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March 2013 - FRMC

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Abraxane® (albumin-bound paclitaxel) - Injectable Treatment for Non–Small-Cell Lung Cancer
03/19/2013
The FDA approved ABRAXANE® for Injectable Suspension as first-line treatment for patients with locally advanced or metastatic non–small-cell lung cancer.
The FDA approved ABRAXANE® for Injectable Suspension as first-line treatment for patients with locally advanced or metastatic non–small-cell lung cancer.
The FDA approved ABRAXANE® for...
03/19/2013
First Report Managed Care
Effective Utilization Management of Specialty Drugs
03/19/2013
Tim Casey
Las Vegas—Although only between 1% and 5% of people use specialty drugs, those products account for 20% of total drug spending, a percentage that is expected to increase to 40% in the coming years, according to HungChing Chan, vice president...
Las Vegas—Although only between 1% and 5% of people use specialty drugs, those products account for 20% of total drug spending, a percentage that is expected to increase to 40% in the coming years, according to HungChing Chan, vice president...
Las Vegas—Although only between...
03/19/2013
First Report Managed Care
Value-Based Benefit Design Increases Adherence and Lowers Costs
03/19/2013
Tim Casey
Las Vegas—In 2009, pharmacy spending accounted for 16% of Whirlpool Corporation’s healthcare spending. Of the 22,000 employees, an increasing number had chronic conditions, including diabetes, coronary artery disease, and asthma. Stacy White,...
Las Vegas—In 2009, pharmacy spending accounted for 16% of Whirlpool Corporation’s healthcare spending. Of the 22,000 employees, an increasing number had chronic conditions, including diabetes, coronary artery disease, and asthma. Stacy White,...
Las Vegas—In 2009, pharmacy...
03/19/2013
First Report Managed Care
Prescription Drugs and Potential for Abuse and Misuse
03/19/2013
Tim Casey
Las Vegas—Providers are usually careful when prescribing opioids and pain medications. The drugs are associated with the potential for misuse and abuse, although there is no single factor to predict whether someone will experience from these...
Las Vegas—Providers are usually careful when prescribing opioids and pain medications. The drugs are associated with the potential for misuse and abuse, although there is no single factor to predict whether someone will experience from these...
Las Vegas—Providers are usually...
03/19/2013
First Report Managed Care
Conference Insider
Copay Assistance Programs for Patients
03/19/2013
Tim Casey
Las Vegas—With several blockbuster drugs losing patent protection in recent years, companies have increased their use of copay or voucher programs, in which drug or device manufacturers provide financial assistance to patients to continue...
Las Vegas—With several blockbuster drugs losing patent protection in recent years, companies have increased their use of copay or voucher programs, in which drug or device manufacturers provide financial assistance to patients to continue...
Las Vegas—With several...
03/19/2013
First Report Managed Care
PBMs: A Wall Street View
03/19/2013
Tim Casey
Las Vegas—As Citi Investment Research’s director of healthcare technology and distribution, George Hill spends most of his days researching and speaking with numerous people in the healthcare industry. Through the conversations and analyses,...
Las Vegas—As Citi Investment Research’s director of healthcare technology and distribution, George Hill spends most of his days researching and speaking with numerous people in the healthcare industry. Through the conversations and analyses,...
Las Vegas—As Citi Investment...
03/19/2013
First Report Managed Care
News Connection
Complications following General Surgery
03/19/2013
Tori Socha
Patients discharged from the hospital are at risk in the immediate postdischarge (PD) period. In the 6 months following an index hospitalization, nearly 1 in 7 surgical patients who were accounted for in the Medicare fee-for-service program...
Patients discharged from the hospital are at risk in the immediate postdischarge (PD) period. In the 6 months following an index hospitalization, nearly 1 in 7 surgical patients who were accounted for in the Medicare fee-for-service program...
Patients discharged from the...
03/19/2013
First Report Managed Care
Conference Insider
Cost Analysis of the Medicare Physician Group Practice Demonstration
03/19/2013
Tori Socha
Accountable care organizations (ACOs) are increasingly being created as payment models designed to improve care and slow the growth of healthcare costs. The Centers for Medicare & Medicaid Services (CMS) has created 3 ACOs that differ in...
Accountable care organizations (ACOs) are increasingly being created as payment models designed to improve care and slow the growth of healthcare costs. The Centers for Medicare & Medicaid Services (CMS) has created 3 ACOs that differ in...
Accountable care organizations...
03/19/2013
First Report Managed Care
Use of Electronic Health Record Systems in Office-Based Practices
03/19/2013
Jill Sederstorm
The use of electronic health record (EHR) systems in office-based physician practices continues to rise, but the prevalence of these systems varies significantly by state. These are just a few of the conclusions drawn from a recent data brief...
The use of electronic health record (EHR) systems in office-based physician practices continues to rise, but the prevalence of these systems varies significantly by state. These are just a few of the conclusions drawn from a recent data brief...
The use of electronic health...
03/19/2013
First Report Managed Care
Study Evaluates Once-Daily Delivery System for GERD
03/19/2013
Eileen Koutnik-Fotopoulos
A study in male Wistar rats found that the microparticulate dosage form of lansoprazole provided effective drug concentration for a longer duration than the conventional extended-release dosage form. Furthermore, the dosage form showed...
A study in male Wistar rats found that the microparticulate dosage form of lansoprazole provided effective drug concentration for a longer duration than the conventional extended-release dosage form. Furthermore, the dosage form showed...
A study in male Wistar rats...
03/19/2013
First Report Managed Care
Refractory Gastroesophageal Reflux Disease: A Review
03/18/2013
Tori Socha
Gastroesophageal reflux disease (GERD) develops when reflux of the contents of the stomach cause troublesome symptoms or complications. There is a high prevalence of GERD among the world population, including an estimated 12% to 20% of the...
Gastroesophageal reflux disease (GERD) develops when reflux of the contents of the stomach cause troublesome symptoms or complications. There is a high prevalence of GERD among the world population, including an estimated 12% to 20% of the...
Gastroesophageal reflux disease...
03/18/2013
First Report Managed Care
Utilizing the GERD Impact Scale to Evaluate Treatment Effectiveness
03/18/2013
Tori Socha
Gastroesophageal reflux disease (GERD) is one of the most common gastrointestinal disorders in the United States.
Gastroesophageal reflux disease (GERD) is one of the most common gastrointestinal disorders in the United States.
Gastroesophageal reflux disease...
03/18/2013
First Report Managed Care
Weight Reduction in Obese Patients with Zonisamide
03/18/2013
Tori Socha
Obese patients who have not achieved adequate weight loss through changes in lifestyle have few nonsurgical therapeutic options. In a recent 16-week trial, the antiepileptic drug zonisamide demonstrated weight loss efficacy in obese adults...
Obese patients who have not achieved adequate weight loss through changes in lifestyle have few nonsurgical therapeutic options. In a recent 16-week trial, the antiepileptic drug zonisamide demonstrated weight loss efficacy in obese adults...
Obese patients who have not...
03/18/2013
First Report Managed Care
Early Resection versus Watchful Waiting in Low-Grade Gliomas
03/18/2013
Tori Socha
The World Health Organization has identified grade II astrocytomas, oligodendrogliomas, and oligoastrocytomas as diffuse low-grade gliomas (LGGs). Surgery is not usually considered for treatment of LGGs and, because current evidence of the...
The World Health Organization has identified grade II astrocytomas, oligodendrogliomas, and oligoastrocytomas as diffuse low-grade gliomas (LGGs). Surgery is not usually considered for treatment of LGGs and, because current evidence of the...
The World Health Organization...
03/18/2013
First Report Managed Care
News
Literature Review Assesses Economic Burden of MS
03/18/2013
Kerri Fitzgerald
Multiple sclerosis (MS) is a costly chronic disease that tends to have an early onset, with most patients diagnosed between 20 and 40 years of age. Due to its onset during a patient’s most productive working years, social costs associated...
Multiple sclerosis (MS) is a costly chronic disease that tends to have an early onset, with most patients diagnosed between 20 and 40 years of age. Due to its onset during a patient’s most productive working years, social costs associated...
Multiple sclerosis (MS) is a...
03/18/2013
First Report Managed Care
News
No Significant Clinical Benefit in Combination Therapy for MS
03/18/2013
Kerri Fitzgerald
Disease-modifying therapies (DMTs) have been available for the treatment of relapsing-remitting multiple sclerosis (MS) since 1993. Currently, 9 distinct marketed entities, representing 6 different therapeutic strategies, all...
Disease-modifying therapies (DMTs) have been available for the treatment of relapsing-remitting multiple sclerosis (MS) since 1993. Currently, 9 distinct marketed entities, representing 6 different therapeutic strategies, all...
Disease-modifying therapies...
03/18/2013
First Report Managed Care
News
Natalizumab for Pediatric Patients with MS
03/18/2013
Tori Socha
Two to 5% of patients with multiple sclerosis (MS) experience their first symptoms before they are 18 years of age. Compared with adults with MS, patients £18 years of age commonly have higher relapse rates and often reach disability...
Two to 5% of patients with multiple sclerosis (MS) experience their first symptoms before they are 18 years of age. Compared with adults with MS, patients £18 years of age commonly have higher relapse rates and often reach disability...
Two to 5% of patients with...
03/18/2013
First Report Managed Care
News
Disability Expectancy Table Useful for Patients and Clinicians
03/18/2013
Tori Socha
The Disability Expectancy Table (DET) was created in order to collect disability information on patients with multiple sclerosis (MS).
The Disability Expectancy Table (DET) was created in order to collect disability information on patients with multiple sclerosis (MS).
The Disability Expectancy Table...
03/18/2013
First Report Managed Care
Dexamethasone Shows No Cardiovascular Advantage
03/18/2013
Eileen Koutnik-Fotopoulos
The use of high-dose dexamethasone as a prophylactic for patients undergoing cardiac surgery did not lower the 30-day incidence of major cardiovascular events compared with placebo, however, it may reduce occurrence of respiratory failure and...
The use of high-dose dexamethasone as a prophylactic for patients undergoing cardiac surgery did not lower the 30-day incidence of major cardiovascular events compared with placebo, however, it may reduce occurrence of respiratory failure and...
The use of high-dose...
03/18/2013
First Report Managed Care
Insurance Status and Postoperative Mortality
03/18/2013
Tori Socha
Hypothesizing that insurance status may be associated with differences in specialized medical and surgical care, researchers noted that nonprivately insured patients fare worse postoperatively than privately insured patients. Those...
Hypothesizing that insurance status may be associated with differences in specialized medical and surgical care, researchers noted that nonprivately insured patients fare worse postoperatively than privately insured patients. Those...
Hypothesizing that insurance...
03/18/2013
First Report Managed Care
IOM Standards and Clinical Practice Guidelines
03/18/2013
Tori Socha
Clinical practice guidelines have played an increasingly important role in dictating the practice of medicine in the United States over the past 20 years. During that time period, the number of organizations creating those guidelines has...
Clinical practice guidelines have played an increasingly important role in dictating the practice of medicine in the United States over the past 20 years. During that time period, the number of organizations creating those guidelines has...
Clinical practice guidelines...
03/18/2013
First Report Managed Care
Orphan Drug Development and Approvals Increasing
03/18/2013
Tim Casey
Two years ago, Amicus Therapeutics, Inc. chief executive officer, John Crowley, attended a Biotechnology Industry Organization board meeting in New York. The members were there to discuss the upcoming reauthorization of the Prescription Drug...
Two years ago, Amicus Therapeutics, Inc. chief executive officer, John Crowley, attended a Biotechnology Industry Organization board meeting in New York. The members were there to discuss the upcoming reauthorization of the Prescription Drug...
Two years ago, Amicus...
03/18/2013
First Report Managed Care
Reimbursement for Oncology, Specialty Drugs
03/18/2013
Tim Casey
When Peter Bach, MD, and his colleagues on the formulary committee at Memorial Sloan-Kettering Cancer Center assessed drugs to treat advanced, metastatic colorectal cancer, they made a decision that drew the attention of the healthcare...
When Peter Bach, MD, and his colleagues on the formulary committee at Memorial Sloan-Kettering Cancer Center assessed drugs to treat advanced, metastatic colorectal cancer, they made a decision that drew the attention of the healthcare...
When Peter Bach, MD, and his...
03/18/2013
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

March 2013 Volume 10 Issue 3

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