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August 2018 - First Report Managed Care

Viewpoint
Off the Sidelines: How Consumers, Employers, and the Government Are Driving Payer-Provider Collaboration
08/30/2018
Emad Rizk, MD
True alignment between payers and providers is the most critical success factor in securing improvements in both the cost and the quality of care. Over the last decade, progress toward this alignment has occurred, observable primarily in the...
True alignment between payers and providers is the most critical success factor in securing improvements in both the cost and the quality of care. Over the last decade, progress toward this alignment has occurred, observable primarily in the...
True alignment between payers...
08/30/2018
First Report Managed Care
Pharmacy Insight
Increasing OTC Drug Availability Could Significantly Decrease Payer Spending
08/30/2018
Russell J. Spjut, PharmD
Increasing access to medications without a prescription, when properly done, has the potential to positively impact many interested parties.
Increasing access to medications without a prescription, when properly done, has the potential to positively impact many interested parties.
Increasing access to medications...
08/30/2018
First Report Managed Care
Managed Care Q&A
What is CAR-T and How Does it Work?
08/30/2018
David Costill
An interview with Nicole M Trask, PharmD, a clinical consultant pharmacist at UMass Medical School and secretary of the AMCP’s Northeast Regional Affiliate.
An interview with Nicole M Trask, PharmD, a clinical consultant pharmacist at UMass Medical School and secretary of the AMCP’s Northeast Regional Affiliate.
An interview with Nicole M...
08/30/2018
First Report Managed Care
Formulary Frontlines®
Pain Management: How The Opioid Misuse Crisis Impacts Formularies
08/30/2018
David Costill; Mary Beth Nierengarten
The United States represents 5.4% of the world’s population; however, it consumes 80% of the world’s opioid supply, according to data from OptumRX. Further, every 16 minutes someone in the United States dies from an opioid related-cause and...
The United States represents 5.4% of the world’s population; however, it consumes 80% of the world’s opioid supply, according to data from OptumRX. Further, every 16 minutes someone in the United States dies from an opioid related-cause and...
The United States represents...
08/30/2018
First Report Managed Care
News Connection
Trump Administration Extends Length of Short-Term Health Plans
08/30/2018
A final rule issued by the HHS has extended the length of limited, short-term health plans to 12 months, according to a press release.
A final rule issued by the HHS has extended the length of limited, short-term health plans to 12 months, according to a press release.
A final rule issued by the HHS...
08/30/2018
First Report Managed Care
News Connection
CMS Reverses Decision, Reinstates Risk-Adjustment Payments
08/30/2018
The Trump Administration has reversed a decision made earlier this month to cease payments to insurers through the ACA’s risk-adjustment reimbursement program.
The Trump Administration has reversed a decision made earlier this month to cease payments to insurers through the ACA’s risk-adjustment reimbursement program.
The Trump Administration has...
08/30/2018
First Report Managed Care
News Connection
VA Centers Need to be Competitive in Order to Improve Quality
08/30/2018
A recent commentary by Kyle Sheetz, MD, and David Shulkin, MD, in the New England Journal of Medicine, argued that increased competition through patient choice could improve quality at VA medical centers. 
A recent commentary by Kyle Sheetz, MD, and David Shulkin, MD, in the New England Journal of Medicine, argued that increased competition through patient choice could improve quality at VA medical centers. 
A recent commentary by Kyle...
08/30/2018
First Report Managed Care
News Connection
Leadership Gaps at VA Could Impact Cerner EHR Rollout
08/30/2018
Lawmakers expressed their frustrations with the lack of crucial leadership at the Department of Veterans Affairs (VA) as the agency prepares for implementation of a new, $16 billion electronic health records (EHR) system.
Lawmakers expressed their frustrations with the lack of crucial leadership at the Department of Veterans Affairs (VA) as the agency prepares for implementation of a new, $16 billion electronic health records (EHR) system.
Lawmakers expressed their...
08/30/2018
First Report Managed Care
Conference Insider
Additional Colorectal Screening Tests Did Not Increase Screening Rates
08/30/2018
A recent study examined the US Preventive Services Task Force (USPSTF) accepted colorectal cancer screening modalities and found that adding two additional screening tests to the current guidelines did not significantly influence the overall...
A recent study examined the US Preventive Services Task Force (USPSTF) accepted colorectal cancer screening modalities and found that adding two additional screening tests to the current guidelines did not significantly influence the overall...
A recent study examined the US...
08/30/2018
First Report Managed Care
Conference Insider
Various Independent Predictors Increase Readmissions for Acute Pancreatitis
08/30/2018
In a recent study presented at Digestive Disease Week 2018, researchers found a wide variation in 30-day readmission rates among hospitals for acute pancreatitis.
In a recent study presented at Digestive Disease Week 2018, researchers found a wide variation in 30-day readmission rates among hospitals for acute pancreatitis.
In a recent study presented at...
08/30/2018
First Report Managed Care
Conference Insider
Pharmacist-Led Drug Monitoring Reduced Remicade Costs, Improved Utility
08/30/2018
A pharmacist-led proactive therapeutic drug-monitoring program for patients taking Remicade (infliximab; Janssen) reduced costs and improved dose utility, according to research presented at Digestive Disease Week 2018.
A pharmacist-led proactive therapeutic drug-monitoring program for patients taking Remicade (infliximab; Janssen) reduced costs and improved dose utility, according to research presented at Digestive Disease Week 2018.
A pharmacist-led proactive...
08/30/2018
First Report Managed Care
Conference Insider
Switching From Continuous to Intermittent Proton Pump Inhibitors Reduces Costs
08/30/2018
According to a presentation at Digestive Disease Week 2018, use of intermittent intravenous proton pump inhibitors among patients with upper gastrointestinal bleeding was significantly cost-saving compared with continuous therapy. 
According to a presentation at Digestive Disease Week 2018, use of intermittent intravenous proton pump inhibitors among patients with upper gastrointestinal bleeding was significantly cost-saving compared with continuous therapy. 
According to a presentation at...
08/30/2018
First Report Managed Care
Conference Insider
Cost-Related Insulin Underuse Common, Associated With Poor Glycemic Control
08/30/2018
Patients often report cost-related insulin underuse that is commonly associated with poor glycemic control, according to research presented at the 2018 78th ADA Scientific Sessions. 
Patients often report cost-related insulin underuse that is commonly associated with poor glycemic control, according to research presented at the 2018 78th ADA Scientific Sessions. 
Patients often report...
08/30/2018
First Report Managed Care
Conference Insider
Flash Continuous Glucose Monitoring Reduces Costs, Improves Adherence
08/30/2018
In accordance with the American Diabetes Association (ADA) recommendations, researchers recently found that flash continuous glucose monitoring improved adherence and reduced acquisition costs when compared with self-monitoring of blood...
In accordance with the American Diabetes Association (ADA) recommendations, researchers recently found that flash continuous glucose monitoring improved adherence and reduced acquisition costs when compared with self-monitoring of blood...
In accordance with the American...
08/30/2018
First Report Managed Care
Conference Insider
Cost-Effective Interventions for Preventing, Managing Diabetes
08/30/2018
A recent systematic review, which was presented at the 2018 78th ADA Scientific Sessions, provided critical information for making evidence-based clinical and public health policy decisions.
A recent systematic review, which was presented at the 2018 78th ADA Scientific Sessions, provided critical information for making evidence-based clinical and public health policy decisions.
A recent systematic review,...
08/30/2018
First Report Managed Care
Conference Insider
No Single Approach for Selecting Most Cost-Effective NDC in 340B Outpatient Pharmacies
08/30/2018
According to recent research, given the volatility in 340B and wholesale acquisition cost (WAC) pricing, a strategy for purchasing the most cost-effective national drug code (NDC) is complex and requires visibility to system purchase volume...
According to recent research, given the volatility in 340B and wholesale acquisition cost (WAC) pricing, a strategy for purchasing the most cost-effective national drug code (NDC) is complex and requires visibility to system purchase volume...
According to recent research,...
08/30/2018
First Report Managed Care
Conference Insider
Formulary Removal of Cholesterol Drug From Inpatient Setting
08/30/2018
Inpatient administration of the cholesterol medication Zetia (ezetimibe; Merck) may be clinically warranted for only a small group of patients who are unresponsive or intolerant to statin therapy, according to research presented at the 2018...
Inpatient administration of the cholesterol medication Zetia (ezetimibe; Merck) may be clinically warranted for only a small group of patients who are unresponsive or intolerant to statin therapy, according to research presented at the 2018...
Inpatient administration of the...
08/30/2018
First Report Managed Care
Copay Accumulator Programs Spark Debate
08/30/2018
Paul Nicolaus
Payers are implementing a new strategy to counter the effects of drug manufacturer patient assistance programs. We take a closer look at these emerging copay accumulator programs and their potential ripple effect. 
Payers are implementing a new strategy to counter the effects of drug manufacturer patient assistance programs. We take a closer look at these emerging copay accumulator programs and their potential ripple effect. 
Payers are implementing a new...
08/30/2018
First Report Managed Care
Innovating Payment Models For Gene Therapy
08/30/2018
Jeff Craven
Gene therapy is a transformational treatment for some patients to potentially cure or prevent rare diseases. But questions still remain about how these drugs should be priced and who will pay for them.
Gene therapy is a transformational treatment for some patients to potentially cure or prevent rare diseases. But questions still remain about how these drugs should be priced and who will pay for them.
Gene therapy is a...
08/30/2018
First Report Managed Care
News
Managed Care Innovator Mary Barton, MD—HEDIS: What’s Changing and How to Get Ready
08/09/2018
Dean Celia
Mary Barton, MD, MPP, vice president of performance at NCQA, explains how the process is becoming more aligned with real-world practice, what specific initiatives are being introduced or changed, and what organizations can start going now to...
Mary Barton, MD, MPP, vice president of performance at NCQA, explains how the process is becoming more aligned with real-world practice, what specific initiatives are being introduced or changed, and what organizations can start going now to...
Mary Barton, MD, MPP, vice...
08/09/2018
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

August 2018 Volume 15 Issue 8

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