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January 2016 - FRMC

New Treatment Option for HYPERKALEMIA: patiromer
02/02/2016
Patients with CKD and hyperkalemia found that treatment with patiromer was associated with a reduction in serum potassium levels and a reduction in recurrence.
Patients with CKD and hyperkalemia found that treatment with patiromer was associated with a reduction in serum potassium levels and a reduction in recurrence.
Patients with CKD and...
02/02/2016
First Report Managed Care
Department
Product Update
02/02/2016
The FDA approved Zurampic (lesinurad) used in combination with a xanthine oxidase inhibitor (XOI) to treat hyperuricemia associated with gout. XOI is used to reduce the production of uric acid in the body.
The FDA approved Zurampic (lesinurad) used in combination with a xanthine oxidase inhibitor (XOI) to treat hyperuricemia associated with gout. XOI is used to reduce the production of uric acid in the body.
The FDA approved Zurampic...
02/02/2016
First Report Managed Care
NON–SMALL-CELL LUNG CANCER: Shifting from Generic Chemotherapy Regimens to Complex Treatment Landscapes
02/02/2016
Eileen Koutnik-Fotopoulos
With new drugs targeting second-line therapy, a crowded treatment algorithm may be on the horizon for patients with NSCLC. 
With new drugs targeting second-line therapy, a crowded treatment algorithm may be on the horizon for patients with NSCLC. 
With new drugs targeting...
02/02/2016
First Report Managed Care
Specialty Drugs: The Tipping Point is Coming
02/02/2016
Eileen Koutnik-Fotopoulos
Payer clients are faced with alarmingly high-cost specialty drug trends with no clear direction on how to balance the dilemma of therapy versus cost. Add the explosive development of new specialty drugs over the next few years and payers...
Payer clients are faced with alarmingly high-cost specialty drug trends with no clear direction on how to balance the dilemma of therapy versus cost. Add the explosive development of new specialty drugs over the next few years and payers...
Payer clients are faced with...
02/02/2016
First Report Managed Care
US Just Scratching Surface of Biosimilar Landscape
02/02/2016
Eileen Koutnik-Fotopoulos
Now that the first biosimilar—filgrastim-sndz—has entered the US marketplace, policies and perceptions around these complex medicines are unfurling.
Now that the first biosimilar—filgrastim-sndz—has entered the US marketplace, policies and perceptions around these complex medicines are unfurling.
Now that the first...
02/02/2016
First Report Managed Care
Should Medicare Negotiate Drug Prices?
02/02/2016
Dean Celia
Drug costs are a top concern for voters, with polls showing that most are open to letting Medicare tackle the issue by negotiating drug prices. Here’s where the presidential candidates stand and what our experts believe are the potential...
Drug costs are a top concern for voters, with polls showing that most are open to letting Medicare tackle the issue by negotiating drug prices. Here’s where the presidential candidates stand and what our experts believe are the potential...
Drug costs are a top concern...
02/02/2016
First Report Managed Care
New Breast Cancer Guidelines and Managed Care
02/02/2016
Dean Celia
The American Cancer Society's revised guidelines have inched closer to United States Preventive Services Task Force recommendations. How will this impact managed care? Our experts sort through the potential effect on Accountable Care...
The American Cancer Society's revised guidelines have inched closer to United States Preventive Services Task Force recommendations. How will this impact managed care? Our experts sort through the potential effect on Accountable Care...
The American Cancer...
02/02/2016
First Report Managed Care
Embracing Change: As the Number of Public and Private ACOs Grow, Lessons Emerge
02/02/2016
Jill Sederstorm
The momentum to establish accountable care organizations (ACOs) continues to grow, as both government and commercial payers make a push for providers to begin baring risk for patient populations. 
The momentum to establish accountable care organizations (ACOs) continues to grow, as both government and commercial payers make a push for providers to begin baring risk for patient populations. 
The momentum to establish...
02/02/2016
First Report Managed Care
Hello, Goodbye—Implications of UnitedHealth`s Potentially Quick ACA Exit
02/02/2016
Paul Nicolaus
Is a fundamental structural issue with the exchange products overall to blame? Our experts think only time will tell. 
Is a fundamental structural issue with the exchange products overall to blame? Our experts think only time will tell. 
Is a fundamental structural...
02/02/2016
First Report Managed Care
Challenges in Oncology Care Management
02/02/2016
Jill Sederstorm
The percentage of MCOs using guidelines and pathways to direct cancer treatment is on the rise. 
The percentage of MCOs using guidelines and pathways to direct cancer treatment is on the rise. 
The percentage of MCOs using...
02/02/2016
First Report Managed Care
Perception of Trust Has Positive Impact on Performance in Buyer-seller Relationship
02/02/2016
Mary Mihalovic
Trust between buyers and suppliers in the health sector is defined as a firm’s belief that the other will act in the best interest of the firm and the relationship, and is definitely perceived to improve performance (defined as the impact...
Trust between buyers and suppliers in the health sector is defined as a firm’s belief that the other will act in the best interest of the firm and the relationship, and is definitely perceived to improve performance (defined as the impact...
Trust between buyers and...
02/02/2016
First Report Managed Care
Newsfeed
Efforts to Implement PCMH Concepts Can Lead to Big Cost Savings for States
02/02/2016
Jill Sederstorm
As 1 of 8 states to conduct a Multi-Payer Advanced Primary Care Practice demonstration project aimed to evaluate the effectiveness of patient-centered medical homes when Medicaid, Medicare, and private payers support it, North Carolina and...
As 1 of 8 states to conduct a Multi-Payer Advanced Primary Care Practice demonstration project aimed to evaluate the effectiveness of patient-centered medical homes when Medicaid, Medicare, and private payers support it, North Carolina and...
As 1 of 8 states to conduct a...
02/02/2016
First Report Managed Care
Generic and Traditional Drugs Also Influence High Costs
02/02/2016
Mary Beth Nierengarten
Along with the high cost of specialty drugs, newly branded and first-time generic drugs will impact drug spending in 2016. 
Along with the high cost of specialty drugs, newly branded and first-time generic drugs will impact drug spending in 2016. 
Along with the high cost of...
02/02/2016
First Report Managed Care
Newsfeed
Virtual Health Assistants: Influencing Patient Behavior to Improve Health Outcomes
02/02/2016
Melissa D. Cooper
Patient behavior can be critical to health outcomes, but how can these individuals’ behavior be influenced to improve health care outcomes? Virtual health assistants, Thomas Morrow, MD, chief medical officer, Next IT, said during the second...
Patient behavior can be critical to health outcomes, but how can these individuals’ behavior be influenced to improve health care outcomes? Virtual health assistants, Thomas Morrow, MD, chief medical officer, Next IT, said during the second...
Patient behavior can be critical...
02/02/2016
First Report Managed Care
Conference Insider
Using the MSSP ACO Model in a PCP-centric Solution Impacts Overall Costs, Improves Care
02/02/2016
Mary Mihalovic
Physician group practice cost and expense findings show primary care involvement impacts overall costs, giving rise to the PCP-centric solution. 
Physician group practice cost and expense findings show primary care involvement impacts overall costs, giving rise to the PCP-centric solution. 
Physician group practice...
02/02/2016
First Report Managed Care

Behind the Bill

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
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, 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 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

Trending Articles

Commentary
Next-Generation Utilization Management: Managing Utilization and Cost Without Denial of Service​​​
03/01/2024
Amit Gupta, MD
Utilization management is evolving from a cost-centric process to a focus on quality of care, with trends including exception-based authorization handling and value-based arrangements to reduce administrative burden and provider abrasion.
Utilization management is evolving from a cost-centric process to a focus on quality of care, with trends including exception-based authorization handling and value-based arrangements to reduce administrative burden and provider abrasion.
Utilization management is...
03/01/2024
First Report Managed Care
Shannon Smith Headshot
Commentary
Adapting to Change: Navigating the New CMS Prior Authorization Guidelines in Health Care
04/02/2024

Shannon Smith, RN, BSN

Shannon Smith, RN, BSN
As the health care industry prepares for the Centers for Medicare & Medicaid Services (CMS) to implement new guidelines to streamline prior authorization procedures, significant operational changes are on the horizon for health care payers....
As the health care industry prepares for the Centers for Medicare & Medicaid Services (CMS) to implement new guidelines to streamline prior authorization procedures, significant operational changes are on the horizon for health care payers....
As the health care industry...
04/02/2024
First Report Managed Care
Conference Coverage
Rare Orphan, Oncology, and Specialty Drugs in Development: Review of Therapeutic Areas, Designations, and Launch Projections
05/01/2024
Danielle Sposato
The specialty pharmacy pipeline was the subject of one of many informative sessions at the annual Asembia Summit this year. Key insights were shared about current drugs in the pipeline according to their drug designations, the phase of each...
The specialty pharmacy pipeline was the subject of one of many informative sessions at the annual Asembia Summit this year. Key insights were shared about current drugs in the pipeline according to their drug designations, the phase of each...
The specialty pharmacy pipeline...
05/01/2024
First Report Managed Care
News
Using Mindfulness-Based Intervention to Improve Fatigue, Mood Challenges in Adolescents With Neuroimmune Disease
05/28/2024
Grace Taylor, MS, MA
Study examines the effectiveness of the Learning to BREATHE mindfulness-based intervention in improving fatigue and mood challenges in a adolescent population with neuroimmune disease.
Study examines the effectiveness of the Learning to BREATHE mindfulness-based intervention in improving fatigue and mood challenges in a adolescent population with neuroimmune disease.
Study examines the effectiveness...
05/28/2024
First Report Managed Care
Leyla Henderson
Conference Coverage
Strategies for Enhancing Infusion Patient Experiences
07/10/2024
Leyla Henderson
An NICA 2024 session speaker shares innovative strategies for enhancing patient satisfaction and improving outcomes in health care settings, emphasizing the importance of patient-centered care and individualized experiences.
An NICA 2024 session speaker shares innovative strategies for enhancing patient satisfaction and improving outcomes in health care settings, emphasizing the importance of patient-centered care and individualized experiences.
An NICA 2024 session speaker...
07/10/2024
First Report Managed Care

January 2016 Volume 13 Issue 1

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