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May 2014 - FRMC

Healthcare Costs Associated with Diagnosed Opioid Abuse
05/21/2014
Kerri Fitzgerald
Tampa—The National Survey on Drug Use and Health estimated that 2.1 million Americans ≥12 years of age had prescription pain reliever abuse or dependence in 2012. Prescription opioid abuse leads to significant economic and healthcare costs,...
Tampa—The National Survey on Drug Use and Health estimated that 2.1 million Americans ≥12 years of age had prescription pain reliever abuse or dependence in 2012. Prescription opioid abuse leads to significant economic and healthcare costs,...
Tampa—The National Survey on...
05/21/2014
First Report Managed Care
Comparison of Diabetes Treatment with DPP-4 Inhibitor or Sulfonylurea
05/21/2014
Kerri Fitzgerald
Tampa—Diabetes is associated with a sizeable national economic burden. In 2012 dollars, the burden of diagnosed cases in the United States was estimated at $245 billion. Patients with type 2 diabetes mellitus (T2DM)—accounting for 90% to 95%...
Tampa—Diabetes is associated with a sizeable national economic burden. In 2012 dollars, the burden of diagnosed cases in the United States was estimated at $245 billion. Patients with type 2 diabetes mellitus (T2DM)—accounting for 90% to 95%...
Tampa—Diabetes is associated...
05/21/2014
First Report Managed Care
Importance of Adherence and Quality Measures for RA
05/21/2014
Tim Casey
Tampa—With the recent FDA approvals of new drugs to treat rheumatoid arthritis (RA) and updated guidelines, healthcare professionals have more information than ever about the disease. Still, speakers at a satellite symposium at the AMCP...
Tampa—With the recent FDA approvals of new drugs to treat rheumatoid arthritis (RA) and updated guidelines, healthcare professionals have more information than ever about the disease. Still, speakers at a satellite symposium at the AMCP...
Tampa—With the recent FDA...
05/21/2014
First Report Managed Care
News
Assessing New Treatment Options for MS
05/21/2014
Tim Casey
Since 2010, the FDA has approved 3 oral drugs—fingolimod, teriflunomide, and dimethyl fumarate—to treat patients with multiple sclerosis (MS).
Since 2010, the FDA has approved 3 oral drugs—fingolimod, teriflunomide, and dimethyl fumarate—to treat patients with multiple sclerosis (MS).
Since 2010, the FDA has approved...
05/21/2014
First Report Managed Care
Payer Knowledge on Oncology Biomarkers
05/21/2014
Kerri Fitzgerald
Tampa—Biomarkers have become an important part of individualized care and targeted therapies. Specifically for oncology, more targeted therapies are receiving FDA approval, with a focus on finding oncology biomarkers that will predict risk,...
Tampa—Biomarkers have become an important part of individualized care and targeted therapies. Specifically for oncology, more targeted therapies are receiving FDA approval, with a focus on finding oncology biomarkers that will predict risk,...
Tampa—Biomarkers have become an...
05/21/2014
First Report Managed Care
Response to Initial Biologic Therapy in IBD
05/21/2014
Melissa D. Cooper
Tampa—Biologics are regularly used to treat different forms of inflammatory bowel disease (IBD). The most common types of IBD are Crohn’s disease and ulcerative colitis. However, biologic therapies used for IBD cost an estimated $15,000 to...
Tampa—Biologics are regularly used to treat different forms of inflammatory bowel disease (IBD). The most common types of IBD are Crohn’s disease and ulcerative colitis. However, biologic therapies used for IBD cost an estimated $15,000 to...
Tampa—Biologics are regularly...
05/21/2014
First Report Managed Care
A Robust Specialty Pipeline for Chronic and Orphan Diseases
05/21/2014
Kerri Fitzgerald
Tampa—The specialty pharmacy market is going to see increased competition and a number of orphan drug and breakthrough therapy approvals in the near future, according to Aimee Tharaldson, PharmD, senior clinic consultant, emerging...
Tampa—The specialty pharmacy market is going to see increased competition and a number of orphan drug and breakthrough therapy approvals in the near future, according to Aimee Tharaldson, PharmD, senior clinic consultant, emerging...
Tampa—The specialty pharmacy...
05/21/2014
First Report Managed Care
News Connection
Outcomes Data for Reimbursement
05/21/2014
Tim Casey
Tampa—Despite the difficulties pharmaceutical manufacturers face in getting drugs approved, the FDA does not require them to submit outcomes data. During a session at the AMCP meeting, 2 speakers mentioned that information could be helpful in...
Tampa—Despite the difficulties pharmaceutical manufacturers face in getting drugs approved, the FDA does not require them to submit outcomes data. During a session at the AMCP meeting, 2 speakers mentioned that information could be helpful in...
Tampa—Despite the difficulties...
05/21/2014
First Report Managed Care
Rapid Learning Systems for Streamlined Care
05/21/2014
Melissa D. Cooper
Tampa—To decrease costs and increase quality of care, the way healthcare providers exchange information and make treatment decisions, must be integrated and provide recommendations. According to Dr. Edward Li, PharmD, BCOP, associate...
Tampa—To decrease costs and increase quality of care, the way healthcare providers exchange information and make treatment decisions, must be integrated and provide recommendations. According to Dr. Edward Li, PharmD, BCOP, associate...
Tampa—To decrease costs and...
05/21/2014
First Report Managed Care
Conference Insider
The Challenges of Migrating the Previously Uninsured into New Insurance Venues
05/21/2014
Mary Mihalovic
Tampa—Managing the movement of the estimated 47 million to 50 million uninsured Americans into new insurance venues was the topic of a roundtable discussion led by Joe deSimone, research director, Health Strategies Group, during a session at...
Tampa—Managing the movement of the estimated 47 million to 50 million uninsured Americans into new insurance venues was the topic of a roundtable discussion led by Joe deSimone, research director, Health Strategies Group, during a session at...
Tampa—Managing the movement of...
05/21/2014
First Report Managed Care
Managed Care Implications for Biosimilars
05/21/2014
Kerri Fitzgerald
While the demand for biologic agents continues to increase, biosimilars are gaining momentum as follow-on reproductions of biologics.
While the demand for biologic agents continues to increase, biosimilars are gaining momentum as follow-on reproductions of biologics.
While the demand for biologic...
05/21/2014
First Report Managed Care
Star Ratings: Strategies for Improving High-Risk Medication Adherence
05/21/2014
Mary Beth Nierengarten
Tampa—The Centers for Medicare & Medicaid Services’ (CMS) 5-Star Quality Rating System provides beneficiaries with information on the quality of Medicare Advantage and prescription drug plans to help select an appropriate plan. Under this...
Tampa—The Centers for Medicare & Medicaid Services’ (CMS) 5-Star Quality Rating System provides beneficiaries with information on the quality of Medicare Advantage and prescription drug plans to help select an appropriate plan. Under this...
Tampa—The Centers for Medicare &...
05/21/2014
First Report Managed Care
Cost Saving Opportunities for Specialty Medications
05/21/2014
Jill Sederstorm
Tampa—Specialty drug spending continues to rise in the United States, but more active management of the specialty drug spending that occurs under the medical benefit could create significant healthcare savings opportunities. Brenda Motheral,...
Tampa—Specialty drug spending continues to rise in the United States, but more active management of the specialty drug spending that occurs under the medical benefit could create significant healthcare savings opportunities. Brenda Motheral,...
Tampa—Specialty drug spending...
05/21/2014
First Report Managed Care
The Shifting Landscape of Obesity Treatment Models
05/21/2014
Kerri Fitzgerald
Tampa—Despite national guidelines and practice tools, only one-third of obese patients report receiving an obesity diagnosis or weight-related counseling. A panel of speakers discussed the treatment therapies for obesity and the burden of...
Tampa—Despite national guidelines and practice tools, only one-third of obese patients report receiving an obesity diagnosis or weight-related counseling. A panel of speakers discussed the treatment therapies for obesity and the burden of...
Tampa—Despite national...
05/21/2014
First Report Managed Care
CMS Initiatives to Fight Medicare Fraud
05/21/2014
Tim Casey
Tampa—For several years, the Centers for Medicare & Medicaid Services (CMS) has implemented numerous antifraud programs. They are intended to identify the pharmacies, patients, prescribers, health plans, manufacturers, pharmacy benefit...
Tampa—For several years, the Centers for Medicare & Medicaid Services (CMS) has implemented numerous antifraud programs. They are intended to identify the pharmacies, patients, prescribers, health plans, manufacturers, pharmacy benefit...
Tampa—For several years, the...
05/21/2014
First Report Managed Care
CER Has Implications for Stakeholders
05/21/2014
Eileen Koutnik-Fotopoulos
The growing availability of new research methods poses challenges and opportunities for today’s formulary decision-makers.
The growing availability of new research methods poses challenges and opportunities for today’s formulary decision-makers.
The growing availability of new...
05/21/2014
First Report Managed Care
Roflumilast Associated with COPD Cost and Healthcare Utilization
05/21/2014
Melissa D. Cooper
Tampa—Exacerbation is the leading cause of hospitalization and death in patients with chronic obstructive pulmonary disease (COPD). In 2010, COPD-related annual total cost was estimated at $49.9 billion. Approximately $29.5 billion of the...
Tampa—Exacerbation is the leading cause of hospitalization and death in patients with chronic obstructive pulmonary disease (COPD). In 2010, COPD-related annual total cost was estimated at $49.9 billion. Approximately $29.5 billion of the...
Tampa—Exacerbation is the...
05/21/2014
First Report Managed Care
HIV Treatment Optimization
05/21/2014
Melissa D. Cooper
Tampa—Medicaid is the largest payer of HIV care in the United States, covering about 4 in 10 patients with HIV. According to estimates, Medicaid spends $5.3 billion on HIV prevention and treatment, with prescription drugs as the largest...
Tampa—Medicaid is the largest payer of HIV care in the United States, covering about 4 in 10 patients with HIV. According to estimates, Medicaid spends $5.3 billion on HIV prevention and treatment, with prescription drugs as the largest...
Tampa—Medicaid is the largest...
05/21/2014
First Report Managed Care
Evaluating the Benefits and Costs of Multiple Myeloma Treatment Options
05/20/2014
Tim Casey
Tampa—Although there is no cure for multiple myeloma (MM), the approval of several drugs in recent years has led to improvements in survival rates and quality of life for patients with the disease. People with MM live an average of at least 8...
Tampa—Although there is no cure for multiple myeloma (MM), the approval of several drugs in recent years has led to improvements in survival rates and quality of life for patients with the disease. People with MM live an average of at least 8...
Tampa—Although there is no cure...
05/20/2014
First Report Managed Care
Conference Insider
Specialty Pharmacy and the ACO Model
05/20/2014
Kerri Fitzgerald
Because of the expanding coverage in both Medicaid and the health insurance exchanges, payment and delivery reforms, including ACOs, are rendered necessary.
Because of the expanding coverage in both Medicaid and the health insurance exchanges, payment and delivery reforms, including ACOs, are rendered necessary.
Because of the expanding...
05/20/2014
First Report Managed Care
Results of the EMD Serono Specialty Digest™, 10th Edition
05/20/2014
Tim Casey
With spending on specialty pharmaceuticals increasing, payers are implementing several initiatives to manage this category.
With spending on specialty pharmaceuticals increasing, payers are implementing several initiatives to manage this category.
With spending on specialty...
05/20/2014
First Report Managed Care
Medical Benefit Management and Integration with the Pharmacy Benefit
05/20/2014
Tim Casey
Tampa—According to data from Medical Mutual, a health insurance company with headquarters in Ohio, more than 15% of cancer diagnoses are incorrect. Furthermore, 45% of patients with cancer do not comply with or complete their prescribed...
Tampa—According to data from Medical Mutual, a health insurance company with headquarters in Ohio, more than 15% of cancer diagnoses are incorrect. Furthermore, 45% of patients with cancer do not comply with or complete their prescribed...
Tampa—According to data from...
05/20/2014
First Report Managed Care
Prescriber Intervention Program Helps Identify Opioid Abuse
05/20/2014
Eileen Koutnik-Fotopoulos
Analysis conducted by investigators at the CDC found that 75.2% of pharmaceutical deaths involved opioids.
Analysis conducted by investigators at the CDC found that 75.2% of pharmaceutical deaths involved opioids.
Analysis conducted by...
05/20/2014
First Report Managed Care
Conference Insider
Former FDA Deputy Commissioner Scott Gottlieb Discusses the ACA
05/20/2014
Tim Casey
Tampa—For 2015 and 2016, former FDA deputy commissioner Scott Gottlieb, MD, expects the enrollment numbers in the state and federal government insurance exchanges to remain around 8 million. When the results of the 2016 presidential election...
Tampa—For 2015 and 2016, former FDA deputy commissioner Scott Gottlieb, MD, expects the enrollment numbers in the state and federal government insurance exchanges to remain around 8 million. When the results of the 2016 presidential election...
Tampa—For 2015 and 2016, former...
05/20/2014
First Report Managed Care
Pfizer, AMCP Foundation Collaborate on Emerging Trends Assessment
05/20/2014
Tim Casey
Tampa—During the drug development process, Pfizer, Inc., follows the FDA’s guidance and conducts trials testing the safety and efficacy of medications. The company also communicates with health plans and other payers to ensure the products...
Tampa—During the drug development process, Pfizer, Inc., follows the FDA’s guidance and conducts trials testing the safety and efficacy of medications. The company also communicates with health plans and other payers to ensure the products...
Tampa—During the drug...
05/20/2014
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

May 2014 Volume 11 Issue 5

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