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December 2017 - FRMC

Conference Insider
Oncology Outlook: Cancer Drug Pipeline Focused on Precision Treatments
01/02/2018
David Costill
Spotlight on the Oncology Pipeline, a session at AMCP Nexus 2017, highlighted three recent and upcoming cancer drug approvals.
Spotlight on the Oncology Pipeline, a session at AMCP Nexus 2017, highlighted three recent and upcoming cancer drug approvals.
Spotlight on the Oncology...
01/02/2018
First Report Managed Care
Conference Insider
30-Day Medicare Spending for Acute Myocardial Infarction Varies Widely
01/02/2018
An investigation into 30-day Medicare spending among patients hospitalized with acute myocardial infarction (AMI) found that spending varies across hospitals
An investigation into 30-day Medicare spending among patients hospitalized with acute myocardial infarction (AMI) found that spending varies across hospitals
An investigation into 30-day...
01/02/2018
First Report Managed Care
Conference Insider
Study Finds Xarelto With Aspirin Reduced Direct Atherosclerotic Disease Costs
01/02/2018
Data from the COMPASS trial, presented at the AHA 2017 Scientific Sessions, found that a regimen of Xarelto (rivaroxaban; Janssen) with 100 mg of aspirin reduced hospitalization, and health services costs among patients with stable...
Data from the COMPASS trial, presented at the AHA 2017 Scientific Sessions, found that a regimen of Xarelto (rivaroxaban; Janssen) with 100 mg of aspirin reduced hospitalization, and health services costs among patients with stable...
Data from the COMPASS trial,...
01/02/2018
First Report Managed Care
Conference Insider
TAVR Does Not Significantly Reduce Mortality Compared With Surgery
01/02/2018
Data presented at the AHA 2017 Scientific Sessions found that all-cause mortality among patients undergoing transcatheter aortic valve replacement (TAVR) was not significantly different compared with patients undergoing surgical aortic valve...
Data presented at the AHA 2017 Scientific Sessions found that all-cause mortality among patients undergoing transcatheter aortic valve replacement (TAVR) was not significantly different compared with patients undergoing surgical aortic valve...
Data presented at the AHA 2017...
01/02/2018
First Report Managed Care
Conference Insider
Novel Cardiovascular Treatments Priced Too High
01/02/2018
A cost analysis of cardiovascular medications approved between 2011 and 2016 found that prices are dramatically disproportionate to the clinical benefit, according to a presentation at the AHA 2017 Scientific Sessions. 
A cost analysis of cardiovascular medications approved between 2011 and 2016 found that prices are dramatically disproportionate to the clinical benefit, according to a presentation at the AHA 2017 Scientific Sessions. 
A cost analysis of...
01/02/2018
First Report Managed Care
Conference Insider
Patient Assistance Program Improves Outcomes for Low-Income RA Patients
01/02/2018
Oftentimes treatment is inadequate due to issues with access to care or medication costs for uninsured patients with rheumatic disease. However, according to an abstract presented at the 2017 ACR/ARHP Annual Meeting, a patient assistance...
Oftentimes treatment is inadequate due to issues with access to care or medication costs for uninsured patients with rheumatic disease. However, according to an abstract presented at the 2017 ACR/ARHP Annual Meeting, a patient assistance...
Oftentimes treatment is...
01/02/2018
First Report Managed Care
Conference Insider
Health Coaching Intervention Improved Rheumatoid Arthritis Symptoms
01/02/2018
A poster presentation at the 2017 ACR/ARHP Annual Meeting found that implementing a digital health coaching program helped to improve healthy behaviors and reduce flare ups among patients with rheumatoid arthritis (RA).
A poster presentation at the 2017 ACR/ARHP Annual Meeting found that implementing a digital health coaching program helped to improve healthy behaviors and reduce flare ups among patients with rheumatoid arthritis (RA).
A poster presentation at the...
01/02/2018
First Report Managed Care
Conference Insider
Remicade Doses Increase Significantly Throughout Administration, Could Impact Costs
01/02/2018
A study comparing Simponi (golimumab) dosing changes over time to Remicade (infliximab) dosing changes over time found that Remicade doses increase significantly throughout the rheumatoid arthritis regimen administration, according to an...
A study comparing Simponi (golimumab) dosing changes over time to Remicade (infliximab) dosing changes over time found that Remicade doses increase significantly throughout the rheumatoid arthritis regimen administration, according to an...
A study comparing Simponi...
01/02/2018
First Report Managed Care
Conference Insider
New Care Model Improves Early PsA Diagnosis in Psoriasis Patients
01/02/2018
Due to a higher rate of undiagnosed psoriatic arthritis (PsA) in psoriasis patients, a new care model suggests that musculoskeletal (MSK) ultrasounds, triage questionnaires, and clinical assessments by an advanced practice physiotherapist...
Due to a higher rate of undiagnosed psoriatic arthritis (PsA) in psoriasis patients, a new care model suggests that musculoskeletal (MSK) ultrasounds, triage questionnaires, and clinical assessments by an advanced practice physiotherapist...
Due to a higher rate of...
01/02/2018
First Report Managed Care
Conference Insider
Multi-Biomarker Disease Activity Scores Significantly Impact Rheumatologists’ Decisions
01/02/2018
A poster presented at the 2017 ACR/ARHP Annual Meeting found that multi-biomarker disease activity (MBDA) score results significantly impacted decisions to switch therapy or add new therapies. 
A poster presented at the 2017 ACR/ARHP Annual Meeting found that multi-biomarker disease activity (MBDA) score results significantly impacted decisions to switch therapy or add new therapies. 
A poster presented at the 2017...
01/02/2018
First Report Managed Care
Conference Insider
Rheumatologist Quality Measurement Performance Varies Widely
01/02/2018
Rheumatology practices had significant variation in quality measurement performance during 2017, according to an educational session at the 2017 ACR/ARHP Annual Meeting.
Rheumatology practices had significant variation in quality measurement performance during 2017, according to an educational session at the 2017 ACR/ARHP Annual Meeting.
Rheumatology practices had...
01/02/2018
First Report Managed Care
News Connection
CMS Releases Payer Guidelines for 2019 Health Plans
01/02/2018
The CMS recently released a draft letter to notify payers of the guideline changes for 2019 qualifying health plans. The letter is released annually to update payers on policy changes that have impacted the deadlines and characteristics of...
The CMS recently released a draft letter to notify payers of the guideline changes for 2019 qualifying health plans. The letter is released annually to update payers on policy changes that have impacted the deadlines and characteristics of...
The CMS recently released a...
01/02/2018
First Report Managed Care
News Connection
CVS Health to Buy Aetna for $69 Billion
01/02/2018
CVS Health and Aetna have announced that the pharmacy retailer will purchase the health insurance company for $69 billion, according to recent reports
CVS Health and Aetna have announced that the pharmacy retailer will purchase the health insurance company for $69 billion, according to recent reports
CVS Health and Aetna have...
01/02/2018
First Report Managed Care
News Connection
Senate Passes Tax Reform Bill Repealing the ACA Individual Mandate
01/02/2018
The Senate recently passed a compressive tax reform bill that included a provision to repeal the ACA’s individual tax mandate.
The Senate recently passed a compressive tax reform bill that included a provision to repeal the ACA’s individual tax mandate.
The Senate recently passed a...
01/02/2018
First Report Managed Care
Managed Care Q&A
The Challenges of Bringing Biosimilars to Market
01/02/2018
Edward Li, Pharm D, MPH, BCOP, a professor in the Department of Pharmacy Practice at the University of New England College of Pharmacy, explains how industry experts can help bring biosimilars to the market faster.
Edward Li, Pharm D, MPH, BCOP, a professor in the Department of Pharmacy Practice at the University of New England College of Pharmacy, explains how industry experts can help bring biosimilars to the market faster.
Edward Li, Pharm D, MPH, BCOP, a...
01/02/2018
First Report Managed Care
Formulary Frontlines®
Preview of the 2018 Pipeline Drugs Expected to Impact Formularies
01/02/2018
As approvals continue to gain momentum in 2018, Formulary Frontlines will continue to cover the latest breaking formulary updates for a wide range of disease states impacting specialty pharmacy spending.
As approvals continue to gain momentum in 2018, Formulary Frontlines will continue to cover the latest breaking formulary updates for a wide range of disease states impacting specialty pharmacy spending.
As approvals continue to gain...
01/02/2018
First Report Managed Care
News
What Should Payers Do to Prepare for 2018, Cover Story Part 2
12/21/2017
Under changing leadership at the HHS, significant changes are likely to come for the ACA.
Under changing leadership at the HHS, significant changes are likely to come for the ACA.
Under changing leadership at the...
12/21/2017
First Report Managed Care
News
Anthem’s Outpatient Imaging Policy: the Economics of Restrictive Policies
12/20/2017
Jill Sederstorm
Anthem recently began rolling out a restrictive outpatient imaging policy, banning the services at hospitals when they are deemed clinically unnecessary.
Anthem recently began rolling out a restrictive outpatient imaging policy, banning the services at hospitals when they are deemed clinically unnecessary.
Anthem recently began rolling...
12/20/2017
First Report Managed Care
News
The Cost Impact of Surprise Hospital Billing
12/20/2017
Paul Nicolaus
Patients can sometimes be seen by out-of-network providers in in-network facilities, leaving them stuck with surprisingly high health bills.
Patients can sometimes be seen by out-of-network providers in in-network facilities, leaving them stuck with surprisingly high health bills.
Patients can sometimes be seen...
12/20/2017
First Report Managed Care
News
December Cover Story: Health Reform Remains Unclear Heading Into 2018, Part 1
12/20/2017
After a year of efforts to repeal the ACA, Obamacare still remains “the law of the land,” and the bill’s future remains unclear.
After a year of efforts to repeal the ACA, Obamacare still remains “the law of the land,” and the bill’s future remains unclear.
After a year of efforts to...
12/20/2017
First Report Managed Care
Viewpoint
Information Asymmetry Impedes Value-Based Care Contracts
12/20/2017
Value-based care contracts have the potential to significantly improve care and reduce costs, but conflicting priorities sometimes make payer-provider contracts untenable.
Value-based care contracts have the potential to significantly improve care and reduce costs, but conflicting priorities sometimes make payer-provider contracts untenable.
Value-based care contracts have...
12/20/2017
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

December 2017 Volume 14 Issue 12

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