Managed Care
Contributing Voices
Frank Diamond

A sweeping proposal for improving veterans’ health care would use the Kaiser Permanente model of separating the insurance and payer arms of the Veterans Health Administration (VHA), making the provider an accountable care organization (ACO) and allowing vets to purchase insurance from consumer plans. Concerned Veterans for America, a bipartisan policy taskforce that is pushing the Veterans Independence Act, includes some heavy hitters such as former Republican Senator Bill Frist, and former Democratic Congressman Jim Marshall.

Anuja N. Roy, PhD
S. Suresh Madhavan, PhD
Andrew Lloyd, PhD
You can put a price tag on a good night’s sleep. Patients are willing to pay nearly $67 for a product that improves sleep onset latency by 10 minutes, reduces wake time after sleep onset by 15 minutes, and improves total sleep time by one hour.
Contributing Voices
Frank Diamond

Ingrid Bergman as Ilsa Lund in Casablanca.

Well-crafted articles sit in mental medicine cabinets; handy for when the next time the malady they address surfaces. This story yesterday ( made me think immediately of this gem that ran in Managed Care back in 2000 ( No one’s yet pinpointed the expiration date for spoiler alerts: Does Ilsa Lund run off with the crafty/noble Rick Blaine or the noble/crafty Victor Laszio? Watch the movie.

So, you’ve been alerted.

Formulary Files
Krishna Rutvij Patel, PharmD
Of the 41 new molecular entities approved by the FDA last year, 17 were orphan drugs and there’s every indication that the trend will continue. Formulary decision makers should not put onerous restrictions on orphan drugs that go beyond the label or guidelines.
Richard Mark Kirkner

Martin Hickey

The second largest consumer oriented and operated plan in the country dies, and more could follow. Critics say that’s what comes of trying to make something out of nothing, as co-ops are a creation of the ACA. Proponents say there’s still hope.
Contributing Voices
Saeed Aminzadeh

As the country’s population of non-native English speakers continues to grow, language differences have become a significant barrier to engaging health plan members and keeping them as healthy as possible.

Last fall, the Census Bureau released data showing that one out of every five U.S. residents doesn't speak English at home.

In fact, the number of people who speak a language other than English at home has reached an all-time high of 61.8 million, up 2.2 million since 2010. The largest increases from 2010 to 2013 were speakers of Spanish, Chinese, and Arabic.

Health plans most  work closely with their members who are non-English speakers.  Population health analytics tell us that language barriers affect care and membership loyalty:

News & Commentary
Lack of insurance and poverty heavily influence whether adults take their medications as prescribed, according to a study by the National Center for Health Statistics. About 14% of uninsured adults under 64 skipped medications to save money, compared to 6% of adults who have insurance.
Contributing Voices
Ted Slafsky

Contrary to the highly misleading picture painted by critics, the 340B drug discount program is working as Congress intended and helping millions of underserved Americans receive better healthcare every year.

The pharmaceutical industry has gone to great lengths to misconstrue how the program functions in an effort to vilify safety-net hospitals. These are the urban and rural facilities across the country that care for all patients, regardless of their ability to pay.

Contributing Voices
Peter Wehrwein

Sovaldi, Harvoni, Viekira Pak, a slew of oncology meds—they’re all contributing to specialty pharmacy sticker shock.

Ivacaftor (Kalydeco) for cystic fibrosis hasn’t been in the news quite as much, but priced at $300,000 per year, it’s also part of the trend of super-high-priced drugs that is sweeping American health care.

Approved by the FDA two years ago, ivacaftor targets a particular genetic mutation that affects only about 4% of people with cystic fibrosis, so despite that stratospheric price, it hasn’t had the same effect on budgets as the hepatitis C drugs like Sovaldi or, increasingly, expensive cancer drugs.

One of our regular contributors, Krishna Patel, wrote about ivacaftor in this month’s issue of Managed Care, and her takeaway was for payers to follow the guidelines for ivacaftor and not erect obstacles to people getting a drug that might make a huge difference in their lives.

But the FDA is expected to approve a new medication some time this year that combines ivacaftor with another medication, lumacaftor. And rather than working in small percentage of people with cystic fibrosis, this new combination is expected to be effective in roughly half of those with the cystic fibrosis who are ages 12 and older.

Kevin Bowen and Patrick Gleason of Prime Therapeutics are presenting a poster today at the annual meeting of Academy of Managed Care Pharmacy in San Diego that gives some estimates of the financial consequences of this new drug on health plans and other payers.