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HMP Global

May 2012 - FRMC

Conference Insider
Improving Adherence in Patients with Chronic Conditions
05/25/2012
Tori Socha
San Francisco—Poor adherence to medication regimens is a growing problem in the United States. At a Managed Care Essentials session at the AMCP meeting, representatives from CVS Caremark presented a session titled Advancing Adherence and the...
San Francisco—Poor adherence to medication regimens is a growing problem in the United States. At a Managed Care Essentials session at the AMCP meeting, representatives from CVS Caremark presented a session titled Advancing Adherence and the...
San Francisco—Poor adherence to...
05/25/2012
First Report Managed Care
Anticoagulation Use in Patients with Atrial Fibrillation
05/25/2012
Tim Casey
San Francisco—Patients with atrial fibrillation (AF), providers, and health plans may benefit from utilizing software that identifies people who are at high risk of stroke, according to a descriptive, retrospective analysis of a comprehensive...
San Francisco—Patients with atrial fibrillation (AF), providers, and health plans may benefit from utilizing software that identifies people who are at high risk of stroke, according to a descriptive, retrospective analysis of a comprehensive...
San Francisco—Patients with...
05/25/2012
First Report Managed Care
Challenges and Emerging Treatments in Schizophrenia
05/25/2012
Jill Sederstorm
San Francisco—Current antipsychotic medications used to treat Schizophrenia are associated with limited efficacy and adverse events; however, treatment of the disease may be improved by new drugs on the horizon or medication therapy...
San Francisco—Current antipsychotic medications used to treat Schizophrenia are associated with limited efficacy and adverse events; however, treatment of the disease may be improved by new drugs on the horizon or medication therapy...
San Francisco—Current...
05/25/2012
First Report Managed Care
Hepatitis C Prevalence and Cost a Greater Burden in Younger Medicare Population
05/25/2012
Mary Mihalovic
San Francisco—The prevalence of hepatitis C (HCV), including advanced liver disease (ALD), and the costs to treat these conditions increased significantly among Medicare patients >65 years of age, according to information presented during...
San Francisco—The prevalence of hepatitis C (HCV), including advanced liver disease (ALD), and the costs to treat these conditions increased significantly among Medicare patients >65 years of age, according to information presented during...
San Francisco—The prevalence of...
05/25/2012
First Report Managed Care
Treatment Persistence among Insulin Glargine Users
05/25/2012
Kevin L. Carter
San Francisco—For insulin-dependent patients with type 2 diabetes mellitus (T2DM), treatment persistence may be critical in maintaining glycemic control. Poor treatment and adherence to treatment plan is associated with poor clinical...
San Francisco—For insulin-dependent patients with type 2 diabetes mellitus (T2DM), treatment persistence may be critical in maintaining glycemic control. Poor treatment and adherence to treatment plan is associated with poor clinical...
San Francisco—For...
05/25/2012
First Report Managed Care
Tools
Exploratory Web-Based SMARTI-I Tool Facilitates Drug Safety, Tolerability Evaluations
05/25/2012
Kristina Woodworth
San Francisco – Researchers from Teva Pharmaceuticals have developed a web-based Safety Monitoring and Reported Tolerability Issues Index (SMARTI-I) system to help identify safety and tolerability issues, especially during formulary decision...
San Francisco – Researchers from Teva Pharmaceuticals have developed a web-based Safety Monitoring and Reported Tolerability Issues Index (SMARTI-I) system to help identify safety and tolerability issues, especially during formulary decision...
San Francisco – Researchers from...
05/25/2012
First Report Managed Care
Growth in the Specialty Drug Pipeline Continues
05/25/2012
Eileen Koutnik-Fotopoulos
San Francisco—The specialty market continues to see a significant rate of growth due to broader use of specialty medications to treat common and rare diseases. Aimee Tharaldson, PharmD, senior clinical consultant, emerging therapeutics, at...
San Francisco—The specialty market continues to see a significant rate of growth due to broader use of specialty medications to treat common and rare diseases. Aimee Tharaldson, PharmD, senior clinical consultant, emerging therapeutics, at...
San Francisco—The specialty...
05/25/2012
First Report Managed Care
Conference Insider
Tumor Necrosis Factor Inhibitors in Patients with Psoriatic Arthritis
05/24/2012
Tori Socha
San Francisco—Due to a lack of head-to-head studies demonstrating the comparative effectiveness of tumor necrosis factor inhibitors (TNFi), only indirect comparisons can be made, according to researchers. The National Institute for Health and...
San Francisco—Due to a lack of head-to-head studies demonstrating the comparative effectiveness of tumor necrosis factor inhibitors (TNFi), only indirect comparisons can be made, according to researchers. The National Institute for Health and...
San Francisco—Due to a lack of...
05/24/2012
First Report Managed Care
Pharmacy’s Role in the Patient-Centered Medical Home
05/24/2012
Ken Palmer
San Francisco–There are numerous key benefits of integrating a pharmacy service into a patient-centered medical home (PCMH) or accountable care organization. Among them are lowering costs through collaborative patient care and improved...
San Francisco–There are numerous key benefits of integrating a pharmacy service into a patient-centered medical home (PCMH) or accountable care organization. Among them are lowering costs through collaborative patient care and improved...
San Francisco–There are numerous...
05/24/2012
First Report Managed Care
Real-World Costs of Biologic Agents for Rheumatoid Arthritis
05/24/2012
Mary Beth Nierengarten
San Francisco—When assessing the treatment costs of biologic agents used to treat patients with rheumatoid arthritis (RA), health plans should calculate reimbursed dollars plus patient copayments rather than wholesale acquisitions costs...
San Francisco—When assessing the treatment costs of biologic agents used to treat patients with rheumatoid arthritis (RA), health plans should calculate reimbursed dollars plus patient copayments rather than wholesale acquisitions costs...
San Francisco—When assessing the...
05/24/2012
First Report Managed Care
Trends in Managed Care Pharmacy
05/24/2012
Tori Socha
San Francisco—Over the past year, there has been a slowing in the rate of growth of expenditures for drugs. At a Contemporary Issues session at the AMCP meeting, Douglas Long, MBA, vice president, industry relations, at IMS Health, Inc.,...
San Francisco—Over the past year, there has been a slowing in the rate of growth of expenditures for drugs. At a Contemporary Issues session at the AMCP meeting, Douglas Long, MBA, vice president, industry relations, at IMS Health, Inc.,...
San Francisco—Over the past...
05/24/2012
First Report Managed Care
Time to Initiation of DMARDs among Patients with RA
05/24/2012
Kevin L. Carter
San Francisco—Rheumatoid arthritis (RA) is a chronic, inflammatory disorder characterized by pain, progressive disability due to inflammation, and joint destruction. Patients with RA often face daunting economic and comorbid burdens. Most...
San Francisco—Rheumatoid arthritis (RA) is a chronic, inflammatory disorder characterized by pain, progressive disability due to inflammation, and joint destruction. Patients with RA often face daunting economic and comorbid burdens. Most...
San Francisco—Rheumatoid...
05/24/2012
First Report Managed Care
Comparative Effectiveness Research by States
05/24/2012
Kevin L. Carter
San Francisco—Jenny Gaffney, a senior manager with Avalere Health in Washington, said at the AMCP meeting that over the past few years comparative effectiveness research (CER) has been utilized increasingly by states looking to improve the...
San Francisco—Jenny Gaffney, a senior manager with Avalere Health in Washington, said at the AMCP meeting that over the past few years comparative effectiveness research (CER) has been utilized increasingly by states looking to improve the...
San Francisco—Jenny Gaffney, a...
05/24/2012
First Report Managed Care
eDossiers Part of the Evolution Demanding Evidence-Based P&T
05/24/2012
Mary Mihalovic
San Francisco—Pharmacy and Therapeutics (P&T) committees have evolved considerably with the demand for evidence-based decisions, according to information presented by Chryss MacGowan, RPh, director, pharmacy services managed care, Denver...
San Francisco—Pharmacy and Therapeutics (P&T) committees have evolved considerably with the demand for evidence-based decisions, according to information presented by Chryss MacGowan, RPh, director, pharmacy services managed care, Denver...
San Francisco—Pharmacy and...
05/24/2012
First Report Managed Care
News
Nonadherence in MS Medications Associated with Age, Hospitalization History, and Copayments
05/24/2012
Jill Sederstorm
San Francisco—A retrospective study of patients with multiple sclerosis (MS) found that nonadherence to disease-modifying drugs (DMDs) was associated with younger age, a history of a hospitalization or emergency department (ED) visits, and...
San Francisco—A retrospective study of patients with multiple sclerosis (MS) found that nonadherence to disease-modifying drugs (DMDs) was associated with younger age, a history of a hospitalization or emergency department (ED) visits, and...
San Francisco—A retrospective...
05/24/2012
First Report Managed Care
Inside Look at a Joint-Owned Specialty Pharmacy
05/24/2012
Jill Sederstorm
San Francisco—A specialty pharmacy jointly owned by a regional health plan and an outside entity can be a successful partnership with high satisfaction, but the risk and operational implications associated with the venture should also be...
San Francisco—A specialty pharmacy jointly owned by a regional health plan and an outside entity can be a successful partnership with high satisfaction, but the risk and operational implications associated with the venture should also be...
San Francisco—A specialty...
05/24/2012
First Report Managed Care
Use of Pens versus Vials for Insulin Delivery
05/24/2012
Tori Socha
San Francisco—It is estimated that diabetes affects 7.5% to 7.9% of Americans and the estimated annual economic burden of type 2 diabetes in the United States is $159.5 billion. Patient outcomes are affected by various factors, including the...
San Francisco—It is estimated that diabetes affects 7.5% to 7.9% of Americans and the estimated annual economic burden of type 2 diabetes in the United States is $159.5 billion. Patient outcomes are affected by various factors, including the...
San Francisco—It is estimated...
05/24/2012
First Report Managed Care
Development of Electronic Prior Authorization Has Reached an Inflection Point
05/24/2012
Kevin L. Carter
San Francisco—“With the possibility of radical changes in the way pharmacy benefits are administered and delivered, the development of electronic prior authorization (ePA) has reached an inflection point, and the industry needs to work...
San Francisco—“With the possibility of radical changes in the way pharmacy benefits are administered and delivered, the development of electronic prior authorization (ePA) has reached an inflection point, and the industry needs to work...
San Francisco—“With the...
05/24/2012
First Report Managed Care
Challenges for Medicaid as Membership Volume Swells
05/24/2012
Mary Mihalovic
San Francisco—The passing of the Patient Protection and Affordable Care Act (ACA) is presenting increasing challenges for managed Medicaid programs, which have already experienced steady growth decade by decade, according to information...
San Francisco—The passing of the Patient Protection and Affordable Care Act (ACA) is presenting increasing challenges for managed Medicaid programs, which have already experienced steady growth decade by decade, according to information...
San Francisco—The passing of the...
05/24/2012
First Report Managed Care
Management Strategies for Febuxostat as Chronic Therapy for Gout
05/24/2012
Kevin L. Carter
San Francisco—Gout affects as many as 5 million people in the United States and is the most common cause of inflammatory arthritis for men >40 years of age in the US. Traditionally, the goals of treatment for this condition have been to...
San Francisco—Gout affects as many as 5 million people in the United States and is the most common cause of inflammatory arthritis for men >40 years of age in the US. Traditionally, the goals of treatment for this condition have been to...
San Francisco—Gout affects as...
05/24/2012
First Report Managed Care
Drug Utilization Similar for Hepatitis C Dual and Triple Therapy
05/24/2012
Mary Mihalovic
San Francisco—The use of the protease inhibitors boceprevir or telaprevir in conjunction with peginterferon and ribavirin (known as triple therapy) for the treatment of type 1 hepatitis C did not result in increased drug utilization compared...
San Francisco—The use of the protease inhibitors boceprevir or telaprevir in conjunction with peginterferon and ribavirin (known as triple therapy) for the treatment of type 1 hepatitis C did not result in increased drug utilization compared...
San Francisco—The use of the...
05/24/2012
First Report Managed Care
Challenges Associated with Multiple Myeloma and Myelofibrosis
05/24/2012
Tim Casey
San Francisco—As rare diseases, multiple myeloma and myelofibrosis, are difficult to manage and associated with high costs. Due to new therapies and evolving strategies that are effective but complex, the challenges are increasing. At the...
San Francisco—As rare diseases, multiple myeloma and myelofibrosis, are difficult to manage and associated with high costs. Due to new therapies and evolving strategies that are effective but complex, the challenges are increasing. At the...
San Francisco—As rare diseases,...
05/24/2012
First Report Managed Care
Conference Insider
FDA Guidance on Unsolicited Requests for Off-Label Information
05/24/2012
Kristina Woodworth
San Francisco—During a Contemporary Issues session at the AMCP meeting, representatives from the FDA Office of Prescription Drug Promotion (OPDP) and the industry reviewed the FDA’s official Guidance for Industry on responding to unsolicited...
San Francisco—During a Contemporary Issues session at the AMCP meeting, representatives from the FDA Office of Prescription Drug Promotion (OPDP) and the industry reviewed the FDA’s official Guidance for Industry on responding to unsolicited...
San Francisco—During a...
05/24/2012
First Report Managed Care
Insurance Exchanges: Update for Managed Care Pharmacy
05/24/2012
Tori Socha
San Francisco—Provisions in the Patient Protection and Affordable Care Act (ACA) call for the establishment of insurance exchanges. These exchanges are intended to provide a competitive marketplace for individuals and employees of small...
San Francisco—Provisions in the Patient Protection and Affordable Care Act (ACA) call for the establishment of insurance exchanges. These exchanges are intended to provide a competitive marketplace for individuals and employees of small...
San Francisco—Provisions in the...
05/24/2012
First Report Managed Care
Conference Insider
Roadmap for Pharmacy HIT Integration
05/24/2012
Tori Socha
An advisory work group met to develop a Roadmap for pharmacists to follow to integrate health information technology (HIT) into their practice.
An advisory work group met to develop a Roadmap for pharmacists to follow to integrate health information technology (HIT) into their practice.
An advisory work group met to...
05/24/2012
First Report Managed Care
Wall Street’s View of Healthcare Reform Initiatives
05/24/2012
Tim Casey
San Francisco—By 2020, healthcare expenditures in the United States are expected to reach nearly $5 trillion and account for 20% of the country’s gross domestic product (GDP), which is twice as much as in most developed countries. With an...
San Francisco—By 2020, healthcare expenditures in the United States are expected to reach nearly $5 trillion and account for 20% of the country’s gross domestic product (GDP), which is twice as much as in most developed countries. With an...
San Francisco—By 2020,...
05/24/2012
First Report Managed Care
Generic Step Therapy Program for Epilepsy Patients
05/24/2012
Eileen Koutnik-Fotopoulos
San Francisco—A step therapy program found that patients with epilepsy who switched to generic formulations had a numerically and statistically significant reduction in costs compared with patients who stayed on brand formulations, based on...
San Francisco—A step therapy program found that patients with epilepsy who switched to generic formulations had a numerically and statistically significant reduction in costs compared with patients who stayed on brand formulations, based on...
San Francisco—A step therapy...
05/24/2012
First Report Managed Care
Vemurafenib for BRAF V600+ Metastatic Melanoma
05/24/2012
Ken Palmer
San Francisco—Metastatic melanoma is a rare but rapidly progressing form of cancer that develops in the melanocytes of the skin. The BRAF protein kinase plays an important role in the progression of the disease. Vemurafenib is a BRAF...
San Francisco—Metastatic melanoma is a rare but rapidly progressing form of cancer that develops in the melanocytes of the skin. The BRAF protein kinase plays an important role in the progression of the disease. Vemurafenib is a BRAF...
San Francisco—Metastatic...
05/24/2012
First Report Managed Care
Comparative Effectiveness Research in Evaluating Lipid-Modifying Therapies
05/24/2012
Tim Casey
San Francisco—Managed care professionals are increasingly utilizing comparative effectiveness research (CER) to determine the effectiveness, safety, and value of drugs. This detailed approach is particularly useful for patients with high...
San Francisco—Managed care professionals are increasingly utilizing comparative effectiveness research (CER) to determine the effectiveness, safety, and value of drugs. This detailed approach is particularly useful for patients with high...
San Francisco—Managed care...
05/24/2012
First Report Managed Care
Conference Insider
Place-of-Service Management for Infusible Drugs
05/24/2012
Kevin L. Carter
San Francisco—Infliximab, a monoclonal antibody against tumor necrosis factor alpha (TNFα), is used to treat autoimmune conditions such as psoriasis, Crohn’s disease, ankylosing spondylitis, psoriatic arthritis, rheumatoid arthritis, and...
San Francisco—Infliximab, a monoclonal antibody against tumor necrosis factor alpha (TNFα), is used to treat autoimmune conditions such as psoriasis, Crohn’s disease, ankylosing spondylitis, psoriatic arthritis, rheumatoid arthritis, and...
San Francisco—Infliximab, a...
05/24/2012
First Report Managed Care
Reducing Fraud, Waste, and Abuse in Small Health Insurance Plans
05/24/2012
Mary Beth Nierengarten
San Francisco—Efforts to reduce fraud, waste, and abuse (FWA) in the US healthcare system are getting a boost from the federal government under the Patient Protection and Affordable Care Act that is allotting $350 million over the next 10...
San Francisco—Efforts to reduce fraud, waste, and abuse (FWA) in the US healthcare system are getting a boost from the federal government under the Patient Protection and Affordable Care Act that is allotting $350 million over the next 10...
San Francisco—Efforts to reduce...
05/24/2012
First Report Managed Care
Trends in Specialty Pharmacy Management
05/24/2012
Tori Socha
San Francisco—Building on the knowledge base from earlier editions, the eighth annual edition of the EMD Serono Specialty Digest™ has been released.
San Francisco—Building on the knowledge base from earlier editions, the eighth annual edition of the EMD Serono Specialty Digest™ has been released.
San Francisco—Building on the...
05/24/2012
First Report Managed Care
Antiretroviral Drugs Help HIV-infected Patients to Maintain Work Productivity
05/24/2012
Mary Beth Nierengarten
San Francisco—Employees with human immunodeficiency virus (HIV) incur considerably higher healthcare costs than non-HIV employees, but absenteeism costs do not drive the cost difference. Among the antiretroviral (ARV) drugs used to treat HIV,...
San Francisco—Employees with human immunodeficiency virus (HIV) incur considerably higher healthcare costs than non-HIV employees, but absenteeism costs do not drive the cost difference. Among the antiretroviral (ARV) drugs used to treat HIV,...
San Francisco—Employees with...
05/24/2012
First Report Managed Care
High-Cost Patients with Diabetes Incur Higher Annual Healthcare Costs
05/24/2012
Mary Beth Nierengarten
San Francisco—Results of a new study show that patients with type 2 diabetes, who are considered high cost, accrue more than $50,000 on average in total healthcare costs each year compared to patients with type 2 diabetes who are considered...
San Francisco—Results of a new study show that patients with type 2 diabetes, who are considered high cost, accrue more than $50,000 on average in total healthcare costs each year compared to patients with type 2 diabetes who are considered...
San Francisco—Results of a new...
05/24/2012
First Report Managed Care
Fixed Dose Combination Therapy and Best Adherence in Patients with Hypertension
05/24/2012
Tim Casey
San Francisco—An analysis of medical and pharmacy claims from a health plan found that patients with hypertension who took fixed dose combinations had better adherence rates compared with patients who took loose dose combination therapy. The...
San Francisco—An analysis of medical and pharmacy claims from a health plan found that patients with hypertension who took fixed dose combinations had better adherence rates compared with patients who took loose dose combination therapy. The...
San Francisco—An analysis of...
05/24/2012
First Report Managed Care
Options to Treat Gout and Increase Medication Adherence
05/24/2012
Tim Casey
San Francisco—According to an article in Arthritis & Rheumatism [2008;58(1):26-35], as many as 3 million people in the United States self-reported having gout in 2008. Another study, published online in Arthritis & Rheumatism on July 28,...
San Francisco—According to an article in Arthritis & Rheumatism [2008;58(1):26-35], as many as 3 million people in the United States self-reported having gout in 2008. Another study, published online in Arthritis & Rheumatism on July 28,...
San Francisco—According to an...
05/24/2012
First Report Managed Care
Update on Medicare Part D Star Ratings
05/24/2012
Tim Casey
San Francisco—In 2012, Medicare Advantage plans will receive bonus payments based on the quality of care they deliver. As part of the Patient Protection and Affordable Care Act, the Centers for Medicare & Medicaid Services implemented a...
San Francisco—In 2012, Medicare Advantage plans will receive bonus payments based on the quality of care they deliver. As part of the Patient Protection and Affordable Care Act, the Centers for Medicare & Medicaid Services implemented a...
San Francisco—In 2012, Medicare...
05/24/2012
First Report Managed Care
Conference Insider
Atypical Antipsychotics in Adolescents with ADHD
05/24/2012
Kristina Woodworth
San Francisco – A pharmacoeconomic analysis presented in a poster session during the AMCP meeting concluded that atypical antipsychotics (AAPs) used as a switch from, or augmentation of, stimulant therapy for attention-deficit/hyperactivity...
San Francisco – A pharmacoeconomic analysis presented in a poster session during the AMCP meeting concluded that atypical antipsychotics (AAPs) used as a switch from, or augmentation of, stimulant therapy for attention-deficit/hyperactivity...
San Francisco – A...
05/24/2012
First Report Managed Care
Low Adherence and Persistence for Migraine Prophylactics
05/24/2012
Jill Sederstorm
San Francisco—A literature review of studies examining adherence habits for migraine patients taking prophylactic medications found that there was low adherence and persistence for those taking propranolol, amitriptyline, and topiramate. The...
San Francisco—A literature review of studies examining adherence habits for migraine patients taking prophylactic medications found that there was low adherence and persistence for those taking propranolol, amitriptyline, and topiramate. The...
San Francisco—A literature...
05/24/2012
First Report Managed Care
News
Multiple Sclerosis and Managed Care Pharmacy
05/24/2012
Tim Casey
San Francisco—With the costs associated with multiple sclerosis (MS) rising, health plans are having a difficult time managing the disease. Many plans are placing more of the financial burden on patients, which has led to decreased medication...
San Francisco—With the costs associated with multiple sclerosis (MS) rising, health plans are having a difficult time managing the disease. Many plans are placing more of the financial burden on patients, which has led to decreased medication...
San Francisco—With the costs...
05/24/2012
First Report Managed Care
Provider and Pharmacist Outreach Helps Decrease Opioid Use
05/24/2012
Eileen Koutnik-Fotopoulos
San Francisco—The World Health Organization estimates that by 2020 mental and substance use disorders will surpass all physical diseases as a major cause of disability worldwide. The Office of National Drug Control Policy’s Monitoring the...
San Francisco—The World Health Organization estimates that by 2020 mental and substance use disorders will surpass all physical diseases as a major cause of disability worldwide. The Office of National Drug Control Policy’s Monitoring the...
San Francisco—The World Health...
05/24/2012
First Report Managed Care
Symposium Discusses Emerging Type 2 Diabetes Treatment Strategies
05/24/2012
Eileen Koutnik-Fotopoulos
Proper glycemic control is crucial in the management of type 2 diabetes to prevent long-term complications and reduce overall healthcare expenditures.
Proper glycemic control is crucial in the management of type 2 diabetes to prevent long-term complications and reduce overall healthcare expenditures.
Proper glycemic control is...
05/24/2012
First Report Managed Care
News
New Onset Depression in Newly Diagnosed MS Patients
05/24/2012
Kevin L. Carter
San Francisco—Patients with multiple sclerosis (MS) are more likely to become depressed than healthy controls and patients with other chronic medical conditions. There are few data regarding the time to onset of depression in newly diagnosed...
San Francisco—Patients with multiple sclerosis (MS) are more likely to become depressed than healthy controls and patients with other chronic medical conditions. There are few data regarding the time to onset of depression in newly diagnosed...
San Francisco—Patients with...
05/24/2012
First Report Managed Care
Conference Insider
An Update on the Federal and State Legislative Picture
05/24/2012
Kevin L. Carter
San Francisco—“Of the many pieces of legislation and regulation being considered in Washington and on the state level, the Patient Protection and Affordable Care Act (ACA) is the most important,” said Thomas R. Bizzaro, RPh, vice president,...
San Francisco—“Of the many pieces of legislation and regulation being considered in Washington and on the state level, the Patient Protection and Affordable Care Act (ACA) is the most important,” said Thomas R. Bizzaro, RPh, vice president,...
San Francisco—“Of the many...
05/24/2012
First Report Managed Care
Using MTM to Improve Medicare Part D Star Ratings
05/24/2012
Mary Beth Nierengarten
San Francisco—Medication therapy management (MTM) services have evolved over the years from their early adoption by self-insured employees and other innovators to mandated use by Medicare Part D plans. Created to facilitate positive...
San Francisco—Medication therapy management (MTM) services have evolved over the years from their early adoption by self-insured employees and other innovators to mandated use by Medicare Part D plans. Created to facilitate positive...
San Francisco—Medication therapy...
05/24/2012
First Report Managed Care
PQA Model Demonstrates Improved Medication Adherence
05/24/2012
Eileen Koutnik-Fotopoulos
San Francisco—Pharmacy Quality Alliance (PQA)’s phase 2 demonstration project, known as the Pennsylvania Collaborative, uses a model that improves patient population health by transforming pharmacy practice. Preliminary results suggest that...
San Francisco—Pharmacy Quality Alliance (PQA)’s phase 2 demonstration project, known as the Pennsylvania Collaborative, uses a model that improves patient population health by transforming pharmacy practice. Preliminary results suggest that...
San Francisco—Pharmacy Quality...
05/24/2012
First Report Managed Care
CMS Ups Expectations for Delivery of MTM and CMRs
05/24/2012
Eileen Koutnik-Fotopoulos
Initiated in 2003 by the CMS, MTM has become an integral component of effective healthcare administration for Medicare Part D eligible beneficiaries.
Initiated in 2003 by the CMS, MTM has become an integral component of effective healthcare administration for Medicare Part D eligible beneficiaries.
Initiated in 2003 by the CMS,...
05/24/2012
First Report Managed Care
Industry Representatives Discuss Challenges Posed by Specialty Pharmacy
05/24/2012
Kristina Woodworth
San Francisco—In a Managed Care Essentials session titled Specialty Pharmacy Challenges at the AMCP meeting, industry representatives led a discussion of current issues faced by the specialty pharmacy market.
San Francisco—In a Managed Care Essentials session titled Specialty Pharmacy Challenges at the AMCP meeting, industry representatives led a discussion of current issues faced by the specialty pharmacy market.
San Francisco—In a Managed Care...
05/24/2012
First Report Managed Care
National Drug Shortages Are Increasing
05/24/2012
Jill Sederstorm
San Francisco—National drug shortages are on the rise and can have costly implications for the healthcare system, but possible legislation could help address the problem, according to a presentation at the AMCP annual meeting.
San Francisco—National drug shortages are on the rise and can have costly implications for the healthcare system, but possible legislation could help address the problem, according to a presentation at the AMCP annual meeting.
San Francisco—National drug...
05/24/2012
First Report Managed Care
Clinical Pathways to Treat Oncology
05/24/2012
Tim Casey
San Francisco—As costs associated with oncology increase and more expensive drugs are approved, managed care companies are having a difficult time managing care for patients with cancer. One way to deal with the issue is to create clinical...
San Francisco—As costs associated with oncology increase and more expensive drugs are approved, managed care companies are having a difficult time managing care for patients with cancer. One way to deal with the issue is to create clinical...
San Francisco—As costs...
05/24/2012
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

Feature Story
A Better Way to Pay for Primary Care
05/31/2024
Mary Beth Nierengarten
A push for a hybrid payment model for primary care is gaining momentum, with advocates urging the CMS to implement changes to increase funding and improve outcomes for patients.
A push for a hybrid payment model for primary care is gaining momentum, with advocates urging the CMS to implement changes to increase funding and improve outcomes for patients.
A push for a hybrid payment...
05/31/2024
First Report Managed Care
Conference Coverage
Mepolizumab Treatment May Reduce Health Care Resource Utilization and OCS in Patients With CRSwNP
04/10/2024
Hannah Musick
Research that will be presented at AMCP 2024 suggests that mepolizumab treatment reduces health care costs and resource utilization in patients with chronic rhinosinusitis with nasal polyps.
Research that will be presented at AMCP 2024 suggests that mepolizumab treatment reduces health care costs and resource utilization in patients with chronic rhinosinusitis with nasal polyps.
Research that will be presented...
04/10/2024
First Report Managed Care
News
Keratoconus Appears to be Associated With Demodex Mites
05/16/2024
Jolynn Tumolo
Keratoconus, an eye disorder that leads to gradual curvature of the cornea, may be associated with Demodex infestation, suggests a small study published in the Oman Journal of Ophthalmology.
Keratoconus, an eye disorder that leads to gradual curvature of the cornea, may be associated with Demodex infestation, suggests a small study published in the Oman Journal of Ophthalmology.
Keratoconus, an eye disorder...
05/16/2024
First Report Managed Care
Alison Lum Headshot
Interview
Transforming Pharmacy Care and Drug Payment Models: Expert Insights From Asembia 2024
06/06/2024
Alison Lum, PharmD
In this interview, Alison Lum, PharmD, vice president of Pharmacy Services at Blue Shield, discussed the panel she moderated at Asembia 2024 and delved into drug payment options' challenges, including the limitations of copay cards and the...
In this interview, Alison Lum, PharmD, vice president of Pharmacy Services at Blue Shield, discussed the panel she moderated at Asembia 2024 and delved into drug payment options' challenges, including the limitations of copay cards and the...
In this interview, Alison Lum,...
06/06/2024
First Report Managed Care
Ashley Joseph
Conference Coverage
The Impact of AI on Infusion Patient Care and Operational Efficiency
07/22/2024
Ashley Joseph
NICA 2024 session speaker Ashley Joseph of LeanTaas shares insights on how AI technologies are revolutionizing infusion therapy operations, improving care coordination, and ultimately enhancing the patient experience in these critical care...
NICA 2024 session speaker Ashley Joseph of LeanTaas shares insights on how AI technologies are revolutionizing infusion therapy operations, improving care coordination, and ultimately enhancing the patient experience in these critical care...
NICA 2024 session speaker Ashley...
07/22/2024
First Report Managed Care

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