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April 2015 - FRMC

Coordinating Managed Care and Long-Term Services and Support
06/18/2015
Melissa D. Cooper
In the United States, two-thirds of nursing home residents’ costs are funded by Medicaid.
In the United States, two-thirds of nursing home residents’ costs are funded by Medicaid.
In the United States, two-thirds...
06/18/2015
First Report Managed Care
Conference Insider
Improving Care Coordination in Medicaid Managed Care
06/18/2015
Melissa D. Cooper
An increasing number of aging adults and disabled individuals are enrolling in Medicaid due to the recent decision by many states to expand Medicaid coverage.
An increasing number of aging adults and disabled individuals are enrolling in Medicaid due to the recent decision by many states to expand Medicaid coverage.
An increasing number of...
06/18/2015
First Report Managed Care
News
Effect of Medicare Part D and Generics on Breast Cancer Treatment
06/18/2015
Melissa D. Cooper
In the United States, breast cancer is the second most common cancer diagnosis and the second most fatal form of cancer among women. Endocrine therapy agents, including aromatase inhibitors (AIs) and tamoxi- fen, have shown effectiveness in...
In the United States, breast cancer is the second most common cancer diagnosis and the second most fatal form of cancer among women. Endocrine therapy agents, including aromatase inhibitors (AIs) and tamoxi- fen, have shown effectiveness in...
In the United States, breast...
06/18/2015
First Report Managed Care
News
11 Million Americans Gain Insurance Since Passage of ACA
06/18/2015
Jolynn Tumolo
Since President Barack Obama signed the Patient Protection and Affordable Care Act (ACA) into law 5 years ago, the number of insured Americans has dropped by more than 11 million to the lowest level in 15 years, according to new...
Since President Barack Obama signed the Patient Protection and Affordable Care Act (ACA) into law 5 years ago, the number of insured Americans has dropped by more than 11 million to the lowest level in 15 years, according to new...
Since President Barack Obama...
06/18/2015
First Report Managed Care
An Analysis of Prescription Drug Use by Exchange Enrollees in the First Year of Coverage
06/18/2015
Kerri Fitzgerald
According to a report from Prime Therapeutics, customers who purchased health insurance on the exchange via the Patient Protection and Affordable Care Act filled 13.6% more prescriptions on average compared with commercial members.
According to a report from Prime Therapeutics, customers who purchased health insurance on the exchange via the Patient Protection and Affordable Care Act filled 13.6% more prescriptions on average compared with commercial members.
According to a report from Prime...
06/18/2015
First Report Managed Care
News
Examining Treatment Costs Related to HIV-Positive Dually Enrolled Medicare Beneficiaries
06/18/2015
Kerri Fitzgerald
In the United States, Medicare and Medicaid account for more than three-quarters of domestic federal spending on HIV/AIDS treatment. In turn, policymakers are interested in monitoring the cost and quality of treatments for HIV/AIDS. 
In the United States, Medicare and Medicaid account for more than three-quarters of domestic federal spending on HIV/AIDS treatment. In turn, policymakers are interested in monitoring the cost and quality of treatments for HIV/AIDS. 
In the United States, Medicare...
06/18/2015
First Report Managed Care
News
Long-Term Mortality Higher in Patients with Diabetes and COPD
06/18/2015
Mary Mihalovic
Patients with a confirmed physician's diagnosis of diabetes had a higher risk of long-term mortality after a mild to moderate exacerbation of chronic obstructive pulmonary disease (COPD), according to the results of a recent study.
Patients with a confirmed physician's diagnosis of diabetes had a higher risk of long-term mortality after a mild to moderate exacerbation of chronic obstructive pulmonary disease (COPD), according to the results of a recent study.
Patients with a confirmed...
06/18/2015
First Report Managed Care
Targeted Biopsy Identifies Prostate Cancer Better than Standard Biopsy
06/18/2015
Mary Mihalovic
A study of men undergoing biopsy for suspected prostate cancer used targeted MRI/ultrasound fusion biopsy to detect cancers.    
A study of men undergoing biopsy for suspected prostate cancer used targeted MRI/ultrasound fusion biopsy to detect cancers.    
A study of men undergoing biopsy...
06/18/2015
First Report Managed Care
News
5 Years After ACA Enacted: Poll Examines Opinion on the Law
06/18/2015
Kerri Fitzgerald
March marked 5 years since the Patient Protection and Affordable Care Act (ACA) was passed into law. With the Supreme Court set to weigh in on the law in the case of King v. Burwell, the Kaiser Family Foundation presented results of a poll...
March marked 5 years since the Patient Protection and Affordable Care Act (ACA) was passed into law. With the Supreme Court set to weigh in on the law in the case of King v. Burwell, the Kaiser Family Foundation presented results of a poll...
March marked 5 years since the...
06/18/2015
First Report Managed Care
Conference Insider
Integrating Managed Care and Medicaid
06/18/2015
Melissa D. Cooper
In 2013, state and local Medicaid spending increased 5.9% and federal Medicaid spending increased 6.2%, with a total increase of 6.1% in Medicaid expenditures.
In 2013, state and local Medicaid spending increased 5.9% and federal Medicaid spending increased 6.2%, with a total increase of 6.1% in Medicaid expenditures.
In 2013, state and local...
06/18/2015
First Report Managed Care
MEASLES OUTBREAK FUELS VACCINE DEBATE
06/18/2015
Eileen Koutnik-Fotopoulos
Similarly, CDC Calls for 2016 Overhaul of Influenza Vaccine 
Similarly, CDC Calls for 2016 Overhaul of Influenza Vaccine 
Similarly, CDC Calls...
06/18/2015
First Report Managed Care

Pipeline Projections

PIPELINE PROJECTIONS
Emerging Therapies Reshaping Atopic Dermatitis Care
03/26/2026
Roy Moore
Roy Moore outlines how a rapidly expanding atopic dermatitis pipeline is intensifying competition, reshaping payer strategies, and raising the bar for new therapies.
Roy Moore outlines how a rapidly expanding atopic dermatitis pipeline is intensifying competition, reshaping payer strategies, and raising the bar for new therapies.
Roy Moore outlines how a rapidly...
03/26/2026
First Report Managed Care
Pipe
Pipeline Projections
Emerging Migraine Treatments Challenge a Mature Market
11/20/2025
Roy Moore
Roy Moore of Clarivate’s market access team discussed the evolving migraine treatment landscape, highlighting the maturation of the acute and prophylactic markets, the emergence of new therapies such as triptan-COX-2 combinations, gepants,...
Roy Moore of Clarivate’s market access team discussed the evolving migraine treatment landscape, highlighting the maturation of the acute and prophylactic markets, the emergence of new therapies such as triptan-COX-2 combinations, gepants,...
Roy Moore of Clarivate’s market...
11/20/2025
First Report Managed Care
Pipeline Projections
Pipeline Projections
Redefining Asthma Management With Emerging Anti-Inflammatories
10/01/2025
Roy Moore
Roy Moore, a market access expert, discusses the evolving asthma drug pipeline, highlighting upcoming therapies—including Breztri, depemokimab, and masitinib—their potential to improve adherence and outcomes, payer considerations around cost...
Roy Moore, a market access expert, discusses the evolving asthma drug pipeline, highlighting upcoming therapies—including Breztri, depemokimab, and masitinib—their potential to improve adherence and outcomes, payer considerations around cost...
Roy Moore, a market access...
10/01/2025
First Report Managed Care
Pipeline Projections
The Shift in MS Care as Biologics and BTK Inhibitors Advance
07/25/2025
Roy Moore
In this edition of Pipeline Projections, Roy Moore breaks down the rapidly evolving landscape of multiple sclerosis treatments—highlighting the shift from injectables to orals, the rise of monoclonal antibodies, and the promise of innovative...
In this edition of Pipeline Projections, Roy Moore breaks down the rapidly evolving landscape of multiple sclerosis treatments—highlighting the shift from injectables to orals, the rise of monoclonal antibodies, and the promise of innovative...
In this edition of Pipeline...
07/25/2025
First Report Managed Care
Pipeline Projections
How Biosimilars Are Shaping RA Treatment and Reimbursement Strategies
04/29/2025
Roy Moore
In this episode of Pipeline Projections, Roy Moore—Senior Healthcare Research & Data Analyst at Clarivate—discusses the expanding biosimilar pipeline for autoimmune diseases. He highlights recent FDA approvals, formulary and pricing...
In this episode of Pipeline Projections, Roy Moore—Senior Healthcare Research & Data Analyst at Clarivate—discusses the expanding biosimilar pipeline for autoimmune diseases. He highlights recent FDA approvals, formulary and pricing...
In this episode of Pipeline...
04/29/2025
First Report Managed Care

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Behind the Bill

Behind the Bill
HHS Hits Reset on 340B Rebate Model After Court Setbacks
02/11/2026
Juliet Gallagher
The US Department of Health and Human Services (HHS) has formally scrapped its 340B Rebate Model Pilot Program following a series of court rulings that blocked its implementation—signaling a significant pause in one of the most closely...
The US Department of Health and Human Services (HHS) has formally scrapped its 340B Rebate Model Pilot Program following a series of court rulings that blocked its implementation—signaling a significant pause in one of the most closely...
The US Department of Health and...
02/11/2026
First Report Managed Care
Behind the Bill
Funding Package Extends Medicare Telehealth, Enacts PBM Reforms, and Updates Hospital Oversight
02/05/2026
Juliet Gallagher
On February 3, 2026, President Donald Trump signed a broad government funding package that includes multi-year extensions for Medicare teleath and hospital-at-home programs, new oversight requirements for pharmacy benefit managers (PBMs), and...
On February 3, 2026, President Donald Trump signed a broad government funding package that includes multi-year extensions for Medicare teleath and hospital-at-home programs, new oversight requirements for pharmacy benefit managers (PBMs), and...
On February 3, 2026, President...
02/05/2026
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 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 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 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 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 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 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 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 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

April 2015 Volume 12 Issue 4

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