humana, on several health care–related topics, particularly challenges to providing value-based care amid the COVID-19 pandemic.

“I would say there’s a tremendous amount of uncertainty right now,” said Shrank. “There’s a lot that we can’t predict accurately with respect to the trajectory of the pandemic.”

Shrank noted that during this time, his organization’s affiliated partners are looking for a path to resiliency, with many exploring new ways of contracting with Humana from a value-based perspective.

“Our approach is to work really closely with our providers and try to understand how we can be part of the solution: to help them, and to help them help our members through these really uncertain times,” said Shrank.

For the full interview, visit ajmc.com.

Balancing Evidence With Action: Dr Patricia Salber Interviews Dr Denise Basow

In this week’s Managed Care Cast, Dr Patricia Salber, of The Doctor Weighs In, spoke with Dr Denise Basow, president and CEO of clinical effectiveness at Wolters Kluwer, on balancing evidence-based science with action amid the pandemic.

As a global provider of professional information for groups such as clinicians and regulatory sectors, Basow described how her organization has worked to advise clients on all COVID-19–related aspects, which seemingly change by the day.

In speaking on this onslaught of novel information, Basow addresses the risk of misinformation, the wide range of information sources available, and much more.

For the full interview, visit ajmc.com.

Libtayo Accepted for FDA Priority Review in NSCLC With PD-L1 Expression

This past week, Regeneron’s PD-1 inhibitor cemiplimab-rwlc, sold as Libtayo, was accepted for priority review by the FDA for the treatment of first-line locally advanced or metastatic non–small cell lung cancer with PD-L1 expression of at least 50%.

The supplemental Biologics License Application accepted for review, which has a target decision date of February 28, 2021, is based on results from the EMPOWER-Lung 1 trial of cemiplimab monotherapy vs platinum-doublet chemotherapy.

The randomized, phase 3, open-label trial separated 710 patients with advanced non–small cell lung cancer into 2 cohorts, with 1 group receiving cemiplimab and the other undergoing standard-of-care chemotherapy.

In comparison with the chemotherapy group, the cemiplimab cohort exhibited:

• A 32% lower risk of death
• A 41% lower risk of disease progression
• An objective response rate of 37% compared with 21% of those undergoing chemotherapy

In addition to the FDA review, the European Medicines Agency is assessing the drug for the same indication, with a decision anticipated in the second quarter of 2021.

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.

Patterns of chemotherapy use in lung cancer and the related costs were the topic of a 2008 paper, led by Dr Scott Ramsey of the University of Washington.

A claims analysis found that second- and third-line chemotherapy were prescribed relatively infrequently at that time; of the patients who had first-line chemotherapy, a quarter had second-line therapy and only 10% had third-line therapy. Direct medical costs increased substantially with each treatment, especially if the therapy was used off-label.

This paper appeared in the era before clinical pathways, and payment reform encouraged more stratification in care.

For the paper, visit ajmc.com.

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