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January 2017 - FRMC

Managed Care Q&A
Improving Behavioral Health Through ACOs and Integrated Care
01/23/2017
David Costill
According to Neil B Minkoff, MD, the cost burden of behavioral health issues in the US ranges from $200 to $500 billion a year.
According to Neil B Minkoff, MD, the cost burden of behavioral health issues in the US ranges from $200 to $500 billion a year.
According to Neil B Minkoff, MD,...
01/23/2017
First Report Managed Care
News Connection
Biosimilar Shows Equivalent Efficacy to Humira for RA
01/23/2017
The investigational biosimilar PF-06410293 demonstrates equivalent efficacy to the biologic Humira in patients with rheumatoid arthritis (RA).
The investigational biosimilar PF-06410293 demonstrates equivalent efficacy to the biologic Humira in patients with rheumatoid arthritis (RA).
The investigational biosimilar...
01/23/2017
First Report Managed Care
News Connection
Faslodex Comparable to Arimidex in Phase 3 Trials
01/23/2017
In a study, postmenopausal women diagnosed with locally-advanced or metastatic breast cancer showed an improvement with Faslodex.
In a study, postmenopausal women diagnosed with locally-advanced or metastatic breast cancer showed an improvement with Faslodex.
In a study, postmenopausal women...
01/23/2017
First Report Managed Care
News Connection
Clinical Trial Program Expands Investigations on Keytruda Combination Therapy for Select Cancers
01/23/2017
A clinical trial program met to evaluate the safety and efficacy of epacadostat as a component of combination therapy for oncology patients.
A clinical trial program met to evaluate the safety and efficacy of epacadostat as a component of combination therapy for oncology patients.
A clinical trial program met to...
01/23/2017
First Report Managed Care
News Connection
Senate, House Pass Budget Measure to Repeal ACA
01/23/2017
Following a 51 to 48 vote in the Senate, the House of Representatives voted 227 to 198 in favor of a budget measure that is being totted as the initial step to repealing the Affordable Care Act.
Following a 51 to 48 vote in the Senate, the House of Representatives voted 227 to 198 in favor of a budget measure that is being totted as the initial step to repealing the Affordable Care Act.
Following a 51 to 48 vote in the...
01/23/2017
First Report Managed Care
News Connection
ACA Tax Penalties Decreased in 2015
01/23/2017
Fewer Americans paid penalties for lacking health insurance in 2015 than 2014, according to a letter from IRS Commissioner John A Koskinen.
Fewer Americans paid penalties for lacking health insurance in 2015 than 2014, according to a letter from IRS Commissioner John A Koskinen.
Fewer Americans paid penalties...
01/23/2017
First Report Managed Care
News Connection
Hospitals Affiliated With Medicare ACOs Decreased Readmission Rates Faster
01/23/2017
After Medicare introduced readmission penalties, hospitals that were part of Medicare accountable care organizations (ACOs) reduced readmission rates of patients discharged to skilled nursing facilities more quickly than other hospitals.
After Medicare introduced readmission penalties, hospitals that were part of Medicare accountable care organizations (ACOs) reduced readmission rates of patients discharged to skilled nursing facilities more quickly than other hospitals.
After Medicare introduced...
01/23/2017
First Report Managed Care
News Connection
ACOs Improve Care Value For Pediatric Patients With Complex Conditions
01/23/2017
A recent study published in Pediatrics found that development of a quality-improvement initiative through an accountable care organization (ACO) helped to improve quality and value of care for pediatric patients with complex medical...
A recent study published in Pediatrics found that development of a quality-improvement initiative through an accountable care organization (ACO) helped to improve quality and value of care for pediatric patients with complex medical...
A recent study published in...
01/23/2017
First Report Managed Care
News Connection
ACA Reduced Socioeconomic Barriers to Cancer Screening
01/23/2017
After the Patient Protection and Affordable Care Act (ACA) eliminated out-of-pocket expenses for recommended cancer screenings, use of mammography increased across socioeconomic groups; use of colonoscopy, however, did not.
After the Patient Protection and Affordable Care Act (ACA) eliminated out-of-pocket expenses for recommended cancer screenings, use of mammography increased across socioeconomic groups; use of colonoscopy, however, did not.
After the Patient Protection and...
01/23/2017
First Report Managed Care
News Connection
Psychology Essential to the PCMH Model
01/23/2017
According to Nadine J Kaslow, PhD, "A prime reason for integrating behavioral health into patient-centered medical homes is that behavioral health problems are very common in medical patients and frequently complicate care delivery and...
According to Nadine J Kaslow, PhD, "A prime reason for integrating behavioral health into patient-centered medical homes is that behavioral health problems are very common in medical patients and frequently complicate care delivery and...
According to Nadine J Kaslow,...
01/23/2017
First Report Managed Care
News Connection
Primary Care Involvement Reduces Intensity, Cost of End-of-Life Care
01/23/2017
High primary care physician involvement during the last 6 months of a patient’s life is associated with less intensive and less costly care, according to a study in the Annals of Family Medicine.
High primary care physician involvement during the last 6 months of a patient’s life is associated with less intensive and less costly care, according to a study in the Annals of Family Medicine.
High primary care physician...
01/23/2017
First Report Managed Care
News Connection
“Screen-and-Treat” Ineffective Against Type 2 Diabetes
01/23/2017
Because prediabetes screening tests are often inaccurate, individual treatment interventions offered only to patients identified as high risk are unlikely to have a substantial impact on the worsening epidemic of type 2 diabetes, according to...
Because prediabetes screening tests are often inaccurate, individual treatment interventions offered only to patients identified as high risk are unlikely to have a substantial impact on the worsening epidemic of type 2 diabetes, according to...
Because prediabetes screening...
01/23/2017
First Report Managed Care
News
Employing Managed Care to Avert a Diabetes Epidemic
01/23/2017
Mary Beth Nierengarten
Diabetes and pre-diabetes represent a growing threat to the health of the American public and the future of the health care system at-large.
Diabetes and pre-diabetes represent a growing threat to the health of the American public and the future of the health care system at-large.
Diabetes and pre-diabetes...
01/23/2017
First Report Managed Care
News
Cancer Immunotherapy: Navigating a New Frontier
01/23/2017
Dean Celia
The impact of expanded treatment areas, approvals for first-line therapy, and combination regimens, and immunotherapies are being determined.
The impact of expanded treatment areas, approvals for first-line therapy, and combination regimens, and immunotherapies are being determined.
The impact of expanded treatment...
01/23/2017
First Report Managed Care
ACOs: Improving Care Through Nonmedical Services
01/23/2017
Jill Sederstorm
Accountable care organizations (ACOs) are offering services to address patients nonmedical needs and medical needs to reduce health care costs.
Accountable care organizations (ACOs) are offering services to address patients nonmedical needs and medical needs to reduce health care costs.
Accountable care organizations...
01/23/2017
First Report Managed Care
Payer Roundtable: The 21st Century Cures Act
01/23/2017
Dean Celia
In December 2016, the 21st Century Cures Act was signed into law in an effort to improve the quality, research, and efficacy of health care delivery in the US. 
In December 2016, the 21st Century Cures Act was signed into law in an effort to improve the quality, research, and efficacy of health care delivery in the US. 
In December 2016, the 21st...
01/23/2017
First Report Managed Care
Formulary Frontlines®
Headaches & Migraines: Barriers to Treatment Burden Health Care System
01/23/2017
Eileen Koutnik-Fotopoulos
The burden of headache disorders is compounded by delayed diagnosis and other barriers to effective therapy.
The burden of headache disorders is compounded by delayed diagnosis and other barriers to effective therapy.
The burden of headache disorders...
01/23/2017
First Report Managed Care
Department
ED Visits, Physician’s Office Use Higher Among Crohn’s Disease Patients
01/23/2017
Patients with Crohn’s disease utilize emergency departments and physician’s offices more frequently than patients with ulcerative colitis.
Patients with Crohn’s disease utilize emergency departments and physician’s offices more frequently than patients with ulcerative colitis.
Patients with Crohn’s disease...
01/23/2017
First Report Managed Care
Department
Remicade Results in Lost Productivity Compared to Entyvio
01/23/2017
Due to an increased amount of infusion time required to administer, use of Remicade (infliximab; Janssen) results in additional billing hours and loss of productivity compared to use of Entyvio (vedolizumab; Takeda), according to a poster...
Due to an increased amount of infusion time required to administer, use of Remicade (infliximab; Janssen) results in additional billing hours and loss of productivity compared to use of Entyvio (vedolizumab; Takeda), according to a poster...
Due to an increased amount of...
01/23/2017
First Report Managed Care
Department
Understanding the Burden of IBD-Related Hospital Readmissions
01/23/2017
A poster presentation at the 2016 Advances in IBD Conference outlined how inflammatory bowel diseases affects hospital readmissions in the United States.
A poster presentation at the 2016 Advances in IBD Conference outlined how inflammatory bowel diseases affects hospital readmissions in the United States.
A poster presentation at the...
01/23/2017
First Report Managed Care
Department
Patient Engagement Reduces Costs Among Crohn’s Patients
01/23/2017
A joint-venture patient engagement program helped to reduce relative risk and treatment costs among patients with Crohn’s disease.
A joint-venture patient engagement program helped to reduce relative risk and treatment costs among patients with Crohn’s disease.
A joint-venture patient...
01/23/2017
First Report Managed Care
Department
Improving Access to Urgent IBD Care
01/23/2017
A collaboration aimed at improving access to urgent care for patients with inflammatory bowel disease helped to reduce emergency department overutilization.
A collaboration aimed at improving access to urgent care for patients with inflammatory bowel disease helped to reduce emergency department overutilization.
A collaboration aimed at...
01/23/2017
First Report Managed Care
Department
ED Visits for Headaches Increasing Significantly Among Children
01/23/2017
Research presented at the AAP 2016 National Conference and Exhibition found a trend of pediatric patients reporting to the ED for headache-related reasons. 
Research presented at the AAP 2016 National Conference and Exhibition found a trend of pediatric patients reporting to the ED for headache-related reasons. 
Research presented at the AAP...
01/23/2017
First Report Managed Care
Department
Uninsured Children Transferred After ED Visits More Than Privately Insured Children
01/23/2017
Transfers from the emergency department to another facility occur more frequently among pediatric patients without insurance or with Medicaid.
Transfers from the emergency department to another facility occur more frequently among pediatric patients without insurance or with Medicaid.
Transfers from the emergency...
01/23/2017
First Report Managed Care
Department
Arzerra “Highly Cost-Effective” Among Patients With Relapsed Chronic Lymphocytic Leukemia
01/23/2017
Researchers found that Arzerra (ofatumumab; Novartis) in combination with fludarabine and cyclophosphamide was more cost-effective than fludarabine and cyclophosphamide alone.
Researchers found that Arzerra (ofatumumab; Novartis) in combination with fludarabine and cyclophosphamide was more cost-effective than fludarabine and cyclophosphamide alone.
Researchers found that Arzerra...
01/23/2017
First Report Managed Care
Department
Costs Similar Among Multiple Myeloma Patients Treated With Kyprolis vs Pomalyst
01/23/2017
According to recent research presented at the 2016 ASH Annual Meeting and Exposition, multiple myeloma treatment costs are not significantly different when using Kyprolis (carfilzomib; Amgen) compared to treatment with Pomalyst (pomalidomide;...
According to recent research presented at the 2016 ASH Annual Meeting and Exposition, multiple myeloma treatment costs are not significantly different when using Kyprolis (carfilzomib; Amgen) compared to treatment with Pomalyst (pomalidomide;...
According to recent research...
01/23/2017
First Report Managed Care
Department
Novel Device Provides Rapid, Low-Cost Blood Clot Testing
01/23/2017
According to recent research presented at the 2016 ASH Annual Meeting and Exposition, a newly developed handheld device can offer rapid and comprehensive assessment of blood clotting using less than a drop of blood.
According to recent research presented at the 2016 ASH Annual Meeting and Exposition, a newly developed handheld device can offer rapid and comprehensive assessment of blood clotting using less than a drop of blood.
According to recent research...
01/23/2017
First Report Managed Care
Department
Bioengineering Innovations Highlight the Future of Cancer, Hemophilia Treatment
01/23/2017
A collection of studies presented at the 2016 ASH Annual Meeting and Exposition highlighted advances in biomedical engineering that could improve the delivery of treatments for patients with cancer and hematological-related illnesses. 
A collection of studies presented at the 2016 ASH Annual Meeting and Exposition highlighted advances in biomedical engineering that could improve the delivery of treatments for patients with cancer and hematological-related illnesses. 
A collection of studies...
01/23/2017
First Report Managed Care
Department
ASCO, ESMO Value Frameworks Imperfectly Apply to Hematology
01/23/2017
Current value frameworks issued by leading medical societies may not be easily generalizable to the treatment of hematologic malignancies.
Current value frameworks issued by leading medical societies may not be easily generalizable to the treatment of hematologic malignancies.
Current value frameworks issued...
01/23/2017
First Report Managed Care
Department
Cessation of Treatment May Be Possible for Patients With Chronic Myeloid Leukemia
01/23/2017
Patients with stable chronic myeloid leukemia can safely cease or reduce treatment with tyrosine kinase inhibitors to avoid side effects and treatment costs. 
Patients with stable chronic myeloid leukemia can safely cease or reduce treatment with tyrosine kinase inhibitors to avoid side effects and treatment costs. 
Patients with stable chronic...
01/23/2017
First Report Managed Care
Department
FDA Releases Final Guidelines on Naming Biosimilars
01/18/2017
The FDA recently released guidelines for naming both biologic medicines and biosimilar copies.
The FDA recently released guidelines for naming both biologic medicines and biosimilar copies.
The FDA recently released...
01/18/2017
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

News
Comparative Effectiveness for Bronchodilator Responsiveness Testing
02/09/2024
Emry Lloyd
A new study compares the efficacy of salbutamol administration via a nebulizer vs a metered-dose inhaler with a spacer for bronchodilator responsiveness testing.
A new study compares the efficacy of salbutamol administration via a nebulizer vs a metered-dose inhaler with a spacer for bronchodilator responsiveness testing.
A new study compares the...
02/09/2024
First Report Managed Care
News
Trial to Test CAR T-Cell Therapy for Refractory Progressive MS
03/18/2024
Jolynn Tumolo
An autologous, fully human CD19 chimeric antigen receptor (CAR) T-cell product candidate recently received clearance from the US Food and Drug Administration (FDA) as an investigational new drug for the treatment of patients with refractory...
An autologous, fully human CD19 chimeric antigen receptor (CAR) T-cell product candidate recently received clearance from the US Food and Drug Administration (FDA) as an investigational new drug for the treatment of patients with refractory...
An autologous, fully human CD19...
03/18/2024
First Report Managed Care
Conference Coverage
PBM Legislation: Navigating Congressional Delays and Encouraging Progress
04/17/2024
Hannah Musick
Explore the world of federal pharmacy benefit manager (PBM) legislation and its potential impact on stakeholders in this in-depth analysis presented by Ross Margulies, JD, MPH, Partner and Co-Chair Healthcare and Life Sciences Coverage &...
Explore the world of federal pharmacy benefit manager (PBM) legislation and its potential impact on stakeholders in this in-depth analysis presented by Ross Margulies, JD, MPH, Partner and Co-Chair Healthcare and Life Sciences Coverage &...
Explore the world of federal...
04/17/2024
First Report Managed Care
Conference Coverage
The Impact of Fatigue on Prospective Memory in Persons With MS
05/23/2024
Hannah Musick
High fatigue levels in persons with multiple sclerosis (MS) are significantly associated with subjective impairment in prospective memory, particularly in tasks such as forgetting the date and missing appointments.
High fatigue levels in persons with multiple sclerosis (MS) are significantly associated with subjective impairment in prospective memory, particularly in tasks such as forgetting the date and missing appointments.
High fatigue levels in persons...
05/23/2024
First Report Managed Care
Interview
Enhancing Patient Services: Payer and Provider Considerations
06/28/2024
Patient services emerged as a central topic at AXS24, with many stakeholders emphasizing the need for consistency and accessibility in patient support. They also highlighted the importance of addressing both financial and emotional support...
Patient services emerged as a central topic at AXS24, with many stakeholders emphasizing the need for consistency and accessibility in patient support. They also highlighted the importance of addressing both financial and emotional support...
Patient services emerged as a...
06/28/2024
First Report Managed Care

January 2017 Volume 14 Issue 1

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