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February 2017 - FRMC

Managed Care Q&A
Can “Travel Practice” Help Cut Orthopedic Surgery Costs?
02/15/2017
David Costill
Jim Polsfut, CEO of the North American Specialty Hospital recently said, "The bottom line for employers: even after factoring in the cost of travel and accommodations for the patient… the savings are significant."
Jim Polsfut, CEO of the North American Specialty Hospital recently said, "The bottom line for employers: even after factoring in the cost of travel and accommodations for the patient… the savings are significant."
Jim Polsfut, CEO of the North...
02/15/2017
First Report Managed Care
Department
Big Data: Moving Toward the Information Revolution
02/15/2017
Jose Almeida, MD
The big data revolution in health care is significant because with health care costs increasing every year, the demand for a big data driven system is skyrocketing. 
The big data revolution in health care is significant because with health care costs increasing every year, the demand for a big data driven system is skyrocketing. 
The big data revolution in...
02/15/2017
First Report Managed Care
News Connection
FDA Issues Biosimilar Interchangeability Guidance
02/15/2017
Last month, the FDA released its guidance for drugmakers attempting to gain approval for interchangeability between a biosimilar and reference product. 
Last month, the FDA released its guidance for drugmakers attempting to gain approval for interchangeability between a biosimilar and reference product. 
Last month, the FDA released its...
02/15/2017
First Report Managed Care
News Connection
California Lawmaker Introduces Bill to Ban Prescription Drug Coupons
02/15/2017
California assemblyman Jim Wood, DDS, introduced legislation that would prohibit the use of prescription drug coupons for medications with cheaper alternatives.
California assemblyman Jim Wood, DDS, introduced legislation that would prohibit the use of prescription drug coupons for medications with cheaper alternatives.
California assemblyman Jim Wood,...
02/15/2017
First Report Managed Care
News Connection
Senate Confirms Tom Price as HHS Secretary
02/15/2017
The US Senate officially confirmed Representative Tom Price, MD, to head the Department of Health and Human Services, with a 52-48 vote.
The US Senate officially confirmed Representative Tom Price, MD, to head the Department of Health and Human Services, with a 52-48 vote.
The US Senate officially...
02/15/2017
First Report Managed Care
News Connection
Repatha Reduces Cardiovascular Risk, Amgen Says
02/15/2017
Results from a recent trial showed that Repatha reduces the risk of cardiovascular events in patients with clinically evident atherosclerotic cardiovascular disease.
Results from a recent trial showed that Repatha reduces the risk of cardiovascular events in patients with clinically evident atherosclerotic cardiovascular disease.
Results from a recent trial...
02/15/2017
First Report Managed Care
News Connection
FDA Approves Opdivo for Select Patients With Urothelial Carcinoma
02/15/2017
The FDA, under accelerated approval, has approved intravenous Opdivo (nivolumab, Bristol-Myers Squibb) for patients with locally advanced or metastatic urothelial carcinoma whose disease has progressed during or following platinum-containing...
The FDA, under accelerated approval, has approved intravenous Opdivo (nivolumab, Bristol-Myers Squibb) for patients with locally advanced or metastatic urothelial carcinoma whose disease has progressed during or following platinum-containing...
The FDA, under accelerated...
02/15/2017
First Report Managed Care
News Connection
Ertugliflozin Monotherapy Effective for Glycemic Control in Type 2 Diabetes
02/15/2017
Used as monotherapy, ertugliflozin provides effective glycemic control for patients with type 2 diabetes inadequately treated by diet and exercise alone. 
Used as monotherapy, ertugliflozin provides effective glycemic control for patients with type 2 diabetes inadequately treated by diet and exercise alone. 
Used as monotherapy,...
02/15/2017
First Report Managed Care
News Connection
New Guideline for Managing Chest Pain in the ED Could Cut Overutilization Costs
02/15/2017
Up to one-third of patients with chest pain could be safely taken off emergency department heart monitors.
Up to one-third of patients with chest pain could be safely taken off emergency department heart monitors.
Up to one-third of patients with...
02/15/2017
First Report Managed Care
News Connection
Some Physicians Charge Up to 6 Times What Medicare Pays
02/15/2017
Physicians, on average, charge roughly 2.5 times the amount Medicare actually pays, with some specialists—anesthesiologists, emergency physicians, and radiologists among them—charging up to 6 times what Medicare pays for the same service. 
Physicians, on average, charge roughly 2.5 times the amount Medicare actually pays, with some specialists—anesthesiologists, emergency physicians, and radiologists among them—charging up to 6 times what Medicare pays for the same service. 
Physicians, on average, charge...
02/15/2017
First Report Managed Care
News Connection
Less Inclusive Lung Cancer Screening Cost-Effective
02/15/2017
Computed tomography (CT) lung cancer screening for current or former smokers is currently suggested in the US and is being considered in other countries as well.
Computed tomography (CT) lung cancer screening for current or former smokers is currently suggested in the US and is being considered in other countries as well.
Computed tomography (CT) lung...
02/15/2017
First Report Managed Care
News Connection
Providers Failing to Recommend Genetic Testing to Breast Cancer Patients
02/15/2017
Physicians often fail to recommend genetic testing and genetic counseling for patients with breast cancer at high risk for mutations associated with ovarian and other cancers, according to new research published in JAMA.
Physicians often fail to recommend genetic testing and genetic counseling for patients with breast cancer at high risk for mutations associated with ovarian and other cancers, according to new research published in JAMA.
Physicians often fail to...
02/15/2017
First Report Managed Care
News Connection
Oncologists Flock to CMS Bundled Payment Model
02/15/2017
A voluntary oncology bundled payment program from CMS has generated heavy interest among oncology providers.
A voluntary oncology bundled payment program from CMS has generated heavy interest among oncology providers.
A voluntary oncology bundled...
02/15/2017
First Report Managed Care
News Connection
$48 Billion Anthem-Cigna Merger Blocked in Federal Court
02/15/2017
A federal judge recently ruled against US health insurer Anthem Inc’s proposed $54 billion merger with Cigna Corp, citing the merger’s potential to negatively impact competition on the insurance market.
A federal judge recently ruled against US health insurer Anthem Inc’s proposed $54 billion merger with Cigna Corp, citing the merger’s potential to negatively impact competition on the insurance market.
A federal judge recently ruled...
02/15/2017
First Report Managed Care
FDA Releases Draft Guidance on Sharing HCEI Between Pharma, Payers
02/15/2017
David Costill
The FDA released draft guidance to clarify regulations on sharing health care economic information.
The FDA released draft guidance to clarify regulations on sharing health care economic information.
The FDA released draft...
02/15/2017
First Report Managed Care
Generics From Abroad: A solution for drug price gouging?
02/15/2017
Paul Nicolaus
Skyrocketing drug prices have lawmakers and industry stakeholders searching for solutions.
Skyrocketing drug prices have lawmakers and industry stakeholders searching for solutions.
Skyrocketing drug prices have...
02/15/2017
First Report Managed Care
How PBMs Impact the Specialty Drug Market
02/15/2017
Dean Celia
Do pharmacy benefit managers actually help to drive prescription drug costs down or does their presence ultimately add to an already hefty price tag?
Do pharmacy benefit managers actually help to drive prescription drug costs down or does their presence ultimately add to an already hefty price tag?
Do pharmacy benefit managers...
02/15/2017
First Report Managed Care
Weighing the Risks and Benefits of Joint-Venture Health Plans
02/15/2017
Jill Sederstorm
Joint-venture health plans are gaining momentum and have the potential to improve health care delivery and outcomes; but they also carry challenges and risks.
Joint-venture health plans are gaining momentum and have the potential to improve health care delivery and outcomes; but they also carry challenges and risks.
Joint-venture health plans are...
02/15/2017
First Report Managed Care
Tech Disconnect: Poor IT Systems Hinder MACRA Transition
02/15/2017
Eileen Koutnik-Fotopoulos
A report on CMS’ management found that addressing IT infrastructure vulnerabilities will be critical in determining the Quality Payment Program’s success.
A report on CMS’ management found that addressing IT infrastructure vulnerabilities will be critical in determining the Quality Payment Program’s success.
A report on CMS’...
02/15/2017
First Report Managed Care
Formulary Frontlines®
Breakthroughs in Cholesterol Treatment
02/15/2017
Eileen Koutnik-Fotopoulos
Recent developments, including new non-statin therapies and PCSK9 inhibitors, are changing the way providers approach cholesterol reduction.
Recent developments, including new non-statin therapies and PCSK9 inhibitors, are changing the way providers approach cholesterol reduction.
Recent developments, including...
02/15/2017
First Report Managed Care
Department
Biosimilar Pegfilgrastim Equally as Effective, Safe as Neulasta
02/15/2017
Research showed that a biosimilar version of Neulasta (pegfilgrastim) was safe and effective among patients with breast cancer receiving myelotoxic chemotherapy. 
Research showed that a biosimilar version of Neulasta (pegfilgrastim) was safe and effective among patients with breast cancer receiving myelotoxic chemotherapy. 
Research showed that a...
02/15/2017
First Report Managed Care
Department
Symptoms of Menopause Influence Tamoxifen Adherence Rates
02/15/2017
Common menopausal symptoms such as nausea and headaches can be used as predictive tools for adherence to the aromatase inhibitor tamoxifen, according to an analysis of data from the International Breast Cancer Intervention Study (IBIS-1).
Common menopausal symptoms such as nausea and headaches can be used as predictive tools for adherence to the aromatase inhibitor tamoxifen, according to an analysis of data from the International Breast Cancer Intervention Study (IBIS-1).
Common menopausal symptoms such...
02/15/2017
First Report Managed Care
Department
Review of Value-Based Frameworks Reveals Gaps Between Payer, Patient Goals
02/15/2017
A recent presentation at the 2016 San Antonio Breast Cancer Symposium, entitled “Value of Cancer Care for Metastatic Breast Cancer Patients and Providers,” found that goals in value-based frameworks for breast cancer patients are not...
A recent presentation at the 2016 San Antonio Breast Cancer Symposium, entitled “Value of Cancer Care for Metastatic Breast Cancer Patients and Providers,” found that goals in value-based frameworks for breast cancer patients are not...
A recent presentation at the...
02/15/2017
First Report Managed Care
Department
Drug Prices Play Central Role in Cancer Treatment Value Decisions
02/15/2017
Increasing exposure of patients to actual drug prices, through reduced insurance coverage, has made cost a necessary factor in cancer treatment value discussions, argued Peter P Bach, MD, MAPP, director of the Center for Health Policy and...
Increasing exposure of patients to actual drug prices, through reduced insurance coverage, has made cost a necessary factor in cancer treatment value discussions, argued Peter P Bach, MD, MAPP, director of the Center for Health Policy and...
Increasing exposure of patients...
02/15/2017
First Report Managed Care
Department
Preview of AMCP Annual Meeting 2017
02/15/2017
AMCP Annual Meeting 2017 - March 27-30, 2017, Denver, CO
AMCP Annual Meeting 2017 - March 27-30, 2017, Denver, CO
AMCP Annual Meeting 2017 - March...
02/15/2017
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

February 2017 Volume 14 Issue 2

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