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May 2015 - FRMC

CMRs May Reduce Hospitalizations and Pharmacy Costs
06/10/2015
Eileen Koutnik-Fotopoulos
Data has shown that medication therapy management (MTM) can improve patient outcomes. MTMs can be deployed by several av- enues including internal teams at health plans, retail pharmacy, and third-party MTM companies.
Data has shown that medication therapy management (MTM) can improve patient outcomes. MTMs can be deployed by several av- enues including internal teams at health plans, retail pharmacy, and third-party MTM companies.
Data has shown that medication...
06/10/2015
First Report Managed Care
New Versus Old Injectable Antipsychotics for Schizophrenia
06/10/2015
Eileen Koutnik-Fotopoulos
Long-acting injectable (LAI) antipsychotics are highly effective in the management of schizophrenia and associated with a number of potential advantages over oral antipsychotics. First-generation LAIs (LA1s) have been available for more than...
Long-acting injectable (LAI) antipsychotics are highly effective in the management of schizophrenia and associated with a number of potential advantages over oral antipsychotics. First-generation LAIs (LA1s) have been available for more than...
Long-acting injectable (LAI)...
06/10/2015
First Report Managed Care
Conference Insider
Clinical Prior Authorization Edit Curbs Costs for ADD/ADHD Population in Fee-For-Service Arrangements
06/10/2015
Jill Sederstorm
A new study examining the impact of a recently implemented clinical prior authorization edit for attention deficit disorder (ADD) and attention deficit/hyperactivity disorder (ADHD) found that the edit costs increased at a significantly lower...
A new study examining the impact of a recently implemented clinical prior authorization edit for attention deficit disorder (ADD) and attention deficit/hyperactivity disorder (ADHD) found that the edit costs increased at a significantly lower...
A new study examining the impact...
06/10/2015
First Report Managed Care
Cost-Effectiveness of 6 Therapies for RRMS
06/10/2015
Eileen Koutnik-Fotopoulos
Multiple sclerosis is an unpredictable, disabling disease with no known cure. Several disease-modifying treatments exist to reduce disease activity and progression.
Multiple sclerosis is an unpredictable, disabling disease with no known cure. Several disease-modifying treatments exist to reduce disease activity and progression.
Multiple sclerosis is an...
06/10/2015
First Report Managed Care
Study Finds Injectable versus Infusion Biologics Less Costly
06/10/2015
Jill Sederstorm
Autoimmune disorder patients taking injectable biologics had lower average monthly drug costs compared to patients taking infusion biologics, according to the results of a new study.
Autoimmune disorder patients taking injectable biologics had lower average monthly drug costs compared to patients taking infusion biologics, according to the results of a new study.
Autoimmune disorder patients...
06/10/2015
First Report Managed Care
Potential New Cystic Fibrosis Treatment Could Raise Costs
06/10/2015
Jill Sederstorm
New drugs on the horizon for cystic fibrosis (CF) could result in better patient outcomes, but will likely come at a higher cost, according to a poster session at AMCP titled Cystic Fibrosis Prevalence and Total Cost of Care in a Commercially...
New drugs on the horizon for cystic fibrosis (CF) could result in better patient outcomes, but will likely come at a higher cost, according to a poster session at AMCP titled Cystic Fibrosis Prevalence and Total Cost of Care in a Commercially...
New drugs on the horizon for...
06/10/2015
First Report Managed Care
News
Managing Heart Failure
06/10/2015
Eileen Koutnik-Fotopoulos
Heart failure (HF) is the leading cause of rehospitalization in both men and women on Medicare and the underlying cause of >58,000 US deaths in 2011, according to the Centers for Disease Control and Prevention.
Heart failure (HF) is the leading cause of rehospitalization in both men and women on Medicare and the underlying cause of >58,000 US deaths in 2011, according to the Centers for Disease Control and Prevention.
Heart failure (HF) is the...
06/10/2015
First Report Managed Care
Conference Insider
Treating Patients with Relapsing MS
06/10/2015
Melissa D. Cooper
Multiple sclerosis (MS) is an autoimmune disease in which the immune system attacks the protective layer around nerves. During a science and innovation theater at AMCP, Lilly Jung Henson, MD, MMM, FAAN, director of the neurology clinic, Swed-...
Multiple sclerosis (MS) is an autoimmune disease in which the immune system attacks the protective layer around nerves. During a science and innovation theater at AMCP, Lilly Jung Henson, MD, MMM, FAAN, director of the neurology clinic, Swed-...
Multiple sclerosis (MS) is an...
06/10/2015
First Report Managed Care
Conference Insider
Obstacles in the Pursuit of Optimal Hyperkalemia Management
06/10/2015
Melissa D. Cooper
Hyperkalemia is a condition in which potassium levels in the blood are elevated due to decreased kidney function. This condition is extremely common among Medicare-aged patients with chronic kidney disease (CKD) and heart failure (HF).
Hyperkalemia is a condition in which potassium levels in the blood are elevated due to decreased kidney function. This condition is extremely common among Medicare-aged patients with chronic kidney disease (CKD) and heart failure (HF).
Hyperkalemia is a condition in...
06/10/2015
First Report Managed Care
Conference Insider
Targeting Very High Triglycerides in At-Risk Patients
06/10/2015
Eileen Koutnik-Fotopoulos
Hypertriglyceridemia is elevated triglyceride concentration in the blood caused by genetics, obesity, medications, and acute alcohol use with fatty liver disease.
Hypertriglyceridemia is elevated triglyceride concentration in the blood caused by genetics, obesity, medications, and acute alcohol use with fatty liver disease.
Hypertriglyceridemia is elevated...
06/10/2015
First Report Managed Care
Conference Insider
Strategies for Hepatitis C in Managed Care
06/10/2015
Eileen Koutnik-Fotopoulos
With the availability and future approval of novel agents for the treatment of hepatitis C virus (HCV), managed care organization (MCO) de- cision makers must consider many factors as they develop drug management strategies and tactics,...
With the availability and future approval of novel agents for the treatment of hepatitis C virus (HCV), managed care organization (MCO) de- cision makers must consider many factors as they develop drug management strategies and tactics,...
With the availability and future...
06/10/2015
First Report Managed Care
News
Examining Psoriasis and PsA Treatment Landscape
06/10/2015
Eileen Koutnik-Fotopoulos
Managed care organizations and payer organizations need to appropriately and effectively design benefits that optimize both cost efficiency and outcomes.
Managed care organizations and payer organizations need to appropriately and effectively design benefits that optimize both cost efficiency and outcomes.
Managed care organizations and...
06/10/2015
First Report Managed Care
Choosing Therapy for Type 2 Diabetes Based on Patient-Related Variables
06/10/2015
Mary Beth Nierengarten
With the expanding availability of multiple drugs to treat patients with type 2 diabetes, treatment can now be better tailored to the needs of each patient.
With the expanding availability of multiple drugs to treat patients with type 2 diabetes, treatment can now be better tailored to the needs of each patient.
With the expanding availability...
06/10/2015
First Report Managed Care
News
High Cost of Heart Failure for the Medicare Population
06/10/2015
Mary Beth Nierengarten
he high prevalence of heart failure (HF), particularly among Medicare beneficiaries, places a heavy burden on the US healthcare system in terms of morbidity, mortality, and cost.
he high prevalence of heart failure (HF), particularly among Medicare beneficiaries, places a heavy burden on the US healthcare system in terms of morbidity, mortality, and cost.
he high prevalence of heart...
06/10/2015
First Report Managed Care
Conference Insider
Optimizing Clinical and Cost Outcomes for Managing Rheumatoid Arthritis
06/10/2015
Mary Beth Nierengarten
Spending on specialty drugs is growing rapidly in the United States, with an increasing amount of spend shifting to the pharmacy benefit.
Spending on specialty drugs is growing rapidly in the United States, with an increasing amount of spend shifting to the pharmacy benefit.
Spending on specialty drugs is...
06/10/2015
First Report Managed Care
Need for Better Management of Gout
06/10/2015
Mary Beth Nierengarten
Gout is the most common inflammatory arthritis in the United States, affecting at least 8 million people. Over the past 20 years, there has been a marked increase in prevalence and complexity of, as well as increasing incidence of,...
Gout is the most common inflammatory arthritis in the United States, affecting at least 8 million people. Over the past 20 years, there has been a marked increase in prevalence and complexity of, as well as increasing incidence of,...
Gout is the most common...
06/10/2015
First Report Managed Care
News
Treatment Option for Moderate-to-Severe Plaque Psoriasis
06/10/2015
Melissa D. Cooper
Approximately 2.2% of the US population has psoriasis, making it the most common autoimmune disease in the United States. This disease greatly impacts quality of life, especially the lives of those diagnosed with moderate-to- severe...
Approximately 2.2% of the US population has psoriasis, making it the most common autoimmune disease in the United States. This disease greatly impacts quality of life, especially the lives of those diagnosed with moderate-to- severe...
Approximately 2.2% of the US...
06/10/2015
First Report Managed Care
Conference Insider
Polycythemia Vera: Burden of Illness
06/10/2015
Eileen Koutnik-Fotopoulos
Polycythemia vera (PV) is a bone marrow disorder in which the body produces an excessive amount of red blood cells. It is a chronic, progressive myeloproliferative neoplasm that affects approximately 100,000 people in the United States.
Polycythemia vera (PV) is a bone marrow disorder in which the body produces an excessive amount of red blood cells. It is a chronic, progressive myeloproliferative neoplasm that affects approximately 100,000 people in the United States.
Polycythemia vera (PV) is a bone...
06/10/2015
First Report Managed Care
Conference Insider
Idiopathic Pulmonary Fibrosis Treatment Option
06/10/2015
Melissa D. Cooper
Idiopathic pulmonary fibrosis (IPF) is an interstitial lung disease in which the tissue in the lungs hardens causing a progressive decline in lung function. IPF typically occurs in Caucasian males ≥50 years of age who have a history of...
Idiopathic pulmonary fibrosis (IPF) is an interstitial lung disease in which the tissue in the lungs hardens causing a progressive decline in lung function. IPF typically occurs in Caucasian males ≥50 years of age who have a history of...
Idiopathic pulmonary fibrosis...
06/10/2015
First Report Managed Care
Dual Combination Therapy for Type 2 Diabetes
06/10/2015
Eileen Koutnik-Fotopoulos
Centers for Disease Control and Prevention data show that type 2 diabetes is a significant problem in the United States. Nearly 29 million Americans age 20 years or older have diabetes with the majority having type 2 diabetes.
Centers for Disease Control and Prevention data show that type 2 diabetes is a significant problem in the United States. Nearly 29 million Americans age 20 years or older have diabetes with the majority having type 2 diabetes.
Centers for Disease Control and...
06/10/2015
First Report Managed Care
Study Examines Economics of Vedolizumab for IBD
06/10/2015
Eileen Koutnik-Fotopoulos
Biologics for inflammatory bowel disease (IBD) can be administered as self-injection or infusion.
Biologics for inflammatory bowel disease (IBD) can be administered as self-injection or infusion.
Biologics for inflammatory bowel...
06/10/2015
First Report Managed Care
Conference Insider
Cost Savings in the Specialty Medical Benefit
06/10/2015
Melissa D. Cooper
In 2014, only 1% of US prescriptions were specialty drugs, but they represented 31.8% of drug spend. This was a 27.7% increase from 2013, and specialty drug utilization in both the medical benefit and pharmacy benefit markets is expected to...
In 2014, only 1% of US prescriptions were specialty drugs, but they represented 31.8% of drug spend. This was a 27.7% increase from 2013, and specialty drug utilization in both the medical benefit and pharmacy benefit markets is expected to...
In 2014, only 1% of US...
06/10/2015
First Report Managed Care
Impact of Biosimilars on Stakeholders
06/10/2015
Eileen Koutnik-Fotopoulos
Experts discuss biosimilars on the horizon and how the healthcare industry can prepare for biosimilar competition.
Experts discuss biosimilars on the horizon and how the healthcare industry can prepare for biosimilar competition.
Experts discuss biosimilars...
06/10/2015
First Report Managed Care
Therapies for Managing Psoriasis
06/10/2015
Eileen Koutnik-Fotopoulos
An increased understanding of psoriasis pathophysiology has led to the release of new treatment targets.
An increased understanding of psoriasis pathophysiology has led to the release of new treatment targets.
An increased understanding of...
06/10/2015
First Report Managed Care
Prevalence of Specialty Drugs Continues
06/09/2015
Jill Sederstorm
Specialty drugs continue to make up a large portion of drug development and many specialty medications could soon see generic competition as the patents on 30 specialty products expire before 2020.
Specialty drugs continue to make up a large portion of drug development and many specialty medications could soon see generic competition as the patents on 30 specialty products expire before 2020.
Specialty drugs continue to make...
06/09/2015
First Report Managed Care
Collaborative Initiatives Aim to Improve Care for Patients with Multiple Myeloma
06/09/2015
Mary Beth Nierengarten
Changes in the evolving healthcare environment are focusing on greater cooperation between providers and payers to improve quality of care while reducing cost.
Changes in the evolving healthcare environment are focusing on greater cooperation between providers and payers to improve quality of care while reducing cost.
Changes in the evolving...
06/09/2015
First Report Managed Care
Addressing Oncology Specialty Drug Management
06/09/2015
Oncology drugs rank second to cardiovascular drugs in terms of overall drug spend. Given the prevalence of varying types of cancers and the emotional and financial burdens many patients face, special attention is required when managing these...
Oncology drugs rank second to cardiovascular drugs in terms of overall drug spend. Given the prevalence of varying types of cancers and the emotional and financial burdens many patients face, special attention is required when managing these...
Oncology drugs rank second to...
06/09/2015
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
Who Will Benefit Under the Medicare Part D Out-of-Pocket Spending Cap?
02/27/2024
Dean Celia
Starting in 2024, Medicare Part D enrollees could benefit from a cap placed on out-of-pocket drug spending, thanks to a provision in the Inflation Reduction Act of 2022 (IRA).
Starting in 2024, Medicare Part D enrollees could benefit from a cap placed on out-of-pocket drug spending, thanks to a provision in the Inflation Reduction Act of 2022 (IRA).
Starting in 2024, Medicare Part...
02/27/2024
First Report Managed Care
News
The Impact of Inhibitors on Surgical Management in Patients With Hemophilia
04/04/2024
Hannah Musick
The development of inhibitors in patients with hemophilia poses challenges for achieving perioperative hemostasis and may result in complications and deviations from the surgical plan, highlighting the need for strategies to address inhibitor...
The development of inhibitors in patients with hemophilia poses challenges for achieving perioperative hemostasis and may result in complications and deviations from the surgical plan, highlighting the need for strategies to address inhibitor...
The development of inhibitors in...
04/04/2024
First Report Managed Care
Conference Coverage
Expanding Pharmacists’ Role in Providing Clinical Care: Addressing Public Health Challenges
05/02/2024
Danielle Sposato
Panelists from various backgrounds discuss the critical role of pharmacists in addressing public health challenges such as HIV/AIDS and advocating for expanded clinical care and reimbursement pathways to improve health outcomes in communities.
Panelists from various backgrounds discuss the critical role of pharmacists in addressing public health challenges such as HIV/AIDS and advocating for expanded clinical care and reimbursement pathways to improve health outcomes in communities.
Panelists from various...
05/02/2024
First Report Managed Care
Managed Care Q&A
Prioritizing Patient Voices in Drug Development and Coverage
05/27/2024
In this interview, guest experts discuss the importance of incorporating patient voices into health care decision-making, highlighting opportunities for collaboration and enhancement in drug development and patient coverage.
In this interview, guest experts discuss the importance of incorporating patient voices into health care decision-making, highlighting opportunities for collaboration and enhancement in drug development and patient coverage.
In this interview, guest experts...
05/27/2024
First Report Managed Care
Blog
The Clash Over Medicare: Key Lawsuits Challenging the IRA’s Drug Negotiation Provisions
07/11/2024
Katie Hayes, MJ
The IRA has spawned a series of lawsuits from pharmaceutical companies. Here, we provide the latest status updates on several of them.
The IRA has spawned a series of lawsuits from pharmaceutical companies. Here, we provide the latest status updates on several of them.
The IRA has spawned a series of...
07/11/2024
First Report Managed Care

May 2015 Volume 12 Issue 5

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