First Report Managed Care

Regulatory Insights

Subsidies, Savings, and Stalemates: What Congress's Year-End Gridlock Means for Health Plans in 2026

As health policy debates resurface in Washington, unresolved battles over Affordable Care Act (ACA) subsidies, health savings accounts, and pharmacy benefit manager (PBM) reform are shaping a high-stakes landscape for payers heading into the new year.

Formulary Frontlines

Comparative Review of Migraine Therapeutics Coverage Across 3 Major Health Plans

Our latest Formulary Frontlines analysis compares how Blue Cross Blue Shield, Cigna, and UnitedHealthcare manage coverage across key migraine treatment classes, revealing striking differences in tiering, utilization management, and access philosophy.

Free On-Demand Webinar

Specialty Pharmacy in Flux: Cost, Access & Policy in a Rapidly Changing Market

From explosive demand for GLP-1s and new policy pressures to emerging technologies and affordability challenges, the industry is at a crossroads.

In this exclusive First Report Managed Care webinar, our expert panel unpacks the complex forces reshaping the market—and what stakeholders must do to adapt.

News

Illinois FQHCs Deliver More Guideline-Concordant Kidney Disease Testing, Study Finds

02/03/2026

Grace Taylor, MS, MA

Federally qualified health centers (FQHCs) in Illinois outperformed non-FQHC practices in guideline-recommended kidney disease testing, highlighting the strength of the safety-net model in caring for high-risk populations.

Federally qualified health...

02/03/2026

First Report Managed Care

News

Co-occurring ADHD Associated With Poorer Health Outcomes in Adults With Autism on Medicaid

02/02/2026

Grace Taylor, MS, MA

A large US Medicaid study finds that co-occurring attention-deficit/hyperactivity disorder (ADHD) is common among adults with autism and is linked to higher rates of substance use, cardiovascular conditions, and injury, while ADHD medication...

A large US Medicaid study finds...

02/02/2026

First Report Managed Care

News

CMS Finalizes Rule Updating Medicaid Health Care–Related Tax Policies

01/30/2026

Hannah Musick

The Centers for Medicare & Medicaid Services (CMS) finalized a rule updating oversight of Medicaid provider tax arrangements, aiming to reinforce federal–state financing requirements and ensure that Medicaid funds are used for beneficiary...

The Centers for Medicare &...

01/30/2026

First Report Managed Care

News

Optum Rx’s Cost-Based Pharmacy Payments Signal a Major Shift in Drug Reimbursement

01/27/2026

Lisa Kuhns, PhD, MD

Optum Rx’s full transition from community pharmacies to a cost-based reimbursement model marks a significant shift in how prescription drugs are paid for, aiming to stabilize pharmacy finances amid mounting industry pressures.

Optum Rx’s full transition from...

01/27/2026

First Report Managed Care

News

Study Projects Billions in Savings From Site-Neutral Payments for Routine Services

01/23/2026

Grace Taylor, MS, MA

A national analysis of 2022 commercial claims data suggests that capping payments for routine services at site-neutral Medicare-based rates could save purchasers and patients $10.8 billion annually with only modest effects on hospital margins.

A national analysis of 2022...

01/23/2026

First Report Managed Care

News

Medicare Part D Formularies Remain Broad for IRA-Negotiated Drugs

01/20/2026

Grace Taylor, MS, MA

Despite broad Medicare Part D coverage for Inflation Reduction Act (IRA)-negotiated drugs, data suggest formulary access is narrowing for non-selected therapies—particularly orphan drugs—raising concerns about patient access as price...

Despite broad Medicare Part D...

01/20/2026

First Report Managed Care

News

US Observational Data Show Variable Real-World Outcomes With JAK Inhibitors in RA

01/19/2026

Juliet Gallagher

Real-world evidence (RWE) is increasingly used to complement randomized controlled trial data in rheumatoid arthritis treatment decision-making. A new study synthesized observational studies evaluating the real-world effectiveness of Janus...

Real-world evidence (RWE) is...

01/19/2026

First Report Managed Care

News

Miami Drug Wholesaler Enters Federal Opioid Deferred Prosecution Agreement

01/14/2026

Hannah Musick

A Miami pharmaceutical wholesaler admitted to knowingly supplying millions of opioid pills to Houston-area pill mill pharmacies under a federal deferred prosecution agreement, highlighting continued enforcement against opioid diversion across...

A Miami pharmaceutical...

01/14/2026

First Report Managed Care

News

House Passes Bill to Extend ACA Premium Tax Credits

01/13/2026

Hannah Musick

The US House has advanced a bipartisan-backed bill to extend enhanced Affordable Care Act (ACA) premium tax credits, setting up a high-stakes Senate debate with major implications for insurance affordability and patient access to care.

The US House has advanced a...

01/13/2026

First Report Managed Care

News

Specialist Access Eliminates Racial Gaps in Rheumatoid Arthritis DMARD Use

01/12/2026

Lisa Kuhns, PhD, MD

Racial inequities in access to modern rheumatoid arthritis (RA) therapies persist across the United States, but disappear among patients who reach rheumatology care, according to study results published in The Journal of Rheumatology.

Racial inequities in access to...

01/12/2026

First Report Managed Care

KOL Insights

NSCLC, Oncology Coverage, Oncology Access

Videos

What PALOMA-3 Signals for Coverage, Access, and Care Delivery in NSCLC

02/02/2026

Narjust Florez, MD

In this interview, Narjust Florez, MD, discusses how subcutaneous amivantamab from the PALOMA-3 study may improve patient experience, clinic workflow, and treatment adherence while highlighting ongoing unmet needs and real-world...

In this interview, Narjust...

02/02/2026

First Report Managed Care

Videos

Optimizing NSCLC Care Through Extended Dosing and Alternative Formulations

01/27/2026

Corrine Stahura, PharmD, BCOP

Corrine Stahura, PharmD, BCOP, discusses how extended dosing intervals and subcutaneous formulations in non–small cell lung cancer are improving patient convenience, reducing infusion center burden, and enhancing operational efficiency while...

Corrine Stahura, PharmD, BCOP,...

01/27/2026

First Report Managed Care

Videos

Treatment Paradigms in NSCLC: Chemo-Based vs Non-Chemo Regimens

01/27/2026

Rajat Thawani, MD

Dr Rajat Thawani discusses how biomarker-driven strategies, emerging immunotherapies, and novel delivery approaches are rapidly redefining first-line non-small cell lung cancer (NSCLC) treatment—shifting care beyond traditional chemotherapy...

Dr Rajat Thawani discusses how...

01/27/2026

First Report Managed Care

Videos

Evaluating Total Cost Considerations in Non–Small Cell Lung Cancer Care

01/27/2026

Estelamari Rodriguez, MD, MPH

As new subcutaneous and targeted therapies enter the NSCLC landscape, the true cost of care extends far beyond drug price alone. In this interview, Estelamari Rodriguez, MD, MPH, a thoracic oncologist at Sylvester Comprehensive Cancer Center,...

As new subcutaneous and targeted...

01/27/2026

First Report Managed Care

Yuri Fesko, MD, PAMA, Health Care Policy, Medicare

Interview

PAMA and the Downstream Impact of Lab Reimbursement on Cancer Care Access

01/22/2026

Yuri Fesko, MD

In this interview, senior vice president and chief medical officer at Quest Diagnostics, Yuri Fesko, MD, discusses how Medicare laboratory reimbursement under PAMA threatens access to precision cancer diagnostics—particularly for rural and...

In this interview, senior vice...

01/22/2026

First Report Managed Care

Long-Term Care, Post-Acute Care, Lobbying, Politics

Commentary

All Politics Is Local—Why Long-Term and Post-Acute Care Leaders Should Participate in Grassroots Advocacy

01/20/2026

Bill Charnetski

Local long-term and post-acute care leaders can’t afford to sit out politics—by embracing grassroots advocacy, sharing their expertise, and building relationships with lawmakers, they can directly shape the policies that affect their...

Local long-term and post-acute...

01/20/2026

Annals of Long-Term Care

Rural Hospitals, Behavioral Health, Coverage Gaps

Interview

Rural Hospitals on the Front Lines of Behavioral Health Coverage Gaps

01/15/2026

Shannon Werb

Shannon Werb, CEO of Array Behavioral Care, explains how uncertainty around Affordable Care Act (ACA) subsidies and Medicaid eligibility threatens to disrupt behavioral health care first—fueling treatment gaps, increased emergency department...

Shannon Werb, CEO of Array...

01/15/2026

First Report Managed Care

Regulatory Insights

Subsidies, Savings, and Stalemates: What Congress's Year-End Gridlock Means for Health Plans in 2026

12/05/2025

Adam Colborn, JD

As health policy debates resurface in Washington, unresolved battles over ACA subsidies, health savings accounts, and PBM reform are shaping a high-stakes landscape for payers heading into the new year.

As health policy debates...

12/05/2025

First Report Managed Care

Cell & Gene Watch

Reaching Patients Where They Are: Moving CGT Care into the Community

12/05/2025

Joe DePinto

As cell and gene therapies rapidly advance, shrinking the nation’s growing “CGT deserts” by expanding capabilities in community care settings is essential to ensure that breakthrough treatments reach patients equitably—not just those living...

As cell and gene therapies...

12/05/2025

First Report Managed Care

MANAGED CARE Q&A

SDOH Interventions and Managed Care Performance: A Roadmap for Health Plans

12/05/2025

Karen Iapoce, RNC, MSN, CPHQ, LSSBB

Karen Iapoce explains how integrating social determinants of health into managed care workflows can drive measurable improvements in outcomes and Stars performance.

Karen Iapoce explains how...

12/05/2025

First Report Managed Care

Issue Features

Interactive Features

Quiz

Mobile Health’s Expanding Role in Bridging Care Gaps Across the US

11/11/2025

First Report Managed Care

Quiz

Member Engagement Options Under New Digital Marketplace

10/14/2025

True or False: UnitedHealthcare’s new UHC Store is a digital marketplace that allows members to purchase health insurance plans directly from the company.

True or False:...

10/14/2025

First Report Managed Care

Quiz

How AI Transforms Medicare Advantage Operations

09/15/2025

Learn more about how AI tools reshape MA risk adjustment and HEDIS performance.

Learn more about how AI tools...

09/15/2025

First Report Managed Care

Quiz

How Well Do You Know CMS Interoperability?

08/18/2025

Learn more about how real-time data integration, artificial intelligence tools, and expanded telehealth access are transforming Medicaid to deliver more equitable, efficient, and patient-centered care.

Learn more about how real-time...

08/18/2025

First Report Managed Care

Quiz

Medicare Advantage Markets Remain Highly Concentrated

08/04/2025

A study found that Medicare Advantage (MA) markets across the US were classified as highly or very highly concentrated in 2024, raising questions about the competitive dynamics of this rapidly growing insurance sector. Learn more.

A study found that Medicare...

08/04/2025

First Report Managed Care

Behind the Bill

The Senate’s $3 Trillion Deal. Tax Relief Now, Medicaid Coverage Loss Later?

07/02/2025

Katie Hayes, MJ

The Senate has done it. After weeks of behind-the-scenes wrangling and last-minute amendments, lawmakers have passed a sprawling tax-and-spending megabill that makes good on a long-standing Republican goal: making the 2017 Trump tax cuts...

The Senate has done it. After...

07/02/2025

First Report Managed Care

Behind the Bill

When a Cap Isn’t Just a Cap: How a Provider Tax Proposal Could Reshape Medicaid Financing

06/25/2025

Katie Hayes, MJ

In Washington, the most consequential policies are often buried in the fine print. One such detail in the Senate Finance Committee’s latest tax and spending proposal would gradually cap provider taxes—a core funding tool states use to pull in...

In Washington, the most...

06/25/2025

First Report Managed Care

Behind the Bill

Rewriting the Safety Net? Inside the Senate’s Changes to Medicaid and the ACA

06/18/2025

Katie Hayes, MJ

Over the past few weeks, I’ve been following the progress of the One Big Beautiful Bill Act (OBBBA), which started in the House with sweeping tax reforms and some eye-catching health care proposals. Now, the Senate has released its (highly...

Over the past few weeks, I’ve...

06/18/2025

First Report Managed Care

Behind the Bill

How States Might Respond to the One Big Beautiful Bill Act

06/11/2025

Katie Hayes, MJ

With the One Big Beautiful Bill Act (OBBBA) still in the hands of the Senate, much of the national conversation has centered on what this legislation would do to federal coverage programs. But regardless of how the federal process unfolds,...

With the One Big Beautiful Bill...

06/11/2025

First Report Managed Care

Behind the Bill

Is the Affordable Care Act on the Chopping Block? What the One Big Beautiful Bill Act Tells Us.

06/04/2025

Katie Hayes, MJ

It’s been weeks of headline-grabbing debate over Medicaid work requirements, and the “One Big Beautiful Bill Act” remains in the Senate as they deliberate over several health care provisions. While the Medicaid provisions sparked most of the...

It’s been weeks of...

06/04/2025

First Report Managed Care

Behind the Bill

From House to Senate: The Journey of Cutting Medicaid

05/28/2025

Katie Hayes, MJ

Last week, the House of Representatives narrowly passed the One Big Beautiful Bill Act (HR 1, 119th Congress) by a single vote, sending the sweeping tax and spending reconciliation package, backed by President Trump, to the Senate. With its...

Last week, the House of...

05/28/2025

First Report Managed Care

Behind the Bill

Eligibility, Paperwork, and Penalties: The Not-So-Hidden Costs of Medicaid ‘Reform’

05/21/2025

Katie Hayes, MJ

It’s been another eventful week in health policy—a phrase that’s quickly becoming routine. This time, House Republicans advanced a sweeping budget reconciliation bill, designed to implement elements of the March budget resolution, with a...

It’s been another eventful week...

05/21/2025

First Report Managed Care

Behind the Bill

A Busy Week in Drug Pricing Policy: Aligning US Drug Prices With Global Standards?

05/14/2025

Katie Hayes, MJ

It’s been a busy few days for drug pricing policy. While I’d love to dig into the details of both President Trump’s latest executive order and the newest Republican bill that would cut Medicaid spending, we don’t have the time—and this isn’t...

It’s been a busy few days for...

05/14/2025

First Report Managed Care

BEHIND THE BILL

When Agencies Lose Power: How 3 Seismic Shifts are Transforming Pharmaceutical Regulation

05/07/2025

Katie Hayes, MJ

In the span of just 9 months, the landscape of administrative law has undergone a transformation so profound that pharmaceutical executives, health care providers, and patients alike are struggling to navigate the new terrain. The Supreme...

In the span of just 9 months,...

05/07/2025

First Report Managed Care

Behind the Bill

The Medicare Paradox, Part 3: Strategic Trade Doesn’t Have to be a Zero-Sum Game

05/07/2025

Katie Hayes, MJ

Over the past 2 weeks, I’ve examined the growing friction between the Section 232 pharmaceutical tariff investigations and the Medicare drug pricing reforms authorized by the Inflation Reduction Act (IRA). These 2 policy agendas—industrial...

Over the past 2 weeks, I’ve...

05/07/2025

First Report Managed Care