This Week in Managed Care: February 23, 2018


This week, the top managed care stories included the Trump administration proposed extending the duration of short-term health plans; a report found that CAR T-cell therapies are worth their high price tags; the new issue of Evidence-Based Oncology® examined current issues in immunotherapy.

Short-term health plans could last a full year, the high cost of healthcare includes just paying the bill, and a new report finds the cost of CAR T-cell therapy is worth it.

Welcome to This Week in Managed Care, I’m Laura Joszt.

Extending Short-Term Health Plans

The Trump administration this week called for extending limited duration health plans from 3 months to a full year, following an executive order issued in October. CMS Administrator Seema Verma said the plans help people who are between jobs or believe plans under the Affordable Care Act are too expensive.

But the Commonwealth Fund found last year these short-term plans undermine the health system and hurt those with preexisting conditions by causing adverse selection, and keeping healthy people in plans with minimal coverage.

An industry group expressed concern about the proposal. Said Kristine Grow of America’s Health Insurance Plans, “While we are reviewing the proposed rule to understand its impact on the people we serve, we remain concerned that expanded use of short-term policies could further fragment the individual market, which would lead to higher premiums for many consumers, particularly those with preexisting conditions.”

The Price of Healthcare Billing

It’s not just healthcare bills that are high—so is the cost of getting them. A study in JAMA tracked the cost of the billing process, including salary costs, and found that it could cost 215 dollars and 10 cents for a hospital to be paid for a surgery, and 124 dollars and 26 for a typical hospital stay.

Besides that dollar amount, there’s the time spent: processes take between 32 and 100 minutes, the study found.

An editorial in JAMA stated, “As high as these figures are, they likely underestimate the true financial burden of billing for physicians in most health systems.”

CAR T Therapies Worth the Price

Despite their 6-figure price tags, both CAR T-cell therapies are aligned with their clinical value, according to a new report.

The Institute for Clinical and Economic Review (ICER) found value for both Kymriah, approved in August to treat pediatric acute lymphoblastic leukemia, and Yescarta, approved in October to treat adult large B-cell lymphoma.

Drug companies have often criticized ICER’s reports, which frequently conclude that new drugs are too expensive. While the ICER study used a cost of $475,000 for Kymriah and $373,000 for Yescarta, not including administration, researchers found that the number of years of added life made their use worthwhile.

Said Dan Ollendorf, PhD, of ICER, “CAR T therapies represent a critical advancement in treating B-cell malignancies. Based on the evidence currently available, these therapies provide important clinical benefits and appear to be priced in alignment with these benefits. However, the evidence is limited and very short-term, and we may still face short-term affordability questions that will require innovative solutions.”

Immunotherapy in EBO®

Finally, the new issue of Evidence-Based Oncology® examines current issues in immunotherapy, including the search for better biomarkers for treating melanoma, payer coverage of CAR T-cell therapy, and a review of payer coverage for diagnostic tests in non-small cell lung cancer.

The issue also features the story of patient Wes Hall, who has taken part in 3 clinical trials, including 2 involving immunotherapy.

For more, see the full issue.

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

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