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November 2012 - FRMC

Challenges Associated with Schizophrenia
11/20/2013
Tim Casey
Schizophrenia is a disease caused by genetics, brain chemistry, or environmental factors that typically occurs in those between 16 and 35 years of age.
Schizophrenia is a disease caused by genetics, brain chemistry, or environmental factors that typically occurs in those between 16 and 35 years of age.
Schizophrenia is a disease...
11/20/2013
First Report Managed Care
Vascepa™, an Omega-3 Fatty Acid, for Patients with Severe Hypertriglyceridemia
11/27/2012
Tim Casey
Cincinnati—Approximately 4 million people in the United States have severe hypertriglyceridemia, which has been associated with heart disease, stroke, and other conditions. The effects are intensified in people with low high-density...
Cincinnati—Approximately 4 million people in the United States have severe hypertriglyceridemia, which has been associated with heart disease, stroke, and other conditions. The effects are intensified in people with low high-density...
Cincinnati—Approximately 4...
11/27/2012
First Report Managed Care
Lurasidone and Olanzapine in Patients with Schizophrenia
11/27/2012
Jill Sederstorm
Cincinnati—An indirect treatment comparison of 6 atypical antipsychotic (AAP) medications for schizophrenia found that patient discontinuation rates were lowest for lurasidone and olanzapine. The findings from the comparison were presented...
Cincinnati—An indirect treatment comparison of 6 atypical antipsychotic (AAP) medications for schizophrenia found that patient discontinuation rates were lowest for lurasidone and olanzapine. The findings from the comparison were presented...
Cincinnati—An indirect treatment...
11/27/2012
First Report Managed Care
Conference Insider
Association of ACS with Mortality and Morbidity
11/27/2012
Tori Socha
Cincinnati—Acute coronary syndrome (ACS) is one of the most commonly diagnosed cardiovascular illnesses in the United States and one that is responsible for significant morbidity and mortality. Nearly 1.2 million hospital discharges were...
Cincinnati—Acute coronary syndrome (ACS) is one of the most commonly diagnosed cardiovascular illnesses in the United States and one that is responsible for significant morbidity and mortality. Nearly 1.2 million hospital discharges were...
Cincinnati—Acute coronary...
11/27/2012
First Report Managed Care
Costs and Outcomes Comparison of Treatments for Hypertension
11/27/2012
Tori Socha
Cincinnati—Hypertension affects 1 in every 3 adults in the United States and prolonged hypertension can lead to severe complications, including stroke, congestive heart failure, renal failure, myocardial infarction, and other conditions that...
Cincinnati—Hypertension affects 1 in every 3 adults in the United States and prolonged hypertension can lead to severe complications, including stroke, congestive heart failure, renal failure, myocardial infarction, and other conditions that...
Cincinnati—Hypertension affects...
11/27/2012
First Report Managed Care
News
Multiple Sclerosis Patients with High Relapse Rate
11/27/2012
Danielle Seltzer
Cincinnati—Relapsing-remitting multiple sclerosis (MS) is characterized by relapses of symptoms interspersed between periods of remission. Relapses can last for days, weeks, or months and are associated with significant disability and...
Cincinnati—Relapsing-remitting multiple sclerosis (MS) is characterized by relapses of symptoms interspersed between periods of remission. Relapses can last for days, weeks, or months and are associated with significant disability and...
Cincinnati—Relapsing-remitting...
11/27/2012
First Report Managed Care
Comparison of Treatment Therapies for Hypertensive Patients
11/27/2012
Danielle Seltzer
Cincinnati—Hypertension affects >76 million adults in the United States, making it one of the most common chronic diseases. Over the long term, uncontrolled hypertension is associated with risk for cardiovascular diseases and complications...
Cincinnati—Hypertension affects >76 million adults in the United States, making it one of the most common chronic diseases. Over the long term, uncontrolled hypertension is associated with risk for cardiovascular diseases and complications...
Cincinnati—Hypertension affects...
11/27/2012
First Report Managed Care
Drug Burden Score Model in the Patient-Centered Medical Home
11/27/2012
Tori Socha
Cincinnati—Medication therapy management (MTM) often utilizes a combination of prescription drug data and patient demographic information to predict the risk of medication-related complications. At a Pharmacy Partnership Briefing session at...
Cincinnati—Medication therapy management (MTM) often utilizes a combination of prescription drug data and patient demographic information to predict the risk of medication-related complications. At a Pharmacy Partnership Briefing session at...
Cincinnati—Medication therapy...
11/27/2012
First Report Managed Care
Underutilization of Warfarin and Associated Costs
11/27/2012
Tori Socha
Cincinnati—Atrial fibrillation (AF), affecting approximately 2.3 million people in the United States, imposes a substantial clinical and economic burden and is associated with at least a 2-fold increase in the risk of stroke and...
Cincinnati—Atrial fibrillation (AF), affecting approximately 2.3 million people in the United States, imposes a substantial clinical and economic burden and is associated with at least a 2-fold increase in the risk of stroke and...
Cincinnati—Atrial fibrillation...
11/27/2012
First Report Managed Care
Exacerbation Rates and Costs of COPD in a Managed Care Population
11/27/2012
Tori Socha
Cincinnati—Chronic obstructive pulmonary disease (COPD), a progressive disease characterized by persistent airflow limitation, chronic and progressive dyspnea, cough, and sputum production, is often complicated by exacerbations. The...
Cincinnati—Chronic obstructive pulmonary disease (COPD), a progressive disease characterized by persistent airflow limitation, chronic and progressive dyspnea, cough, and sputum production, is often complicated by exacerbations. The...
Cincinnati—Chronic obstructive...
11/27/2012
First Report Managed Care
Real-World Data to Treat Health Conditions
11/27/2012
Eileen Koutnik-Fotopoulos
Cincinnati—A drawback of traditional outcomes research studies is the lack of availability of clinical data within administrative claims databases. Whereas these studies can identify healthcare utilization patterns and, in some cases, proxies...
Cincinnati—A drawback of traditional outcomes research studies is the lack of availability of clinical data within administrative claims databases. Whereas these studies can identify healthcare utilization patterns and, in some cases, proxies...
Cincinnati—A drawback of...
11/27/2012
First Report Managed Care
Treatment of Benign Prostatic Hyperplasia
11/27/2012
Kevin L. Carter
Cincinnati—Benign prostatic hyperplasia (BPH) is the most common urological disorder in elderly men. There were an estimated 28.4 million patients with symptomatic BPH in the United States in 2010. As age increases, so does the prevalence of...
Cincinnati—Benign prostatic hyperplasia (BPH) is the most common urological disorder in elderly men. There were an estimated 28.4 million patients with symptomatic BPH in the United States in 2010. As age increases, so does the prevalence of...
Cincinnati—Benign prostatic...
11/27/2012
First Report Managed Care
Inhaled Corticosteroids Overprescribed for COPD
11/27/2012
Mary Mihalovic
Cincinnati—A large percentage of patients with mild-to-moderate chronic obstructive pulmonary disease (COPD) are being prescribed maintenance therapy with inhaled corticosteroids (ICS), a practice that is not consistent with the Global...
Cincinnati—A large percentage of patients with mild-to-moderate chronic obstructive pulmonary disease (COPD) are being prescribed maintenance therapy with inhaled corticosteroids (ICS), a practice that is not consistent with the Global...
Cincinnati—A large percentage of...
11/27/2012
First Report Managed Care
Roadmap for Pharmacy HIT Integration Sets 4-Year Goals
11/27/2012
Eileen Koutnik-Fotopoulos
Cincinnati—Pharmacist adoption of electronic health records (EHRs) will create the tools to further improve pharmacists’ ability to provide safe and effective medication use by patients with the main goal of facilitating access to electronic,...
Cincinnati—Pharmacist adoption of electronic health records (EHRs) will create the tools to further improve pharmacists’ ability to provide safe and effective medication use by patients with the main goal of facilitating access to electronic,...
Cincinnati—Pharmacist adoption...
11/27/2012
First Report Managed Care
Augmentation Therapy for Patients with Major Depression
11/27/2012
Mary Beth Nierengarten
Cincinnati—For patients with major depressive disorder (MDD) who do not adequately respond to initial treatment with antidepressant therapy (ADT), combination with another ADT is the most common augmentation therapy used by clinicians....
Cincinnati—For patients with major depressive disorder (MDD) who do not adequately respond to initial treatment with antidepressant therapy (ADT), combination with another ADT is the most common augmentation therapy used by clinicians....
Cincinnati—For patients with...
11/27/2012
First Report Managed Care
Comparison of Pharmacy Costs Between HAART Therapies for HIV Infection
11/27/2012
Kevin L. Carter
The accepted therapy for HIV infection has been highly active antiretroviral therapy (HAART).
The accepted therapy for HIV infection has been highly active antiretroviral therapy (HAART).
The accepted therapy for HIV...
11/27/2012
First Report Managed Care
Conference Insider
Federal and State Legislative Impact on Managed Care Pharmacy
11/27/2012
Eileen Koutnik-Fotopoulos
Cincinnati—Federal and state legislative proposals that will affect AMCP members and other stakeholders were the focus of a Contemporary Issues session at the AMCP meeting. Paul Lakomski, RPh, pharmacy director, Empire BlueCross...
Cincinnati—Federal and state legislative proposals that will affect AMCP members and other stakeholders were the focus of a Contemporary Issues session at the AMCP meeting. Paul Lakomski, RPh, pharmacy director, Empire BlueCross...
Cincinnati—Federal and state...
11/27/2012
First Report Managed Care
Protease Inhibitors for Hepatitis C
11/27/2012
Kevin L. Carter
Cincinnati—For pharmacy benefit managers, managing hepatitis C virus (HCV) protease inhibitors present significant challenges, including high costs, treatment complexity, and increased adverse events. RegenceRx Pharmacy Benefit Management in...
Cincinnati—For pharmacy benefit managers, managing hepatitis C virus (HCV) protease inhibitors present significant challenges, including high costs, treatment complexity, and increased adverse events. RegenceRx Pharmacy Benefit Management in...
Cincinnati—For pharmacy benefit...
11/27/2012
First Report Managed Care
Health Spending Continues to Grow but Rate Slows
11/27/2012
Tim Casey
Healthcare spending is now among the most expensive budget items, and there is no end in sight.
Healthcare spending is now among the most expensive budget items, and there is no end in sight.
Healthcare spending is now among...
11/27/2012
First Report Managed Care
News
Predictors of High Relapse Activity in Patients with MS
11/27/2012
Tori Socha
Cincinnati—Worse clinical outcomes can be expected in patients with multiple sclerosis (MS) who have high relapse activity (HRA) due to faster disability progression. Understanding the factors that can predict HRA can help clinicians identify...
Cincinnati—Worse clinical outcomes can be expected in patients with multiple sclerosis (MS) who have high relapse activity (HRA) due to faster disability progression. Understanding the factors that can predict HRA can help clinicians identify...
Cincinnati—Worse clinical...
11/27/2012
First Report Managed Care
Tudorza™ Pressair™ Approved for COPD Symptoms
11/27/2012
Tim Casey
Cincinnati—The Institute of Medicine recently deemed chronic obstructive pulmonary disease (COPD) as a priority, identifying its risks and associated costs. The total yearly cost of COPD is $49.9 billion, while direct costs are $29.5 billion,...
Cincinnati—The Institute of Medicine recently deemed chronic obstructive pulmonary disease (COPD) as a priority, identifying its risks and associated costs. The total yearly cost of COPD is $49.9 billion, while direct costs are $29.5 billion,...
Cincinnati—The Institute of...
11/27/2012
First Report Managed Care
Step Therapy Restriction Policy for Pregabalin
11/27/2012
Mary Beth Nierengarten
Cincinnati—Implementation of a step therapy (ST) restriction policy for pregabalin to treat patients with chronic pain conditions reduced utilization of pregabalin but did not decrease medical or pharmacy costs, reported investigators in a...
Cincinnati—Implementation of a step therapy (ST) restriction policy for pregabalin to treat patients with chronic pain conditions reduced utilization of pregabalin but did not decrease medical or pharmacy costs, reported investigators in a...
Cincinnati—Implementation of a...
11/27/2012
First Report Managed Care
History of Adherence as Indicator of Continued Adherence in Asthma Patients
11/27/2012
Tori Socha
Cincinnati—Approximately 22.2 million Americans are affected by asthma, a chronic respiratory disease. Of the 3 combination therapies available for treatment of uncontrolled moderate to severe persistent asthma, budesonide/formoterol (BFC)...
Cincinnati—Approximately 22.2 million Americans are affected by asthma, a chronic respiratory disease. Of the 3 combination therapies available for treatment of uncontrolled moderate to severe persistent asthma, budesonide/formoterol (BFC)...
Cincinnati—Approximately 22.2...
11/27/2012
First Report Managed Care
Copay Offset Programs: Blessing or Curse?
11/27/2012
Tori Socha
Cincinnati—Copay offset programs are seen as both positive and negative, according to Mark Zitter, founder and CEO of The Zitter Group. In a Contemporary Issues session at the AMCP meeting, Mr. Zitter gave a presentation titled The Growth of...
Cincinnati—Copay offset programs are seen as both positive and negative, according to Mark Zitter, founder and CEO of The Zitter Group. In a Contemporary Issues session at the AMCP meeting, Mr. Zitter gave a presentation titled The Growth of...
Cincinnati—Copay offset programs...
11/27/2012
First Report Managed Care
News
An Indirect Comparison of Therapies for Multiple Sclerosis
11/27/2012
Tori Socha
Cincinnati—The mean annual costs of treating multiple sclerosis (MS) rise with increasing disability, imposing a considerable economic burden on society, according to researchers. It is important for payers making formulary decisions to be...
Cincinnati—The mean annual costs of treating multiple sclerosis (MS) rise with increasing disability, imposing a considerable economic burden on society, according to researchers. It is important for payers making formulary decisions to be...
Cincinnati—The mean annual costs...
11/27/2012
First Report Managed Care
Using Data Generated by Health Economic and Outcomes Research
11/27/2012
Tori Socha
Cincinnati—Health economic and outcomes research (HEOR) has a role in decision-making, but decision makers at health plans rely most heavily on HEOR to support data on safety and efficacy. At a Managed Care Essentials session at the AMCP...
Cincinnati—Health economic and outcomes research (HEOR) has a role in decision-making, but decision makers at health plans rely most heavily on HEOR to support data on safety and efficacy. At a Managed Care Essentials session at the AMCP...
Cincinnati—Health economic and...
11/27/2012
First Report Managed Care
Contraceptive Utilization Expected to Rise as Costs to Consumers Decrease
11/27/2012
Mary Mihalovic
Cincinnati—The implementation of the Patient Protection and Affordable Care Act (ACA), which will provide contraception to consumers as a preventive service without cost sharing, is expected to result in an increase of contraception costs to...
Cincinnati—The implementation of the Patient Protection and Affordable Care Act (ACA), which will provide contraception to consumers as a preventive service without cost sharing, is expected to result in an increase of contraception costs to...
Cincinnati—The implementation of...
11/27/2012
First Report Managed Care
Growing Trend Toward Specialty Drugs
11/27/2012
Tim Casey
Cincinnati—Although <1% of patients use specialty medications, they represent >15% of drug spend, and the percentage is likely to increase. In each of the past 3 years, the FDA has approved more specialty than traditional drugs. The...
Cincinnati—Although <1% of patients use specialty medications, they represent >15% of drug spend, and the percentage is likely to increase. In each of the past 3 years, the FDA has approved more specialty than traditional drugs. The...
Cincinnati—Although <1% of...
11/27/2012
First Report Managed Care
Patients with Overactive Bladder Are Not Receiving Pharmacologic Therapy
11/27/2012
Jill Sederstorm
  Cincinnati—A new retrospective study of patients with overactive bladder (OAB) found that only a small percentage of those in the study population received pharmacologic therapy to treat the disorder. The findings from this study were...
  Cincinnati—A new retrospective study of patients with overactive bladder (OAB) found that only a small percentage of those in the study population received pharmacologic therapy to treat the disorder. The findings from this study were...
  Cincinnati—A new...
11/27/2012
First Report Managed Care
Conference Insider
Case Law and Legislative Highlights Affecting Managed Care
11/27/2012
Tori Socha
Cincinnati—Recent years have seen legislative changes that have had an impact on managed care pharmacists.
Cincinnati—Recent years have seen legislative changes that have had an impact on managed care pharmacists.
Cincinnati—Recent years have...
11/27/2012
First Report Managed Care
News
Study Finds Severity of Multiple Sclerosis Relapses Increases Cost Burden
11/27/2012
Jill Sederstorm
Cincinnati—Multiple sclerosis (MS) relapses were associated with higher direct and indirect costs for MS patients, according to a new retrospective study. The findings from the study were recently presented during a poster session at the AMCP...
Cincinnati—Multiple sclerosis (MS) relapses were associated with higher direct and indirect costs for MS patients, according to a new retrospective study. The findings from the study were recently presented during a poster session at the AMCP...
Cincinnati—Multiple sclerosis...
11/27/2012
First Report Managed Care
Face-to-Face and Telephonic MTM: A Comparison
11/27/2012
Tori Socha
Cincinnati—With an estimated 3.5 billion prescriptions written each year, the need for a medication management process is evident, according to a Contemporary Issues session at the AMCP meeting. Linda Strand, PharmD, PhD, Thomas Albers, BS,...
Cincinnati—With an estimated 3.5 billion prescriptions written each year, the need for a medication management process is evident, according to a Contemporary Issues session at the AMCP meeting. Linda Strand, PharmD, PhD, Thomas Albers, BS,...
Cincinnati—With an estimated 3.5...
11/27/2012
First Report Managed Care
Conference Insider
Uncontrolled Serum Uric Acid and Healthcare Resource Use
11/26/2012
Tori Socha
Cincinnati—Gout, an inflammatory arthritis, is characterized by intense pain. It is caused by the formation of monosodium urate crystals in joint and other tissues and is associated with hyperuricemia (elevated levels of uric acid [sUA]). The...
Cincinnati—Gout, an inflammatory arthritis, is characterized by intense pain. It is caused by the formation of monosodium urate crystals in joint and other tissues and is associated with hyperuricemia (elevated levels of uric acid [sUA]). The...
Cincinnati—Gout, an inflammatory...
11/26/2012
First Report Managed Care
Evidence-Based Assessments to Evaluate Medication Value
11/26/2012
Eileen Koutnik-Fotopoulos
Medication assessments directly impact the way a drug is covered, and medications that have shown high potential clinical value have better odds of being covered.
Medication assessments directly impact the way a drug is covered, and medications that have shown high potential clinical value have better odds of being covered.
Medication assessments directly...
11/26/2012
First Report Managed Care
A Program to Identify Opioid-Dependent Health Plan Members
11/26/2012
Tori Socha
Cincinnati—According to an article in Drug and Alcohol Dependence, the risk for death for patients who are dependent on opioids is 5.71 times greater than for healthy individuals of similar age, sex, and race. In June 2012, Aetna Pharmacy...
Cincinnati—According to an article in Drug and Alcohol Dependence, the risk for death for patients who are dependent on opioids is 5.71 times greater than for healthy individuals of similar age, sex, and race. In June 2012, Aetna Pharmacy...
Cincinnati—According to an...
11/26/2012
First Report Managed Care
The Role of the Pharmacist in Treating the Cancer Patient
11/26/2012
Tori Socha
Historically, care for a patient with cancer was managed by just a physician and the patient.
Historically, care for a patient with cancer was managed by just a physician and the patient.
Historically, care for a patient...
11/26/2012
First Report Managed Care
Pain-Related Healthcare Costs
11/26/2012
Kerri Fitzgerald
Cincinnati—In the recent past, there have been studies conducted to determine the effects of prior authorization (PA) programs in Medicaid and commercial health plans for Lyrica® (pregabalin). The studies have provided evidence associating...
Cincinnati—In the recent past, there have been studies conducted to determine the effects of prior authorization (PA) programs in Medicaid and commercial health plans for Lyrica® (pregabalin). The studies have provided evidence associating...
Cincinnati—In the recent past,...
11/26/2012
First Report Managed Care
FDA Designations of Brand and Generic Products
11/26/2012
Tori Socha
Cincinnati—The designation of a particular drug as a brand or generic drug is determined using the differences among 3 types of FDA drug approval applications, according to a speaker at a Contemporary Issues session at the AMCP meeting. Keith...
Cincinnati—The designation of a particular drug as a brand or generic drug is determined using the differences among 3 types of FDA drug approval applications, according to a speaker at a Contemporary Issues session at the AMCP meeting. Keith...
Cincinnati—The designation of a...
11/26/2012
First Report Managed Care
Personalized Medicine and Managed Care
11/26/2012
Tori Socha
Cincinnati—At a Contemporary Issues session at the AMCP meeting, speakers discussed aspects of personalized medicine (PM) that relate to managed care. The session was titled Personalized Medicine in Managed Care. Diana I. Brixner, RPh,...
Cincinnati—At a Contemporary Issues session at the AMCP meeting, speakers discussed aspects of personalized medicine (PM) that relate to managed care. The session was titled Personalized Medicine in Managed Care. Diana I. Brixner, RPh,...
Cincinnati—At a Contemporary...
11/26/2012
First Report Managed Care
Utilizing New Techniques to Manage Multiple Myeloma
11/26/2012
Tim Casey
Cincinnati—For decades, managed care executives rarely questioned the costs of oncology treatments. They were always included in the formulary. However, as specialty drugs become more popular and the price of therapies continues to rise,...
Cincinnati—For decades, managed care executives rarely questioned the costs of oncology treatments. They were always included in the formulary. However, as specialty drugs become more popular and the price of therapies continues to rise,...
Cincinnati—For decades, managed...
11/26/2012
First Report Managed Care
Physician Education and Improvements in Patient Adherence
11/26/2012
Tori Socha
Cincinnati—Three healthcare organizations (a managed care company [Aetna], a pharmaceutical manufacturer [Pfizer], and a quality improvement company [Total Therapeutic Management, Inc. (TTM)], recently completed a 16-month project to educate...
Cincinnati—Three healthcare organizations (a managed care company [Aetna], a pharmaceutical manufacturer [Pfizer], and a quality improvement company [Total Therapeutic Management, Inc. (TTM)], recently completed a 16-month project to educate...
Cincinnati—Three healthcare...
11/26/2012
First Report Managed Care
Using Average Acquisition Cost for Medicaid Reimbursement
11/26/2012
Tori Socha
Cincinnati—Patrick Lupinetti, senior vice president, First Databank, Inc., is an expert on government drug pricing. At the AMCP meeting, he presented a Contemporary Issues session titled Drug Pricing Developments-AAC (Average Acquisition...
Cincinnati—Patrick Lupinetti, senior vice president, First Databank, Inc., is an expert on government drug pricing. At the AMCP meeting, he presented a Contemporary Issues session titled Drug Pricing Developments-AAC (Average Acquisition...
Cincinnati—Patrick Lupinetti,...
11/26/2012
First Report Managed Care
Considering Heterogeneity of Treatment Effects
11/26/2012
Tim Casey
Cincinnati—Speakers at the AMCP meeting urged healthcare professionals initiating therapies or deciding what drugs to cover to consider that treatments may work differently for people with the same disease. During a satellite symposium titled...
Cincinnati—Speakers at the AMCP meeting urged healthcare professionals initiating therapies or deciding what drugs to cover to consider that treatments may work differently for people with the same disease. During a satellite symposium titled...
Cincinnati—Speakers at the AMCP...
11/26/2012
First Report Managed Care
Managed Care Approaches for Treating Eye Diseases
11/26/2012
Tim Casey
Cincinnati—As adults age, there is an increased risk of abnormal eye functions and even blinding disorders. Diseases such as glaucoma, diabetic retinopathy, and macular edema are sometimes overlooked by managed care professionals; however,...
Cincinnati—As adults age, there is an increased risk of abnormal eye functions and even blinding disorders. Diseases such as glaucoma, diabetic retinopathy, and macular edema are sometimes overlooked by managed care professionals; however,...
Cincinnati—As adults age, there...
11/26/2012
First Report Managed Care
The Evolution of Pharmacy Benefit Management
11/26/2012
Tori Socha
Cincinnati—At a Managed Care Essentials session at the AMCP meeting, Robert Navarro, PharmD, clinical professor of pharmaceutical outcomes and policy at the University of Florida College of Pharmacy, outlined the components of benefit design...
Cincinnati—At a Managed Care Essentials session at the AMCP meeting, Robert Navarro, PharmD, clinical professor of pharmaceutical outcomes and policy at the University of Florida College of Pharmacy, outlined the components of benefit design...
Cincinnati—At a Managed Care...
11/26/2012
First Report Managed Care
Conference Insider
Fighting Medicare Part D Fraud
11/26/2012
Tim Casey
Cincinnati—Since the Patient Protection and Affordable Care Act (ACA) passed in 2010, federal and local governments have gained power to deal with an issue that has been plaguing healthcare for a long time: Medicare fraud. Illegal pharmacies...
Cincinnati—Since the Patient Protection and Affordable Care Act (ACA) passed in 2010, federal and local governments have gained power to deal with an issue that has been plaguing healthcare for a long time: Medicare fraud. Illegal pharmacies...
Cincinnati—Since the Patient...
11/26/2012
First Report Managed Care
Pipeline Filled with Promising Drugs
11/26/2012
Tim Casey
Cincinnati—Despite patents for blockbuster drugs such as Lipitor® (atorvastatin calcium) and Plavix® (clopidogrel bisulfate) expiring in the past year, pharmaceutical manufacturers have received some positive news in 2012 when it comes to...
Cincinnati—Despite patents for blockbuster drugs such as Lipitor® (atorvastatin calcium) and Plavix® (clopidogrel bisulfate) expiring in the past year, pharmaceutical manufacturers have received some positive news in 2012 when it comes to...
Cincinnati—Despite patents for...
11/26/2012
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

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

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