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November 2016 - FRMC

Managed Care Q&A
Quality Care: A Unique Perspective Part 2
12/09/2016
Dean Celia
Margaret E O’Kane continues the discussion on the evolution of quality care, including challenges that have been overcome and those that remain.
Margaret E O’Kane continues the discussion on the evolution of quality care, including challenges that have been overcome and those that remain.
Margaret E O’Kane continues the...
12/09/2016
First Report Managed Care
News Connection
Push to Address High Drug Prices Could Table Cure Act
11/27/2016
The future of the 21st Century Cure Act, which includes funds for medical research and aims to speed up the FDA's drug approval process, is up in the air following a recent push from patient advocacy and union groups to hold the bill until...
The future of the 21st Century Cure Act, which includes funds for medical research and aims to speed up the FDA's drug approval process, is up in the air following a recent push from patient advocacy and union groups to hold the bill until...
The future of the 21st Century...
11/27/2016
First Report Managed Care
Managed Care Q&A
Improving Diabetes Awareness Through Managed Care
11/22/2016
David Costill
An interview with Albert Tzeel, MD, regional medical director, Humana
An interview with Albert Tzeel, MD, regional medical director, Humana
An interview with Albert Tzeel,...
11/22/2016
First Report Managed Care
News Connection
Investigational Biologic Benefits Patients With Multidrug-Resistant HIV in Phase 3 Trial
11/22/2016
Treatment with the investigational biologic ibalizumab (TaiMed Biologics/Theratechnologies) appeared to safely reduce the viral loads of patients with multidrug-resistant HIV, according to late-breaking phase III trial results recently...
Treatment with the investigational biologic ibalizumab (TaiMed Biologics/Theratechnologies) appeared to safely reduce the viral loads of patients with multidrug-resistant HIV, according to late-breaking phase III trial results recently...
Treatment with the...
11/22/2016
First Report Managed Care
News Connection
Investigational Dupixent Significantly Eases Uncontrolled Atopic Dermatitis
11/22/2016
A pair of identically designed phase 3 trials found that Dupixent (dupilumab; Sanofi/Regeneron) improved symptoms of moderate-to-severe atopic dermatitis, including itching, anxiety and depression, and quality of life, compared with placebo.
A pair of identically designed phase 3 trials found that Dupixent (dupilumab; Sanofi/Regeneron) improved symptoms of moderate-to-severe atopic dermatitis, including itching, anxiety and depression, and quality of life, compared with placebo.
A pair of identically designed...
11/22/2016
First Report Managed Care
News Connection
Lynparza Lengthens Survival in Women with Ovarian Cancer
11/22/2016
Women who took Lynparza (olaparib; AstraZeneca) tablets as a monotherapy for maintenance treatment of platinum-sensitive relapsed BRCA-mutated ovarian cancer showed significantly improved progression-free survival compared with women who took...
Women who took Lynparza (olaparib; AstraZeneca) tablets as a monotherapy for maintenance treatment of platinum-sensitive relapsed BRCA-mutated ovarian cancer showed significantly improved progression-free survival compared with women who took...
Women who took Lynparza...
11/22/2016
First Report Managed Care
News Connection
Amyloid Positron Emission Tomography Improves Diagnosis, Management of Alzheimer Disease
11/22/2016
A recently study suggests amyloid positron emission tomography alongside routine cognitive impairment assessment may improve physicians’ diagnosis and management of Alzheimer disease.
A recently study suggests amyloid positron emission tomography alongside routine cognitive impairment assessment may improve physicians’ diagnosis and management of Alzheimer disease.
A recently study suggests...
11/22/2016
First Report Managed Care
News Connection
Mail-Order Pharmacies Potentially Linked to Higher Medication Adherence
11/22/2016
Recent data show higher medical adherence by patients who use mail-order pharmacies compared to those who use retail pharmacies, although more research is still needed.
Recent data show higher medical adherence by patients who use mail-order pharmacies compared to those who use retail pharmacies, although more research is still needed.
Recent data show higher medical...
11/22/2016
First Report Managed Care
News Connection
Results Mixed for PCMH Diabetes Care
11/22/2016
Results of a new study suggest that patient-centered medical homes (PCMHs) have diverse effects on different outcomes for diabetes care.
Results of a new study suggest that patient-centered medical homes (PCMHs) have diverse effects on different outcomes for diabetes care.
Results of a new study suggest...
11/22/2016
First Report Managed Care
News Connection
Five Groups Express Concern Over Extending Biologic Competition Protection Under the TPP
11/22/2016
In a recent letter, a group of physician, consumer, and employment groups urged President Obama to waive agreements that would lengthen data protections for biologic medicines in an expansive Asia-Pacific trade deal.
In a recent letter, a group of physician, consumer, and employment groups urged President Obama to waive agreements that would lengthen data protections for biologic medicines in an expansive Asia-Pacific trade deal.
In a recent letter, a group of...
11/22/2016
First Report Managed Care
News Connection
Health Insurers Have “Strong Claim” to Billions in ACA Compensation
11/22/2016
A lawsuit filed by health insurers has a “strong claim” to billions of dollars in compensation from the Affordable Care Act’s risk-corridor program.
A lawsuit filed by health insurers has a “strong claim” to billions of dollars in compensation from the Affordable Care Act’s risk-corridor program.
A lawsuit filed by health...
11/22/2016
First Report Managed Care
News Connection
Allowing Off-Label Drug Promotion Would Hurt Patients and Payers, Experts Warn
11/22/2016
Recent court decisions have endangered the US FDA’s long-standing prohibition against the off-label marketing of pharmaceuticals in favor of free speech protections.
Recent court decisions have endangered the US FDA’s long-standing prohibition against the off-label marketing of pharmaceuticals in favor of free speech protections.
Recent court decisions have...
11/22/2016
First Report Managed Care
News Connection
Intensive Home Care Offers Comparable Treatment at Reduced Cost
11/22/2016
Home care has become a viable, low-cost alternative to hospitalization for certain conditions due to new technology and a growing skilled-nursing workforce. 
Home care has become a viable, low-cost alternative to hospitalization for certain conditions due to new technology and a growing skilled-nursing workforce. 
Home care has become a viable,...
11/22/2016
First Report Managed Care
News Connection
Price Transparency Tool Decreases Spending on Select Services
11/22/2016
Recent data show that a tool that allows patients to view price estimates for procedures prior to undergoing them can result in reduced spending.
Recent data show that a tool that allows patients to view price estimates for procedures prior to undergoing them can result in reduced spending.
Recent data show that a tool...
11/22/2016
First Report Managed Care
Trends Report
Autoimmune Diseases: Multiple Sclerosis
11/22/2016
The final installment of this 3-part First Report Managed Care Trends Report reports the findings from survey participants on multiple sclerosis (MS). 
The final installment of this 3-part First Report Managed Care Trends Report reports the findings from survey participants on multiple sclerosis (MS). 
The final installment of this...
11/22/2016
First Report Managed Care
News
Biosimilars: Too Expensive to Switch?
11/22/2016
Dean Celia
Concern about costs and rising premiums may signal a need for less expensive alternatives, but what if patients are already controlled or ancillary costs increase? 
Concern about costs and rising premiums may signal a need for less expensive alternatives, but what if patients are already controlled or ancillary costs increase? 
Concern about costs and rising...
11/22/2016
First Report Managed Care
Urgent Care & Managed Care: A Popular Source of Low-Cost Care
11/22/2016
Dave Muoio
Walk-in retail and urgent care clinics are popping up all over the country due to their convenience and transparent pricing structure. With the support of managed care organizations, urgent care facilities are poised to change the way health...
Walk-in retail and urgent care clinics are popping up all over the country due to their convenience and transparent pricing structure. With the support of managed care organizations, urgent care facilities are poised to change the way health...
Walk-in retail and urgent care...
11/22/2016
First Report Managed Care
News
Exondys 51: Controversy in the Wake of an Unprecedented FDA Approval
11/22/2016
Jill Sederstorm
With insurers refusing to cover Exondys 51, or imposing coverage restrictions, managed care experts are left wondering: is this a battle worth fighting?
With insurers refusing to cover Exondys 51, or imposing coverage restrictions, managed care experts are left wondering: is this a battle worth fighting?
With insurers refusing to cover...
11/22/2016
First Report Managed Care
Managed Care Q&A
Quality Care: A Unique Perspective Part 1
11/22/2016
Dean Celia
Margaret E O’Kane, an industry leader, addresses the evolution of quality care, including challenges that have been overcome and those that remain.
Margaret E O’Kane, an industry leader, addresses the evolution of quality care, including challenges that have been overcome and those that remain.
Margaret E O’Kane, an industry...
11/22/2016
First Report Managed Care
Formulary Frontlines®
Schizophrenia Therapy: Do Cost-Saving Strategies Conflict With Care?
11/22/2016
Eileen Koutnik-Fotopoulos
Formulary decisions for treating schizophrenia must balance saving costs and improving medication  adherence without contributing to the disease burden.
Formulary decisions for treating schizophrenia must balance saving costs and improving medication  adherence without contributing to the disease burden.
Formulary decisions for treating...
11/22/2016
First Report Managed Care
Department
Biologic Utilization Varies Widely for RA Treatment
11/22/2016
Recent research presented at AMCP Nexus 2016 found that biologic utilization prevalence for the treatment of rheumatoid arthritis (RA) varied widely between Humira (adalimumab; Janssen), Cimzia (certolizumab; UCB Inc), Enbrel (etanercept;...
Recent research presented at AMCP Nexus 2016 found that biologic utilization prevalence for the treatment of rheumatoid arthritis (RA) varied widely between Humira (adalimumab; Janssen), Cimzia (certolizumab; UCB Inc), Enbrel (etanercept;...
Recent research presented at...
11/22/2016
First Report Managed Care
Department
Pain Guardian Program Reduces Opioid Use
11/22/2016
Analysis of the effectiveness of Pain Guardian, a clinical program aimed at curbing opioid abuse and waste, showed that the program significantly decreased opioid utilization, according to a poster presented at AMCP Nexus 2016. 
Analysis of the effectiveness of Pain Guardian, a clinical program aimed at curbing opioid abuse and waste, showed that the program significantly decreased opioid utilization, according to a poster presented at AMCP Nexus 2016. 
Analysis of the effectiveness of...
11/22/2016
First Report Managed Care
Department
Cardiovascular Disease Mortality Associated With Increased Costs Among Patients With Diabetes
11/22/2016
Patients with type 2 diabetes who suffer fatal cardiovascular disease (CVD) events have significantly increased health care costs during the last year of treatment, according to recent research presented at AMCP Nexus 2016.
Patients with type 2 diabetes who suffer fatal cardiovascular disease (CVD) events have significantly increased health care costs during the last year of treatment, according to recent research presented at AMCP Nexus 2016.
Patients with type 2 diabetes...
11/22/2016
First Report Managed Care
Department
Estimation Methods May Not Be Reliable for Projecting Type 2 Diabetes Treatment Costs
11/22/2016
An examination of two different cost estimation methods revealed that health care costs associated with type 2 diabetes varied widely depending on which system was used, suggesting that these tools are unreliable for payers, according to a...
An examination of two different cost estimation methods revealed that health care costs associated with type 2 diabetes varied widely depending on which system was used, suggesting that these tools are unreliable for payers, according to a...
An examination of two different...
11/22/2016
First Report Managed Care
Department
Zepatier Less Costly, More Effective Than Harvoni, Epclusa for Hepatitis C
11/22/2016
According to recent research presented at AMCP Nexus 2016, hepatitis C genotype 1 treatment with Zepatier (elbasvir/grazoprevir; Merck) was more effective and less expensive when compared to Harvoni (ledipasvir/sofosbuvir; Gilead) and...
According to recent research presented at AMCP Nexus 2016, hepatitis C genotype 1 treatment with Zepatier (elbasvir/grazoprevir; Merck) was more effective and less expensive when compared to Harvoni (ledipasvir/sofosbuvir; Gilead) and...
According to recent research...
11/22/2016
First Report Managed Care
Department
RA Drug Coverage Inconsistent Among Largest Private Payers
11/22/2016
According to a poster presentation at AMCP Nexus 2016, the country’s largest private health care payers cover rheumatoid arthritis (RA) drugs inconsistently and use different evidence to support their coverage policy decisions. 
According to a poster presentation at AMCP Nexus 2016, the country’s largest private health care payers cover rheumatoid arthritis (RA) drugs inconsistently and use different evidence to support their coverage policy decisions. 
According to a poster...
11/22/2016
First Report Managed Care
Department
Breakthrough RA, MS Treatments Among Anticipated Drugs in Specialty Pipeline
11/22/2016
During the AMCP Nexus 2016 meeting, Aimee Tharaldson outlined the specialty treatments likely to receive FDA approval in the coming months.
During the AMCP Nexus 2016 meeting, Aimee Tharaldson outlined the specialty treatments likely to receive FDA approval in the coming months.
During the AMCP Nexus 2016...
11/22/2016
First Report Managed Care
Department
Is NASH the Next Hep C? Bracing for a Massive Impact On Spending
11/22/2016
During an educational session at AMCP Nexus 2016, Sara C Erickson, PharmD, health outcomes researcher at MedImpact Healthcare Systems, and Susan Trieu, PharmD, drug information pharmacist at MedImpact Healthcare Systems, presented data...
During an educational session at AMCP Nexus 2016, Sara C Erickson, PharmD, health outcomes researcher at MedImpact Healthcare Systems, and Susan Trieu, PharmD, drug information pharmacist at MedImpact Healthcare Systems, presented data...
During an educational session at...
11/22/2016
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 2016 Volume 13 Issue 11

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