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November 2011 - FRMC

News Connection
Patients with Gout Treated with Febuxostat Compared with Those Treated with Allopurinol
02/09/2012
Mary Beth Nierengarten
Patients with gout treated with febuxostat have more comorbidities and higher mean baseline serum uric acid levels compared with patients treated with allopurinol.
Patients with gout treated with febuxostat have more comorbidities and higher mean baseline serum uric acid levels compared with patients treated with allopurinol.
Patients with gout treated with...
02/09/2012
First Report Managed Care
Healthcare Reform and Changes in Medicaid
11/29/2011
Trisha Lee
Medicaid is a low-income family health insurance program funded jointly by federal and state governments.
Medicaid is a low-income family health insurance program funded jointly by federal and state governments.
Medicaid is a low-income family...
11/29/2011
First Report Managed Care
Prostate Cancer Treatments Pose Challenges for Managed Care
11/29/2011
Tim Casey
Atlanta—With the introduction of several new therapies, the treatment for castration-resistant prostate cancer (CRPC) has gone through a dramatic shift in recent years. By the end of the decade, the market for prostate cancer is expected to...
Atlanta—With the introduction of several new therapies, the treatment for castration-resistant prostate cancer (CRPC) has gone through a dramatic shift in recent years. By the end of the decade, the market for prostate cancer is expected to...
Atlanta—With the introduction of...
11/29/2011
First Report Managed Care
Guideline for Pharmacy Claims Audits Could Add Consistency to the Process
11/29/2011
Jill Sederstorm
A guideline for pharmacy claims audits could help improve collaboration and minimize friction between managed care organizations and community pharmacists.
A guideline for pharmacy claims audits could help improve collaboration and minimize friction between managed care organizations and community pharmacists.
A guideline for pharmacy claims...
11/29/2011
First Report Managed Care
Specialty Medications Becoming More Popular
11/29/2011
Tim Casey
Atlanta—Although <1% of patients use specialty medications, they account for 15% of drug spending. The trend is expected to continue, as numerous expensive specialty drugs have recently been approved by the US Food and Drug Administration...
Atlanta—Although <1% of patients use specialty medications, they account for 15% of drug spending. The trend is expected to continue, as numerous expensive specialty drugs have recently been approved by the US Food and Drug Administration...
Atlanta—Although <1% of...
11/29/2011
First Report Managed Care
Pharmacy and the Medicare Star Rating System
11/29/2011
Tori Socha
Atlanta—The Star Rating System created by the Centers for Medicare & Medicaid Services was added to Medicare programs to help educate beneficiaries about quality of care and increase the transparency of quality data available to consumers....
Atlanta—The Star Rating System created by the Centers for Medicare & Medicaid Services was added to Medicare programs to help educate beneficiaries about quality of care and increase the transparency of quality data available to consumers....
Atlanta—The Star Rating System...
11/29/2011
First Report Managed Care
Pharmacy Benefit Management Supported by Employer Case Study
11/29/2011
Kristina Woodworth
Atlanta—During a Managed Care Essentials session at the AMCP meeting, Kathleen Thompson, manager of total rewards, Matthews International, and Mara Pawlis, senior analytic consultant, CVS Caremark, presented Results of a PBM/Employer...
Atlanta—During a Managed Care Essentials session at the AMCP meeting, Kathleen Thompson, manager of total rewards, Matthews International, and Mara Pawlis, senior analytic consultant, CVS Caremark, presented Results of a PBM/Employer...
Atlanta—During a Managed Care...
11/29/2011
First Report Managed Care
Performance Measures to Enhance Care and Reduce Costs
11/29/2011
Tori Socha
Atlanta—The Patient Protection and Affordable Care Act of 2010 was designed to achieve 3 goals: better health, better care, and lower costs. The National Quality Forum (NQF) has convened the National Priorities Partnership (NPP), a...
Atlanta—The Patient Protection and Affordable Care Act of 2010 was designed to achieve 3 goals: better health, better care, and lower costs. The National Quality Forum (NQF) has convened the National Priorities Partnership (NPP), a...
Atlanta—The Patient Protection...
11/29/2011
First Report Managed Care
Partnership for Patients and Transitions of Care
11/29/2011
Tori Socha
Atlanta—The Partnership for Patients, a public–private initiative to improve hospital care and transitions of care, was launched in April 2011 by Kathleen Sebelius, secretary of the US Department of Health and Human Services, and Donald...
Atlanta—The Partnership for Patients, a public–private initiative to improve hospital care and transitions of care, was launched in April 2011 by Kathleen Sebelius, secretary of the US Department of Health and Human Services, and Donald...
Atlanta—The Partnership for...
11/29/2011
First Report Managed Care
Fraud, Waste, and Abuse Impact Costs, Care, and Safety
11/29/2011
Tori Socha
Atlanta—Each year, billions of dollars are lost to Medicare fraud. In addition to the financial burden, instances of waste and abuse jeopardize both quality of care and patient safety. Raising awareness of the problem is as important a tool...
Atlanta—Each year, billions of dollars are lost to Medicare fraud. In addition to the financial burden, instances of waste and abuse jeopardize both quality of care and patient safety. Raising awareness of the problem is as important a tool...
Atlanta—Each year, billions of...
11/29/2011
First Report Managed Care
Evaluating New Medications with Evidence-Based Value Analysis
11/29/2011
Tori Socha
Of the medications approved by the FDA, many are specialty, biologic, and oncology treatments, making it important to assess the value of emerging therapies.
Of the medications approved by the FDA, many are specialty, biologic, and oncology treatments, making it important to assess the value of emerging therapies.
Of the medications approved by...
11/29/2011
First Report Managed Care
Utilizing HEDIS Measures to Treat Major Depressive Disorder
11/29/2011
Tim Casey
Atlanta—With numerous generic drugs available, the costs of treating depression are often seen as low compared with chronic, more expensive diseases. However, according to a presentation at the AMCP meeting, depression is a common condition...
Atlanta—With numerous generic drugs available, the costs of treating depression are often seen as low compared with chronic, more expensive diseases. However, according to a presentation at the AMCP meeting, depression is a common condition...
Atlanta—With numerous generic...
11/29/2011
First Report Managed Care
Medication Adherence Crucial to Management of Chronic Disease
11/29/2011
Tori Socha
Atlanta—Positive clinical outcomes are strongly associated with patient adherence to prescribed drug regimens, particularly for the treatment of chronic diseases. According to the World Health Organization, nearly 50% of Americans do not take...
Atlanta—Positive clinical outcomes are strongly associated with patient adherence to prescribed drug regimens, particularly for the treatment of chronic diseases. According to the World Health Organization, nearly 50% of Americans do not take...
Atlanta—Positive clinical...
11/29/2011
First Report Managed Care
Social Media and Mobile Health
11/29/2011
Kevin L. Carter
Atlanta—Mobile devices are increasingly ubiquitous and should be utilized to improve connections between practitioners and patients and make the work of healthcare providers more efficient, ultimately benefiting all stakeholders.
Atlanta—Mobile devices are increasingly ubiquitous and should be utilized to improve connections between practitioners and patients and make the work of healthcare providers more efficient, ultimately benefiting all stakeholders.
Atlanta—Mobile devices are...
11/29/2011
First Report Managed Care
Role of the Pharmacist in the Patient-Centered Medical Home
11/29/2011
Tori Socha
Atlanta—In the patient-centered medical home (PCMH), patient services are provided through a consistent, coordinated relationship among the patient, the physician, and other members of the healthcare team, including the pharmacist. The PCMH...
Atlanta—In the patient-centered medical home (PCMH), patient services are provided through a consistent, coordinated relationship among the patient, the physician, and other members of the healthcare team, including the pharmacist. The PCMH...
Atlanta—In the patient-centered...
11/29/2011
First Report Managed Care
Integrating MTM Services into the Patient-Centered Medical Home
11/29/2011
Sylvia Jenkins
Atlanta—In providing medication therapy management (MTM) services, local pharmacists become a valuable resource for case management programs and patient-centered medical home (PCMH) models. Pharmacist–physician collaboration promotes...
Atlanta—In providing medication therapy management (MTM) services, local pharmacists become a valuable resource for case management programs and patient-centered medical home (PCMH) models. Pharmacist–physician collaboration promotes...
Atlanta—In providing medication...
11/29/2011
First Report Managed Care
Generics Step Therapy as a Tool to Influence Current Drug Trend
11/29/2011
Kristina Woodworth
Atlanta—In a Managed Care Essentials session at the AMCP meeting, Anita Allemand, PharmD, vice president, and Anna Theodorou, RPh, MBA, director, industry analytics, both of CVS Caremark, presented Understanding Pharmacy Trend and Its Impact...
Atlanta—In a Managed Care Essentials session at the AMCP meeting, Anita Allemand, PharmD, vice president, and Anna Theodorou, RPh, MBA, director, industry analytics, both of CVS Caremark, presented Understanding Pharmacy Trend and Its Impact...
Atlanta—In a Managed Care...
11/29/2011
First Report Managed Care
Understanding and Applying Comparative Effectiveness Research
11/29/2011
Mary Beth Nierengarten
Atlanta—Driven by the variation in medical care and the increasing cost of healthcare, the US healthcare system is undergoing a transformation in the way healthcare is accessed and delivered. Central to this transformation is the push for...
Atlanta—Driven by the variation in medical care and the increasing cost of healthcare, the US healthcare system is undergoing a transformation in the way healthcare is accessed and delivered. Central to this transformation is the push for...
Atlanta—Driven by the variation...
11/29/2011
First Report Managed Care
The Pharmaceutical Pipeline: 2011 and Beyond
11/29/2011
Tori Socha
Atlanta—The number of drugs granted US Food and Drug Administration (FDA) approval decreased markedly in 2011 compared with other years. The FDA approval rate has slowed and the number of drugs under development has decreased, leading to a...
Atlanta—The number of drugs granted US Food and Drug Administration (FDA) approval decreased markedly in 2011 compared with other years. The FDA approval rate has slowed and the number of drugs under development has decreased, leading to a...
Atlanta—The number of drugs...
11/29/2011
First Report Managed Care
Conference Insider
Trend Toward Pharmacogenomics Means Challenges Ahead for Managed Care
11/29/2011
Mary Mihalovic
Atlanta—The increasing trend toward personalized medicine means managed care must use an “adopt when appropriate” approach rather than one of “adopt everything for everyone,” according to information presented at the AMCP meeting by Laurie...
Atlanta—The increasing trend toward personalized medicine means managed care must use an “adopt when appropriate” approach rather than one of “adopt everything for everyone,” according to information presented at the AMCP meeting by Laurie...
Atlanta—The increasing trend...
11/29/2011
First Report Managed Care
Biosimilars Regulation Highlighted by FDA CDER Representative
11/29/2011
Kristina Woodworth
The biosimilars market is a growing field of competition to branded therapeutic proteins and other biologic products.
The biosimilars market is a growing field of competition to branded therapeutic proteins and other biologic products.
The biosimilars market is a...
11/29/2011
First Report Managed Care
Emerging Methods to Treat Non–Small-Cell Lung Cancer
11/29/2011
Tim Casey
Atlanta—Recent advances in treating patients with non–small-cell lung cancer (NSCLC) may lead to better results and cost-savings, according to a physician and pharmacist who spoke at the AMCP meeting. Doctors are embracing molecular profiling...
Atlanta—Recent advances in treating patients with non–small-cell lung cancer (NSCLC) may lead to better results and cost-savings, according to a physician and pharmacist who spoke at the AMCP meeting. Doctors are embracing molecular profiling...
Atlanta—Recent advances in...
11/29/2011
First Report Managed Care
Collaborative Oncology Management Programs Could Save Costs and Improve Care
11/29/2011
Jill Sederstorm
Atlanta—Innovative approaches to oncology management and collaboration with providers may be viable solutions for health plans to save costs and improve clinical outcomes for cancer patients. Three national health plans shared their...
Atlanta—Innovative approaches to oncology management and collaboration with providers may be viable solutions for health plans to save costs and improve clinical outcomes for cancer patients. Three national health plans shared their...
Atlanta—Innovative approaches to...
11/29/2011
First Report Managed Care
Prescription Volume, Spending Increasing in 2011
11/29/2011
Tim Casey
Atlanta—Total prescription volume and spending on medications both increased in 2010, but the growth rate was the second lowest in the past 10 years. Through the first 6 months of 2011, the rates were better than a year ago, thanks to cough,...
Atlanta—Total prescription volume and spending on medications both increased in 2010, but the growth rate was the second lowest in the past 10 years. Through the first 6 months of 2011, the rates were better than a year ago, thanks to cough,...
Atlanta—Total prescription...
11/29/2011
First Report Managed Care
Conference Insider
Updates on Federal and State Legislative Issues Affecting Managed Care
11/29/2011
Tim Casey
Atlanta—With federal and state governments facing financial difficulties and the adoption of the Patient Protection and Affordable Care Act (ACA), managed care professionals are facing a challenging and changing environment. They must adapt...
Atlanta—With federal and state governments facing financial difficulties and the adoption of the Patient Protection and Affordable Care Act (ACA), managed care professionals are facing a challenging and changing environment. They must adapt...
Atlanta—With federal and state...
11/29/2011
First Report Managed Care

Pipeline Projections

PIPELINE PROJECTIONS
Emerging Therapies Reshaping Atopic Dermatitis Care
03/26/2026
Roy Moore
Roy Moore outlines how a rapidly expanding atopic dermatitis pipeline is intensifying competition, reshaping payer strategies, and raising the bar for new therapies.
Roy Moore outlines how a rapidly expanding atopic dermatitis pipeline is intensifying competition, reshaping payer strategies, and raising the bar for new therapies.
Roy Moore outlines how a rapidly...
03/26/2026
First Report Managed Care
Pipe
Pipeline Projections
Emerging Migraine Treatments Challenge a Mature Market
11/20/2025
Roy Moore
Roy Moore of Clarivate’s market access team discussed the evolving migraine treatment landscape, highlighting the maturation of the acute and prophylactic markets, the emergence of new therapies such as triptan-COX-2 combinations, gepants,...
Roy Moore of Clarivate’s market access team discussed the evolving migraine treatment landscape, highlighting the maturation of the acute and prophylactic markets, the emergence of new therapies such as triptan-COX-2 combinations, gepants,...
Roy Moore of Clarivate’s market...
11/20/2025
First Report Managed Care
Pipeline Projections
Pipeline Projections
Redefining Asthma Management With Emerging Anti-Inflammatories
10/01/2025
Roy Moore
Roy Moore, a market access expert, discusses the evolving asthma drug pipeline, highlighting upcoming therapies—including Breztri, depemokimab, and masitinib—their potential to improve adherence and outcomes, payer considerations around cost...
Roy Moore, a market access expert, discusses the evolving asthma drug pipeline, highlighting upcoming therapies—including Breztri, depemokimab, and masitinib—their potential to improve adherence and outcomes, payer considerations around cost...
Roy Moore, a market access...
10/01/2025
First Report Managed Care
Pipeline Projections
The Shift in MS Care as Biologics and BTK Inhibitors Advance
07/25/2025
Roy Moore
In this edition of Pipeline Projections, Roy Moore breaks down the rapidly evolving landscape of multiple sclerosis treatments—highlighting the shift from injectables to orals, the rise of monoclonal antibodies, and the promise of innovative...
In this edition of Pipeline Projections, Roy Moore breaks down the rapidly evolving landscape of multiple sclerosis treatments—highlighting the shift from injectables to orals, the rise of monoclonal antibodies, and the promise of innovative...
In this edition of Pipeline...
07/25/2025
First Report Managed Care
Pipeline Projections
How Biosimilars Are Shaping RA Treatment and Reimbursement Strategies
04/29/2025
Roy Moore
In this episode of Pipeline Projections, Roy Moore—Senior Healthcare Research & Data Analyst at Clarivate—discusses the expanding biosimilar pipeline for autoimmune diseases. He highlights recent FDA approvals, formulary and pricing...
In this episode of Pipeline Projections, Roy Moore—Senior Healthcare Research & Data Analyst at Clarivate—discusses the expanding biosimilar pipeline for autoimmune diseases. He highlights recent FDA approvals, formulary and pricing...
In this episode of Pipeline...
04/29/2025
First Report Managed Care

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Behind the Bill

Behind the Bill
HHS Hits Reset on 340B Rebate Model After Court Setbacks
02/11/2026
Juliet Gallagher
The US Department of Health and Human Services (HHS) has formally scrapped its 340B Rebate Model Pilot Program following a series of court rulings that blocked its implementation—signaling a significant pause in one of the most closely...
The US Department of Health and Human Services (HHS) has formally scrapped its 340B Rebate Model Pilot Program following a series of court rulings that blocked its implementation—signaling a significant pause in one of the most closely...
The US Department of Health and...
02/11/2026
First Report Managed Care
Behind the Bill
Funding Package Extends Medicare Telehealth, Enacts PBM Reforms, and Updates Hospital Oversight
02/05/2026
Juliet Gallagher
On February 3, 2026, President Donald Trump signed a broad government funding package that includes multi-year extensions for Medicare teleath and hospital-at-home programs, new oversight requirements for pharmacy benefit managers (PBMs), and...
On February 3, 2026, President Donald Trump signed a broad government funding package that includes multi-year extensions for Medicare teleath and hospital-at-home programs, new oversight requirements for pharmacy benefit managers (PBMs), and...
On February 3, 2026, President...
02/05/2026
First Report Managed Care
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

November 2011 Volume 8 Issue 11

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