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November 2017 - FRMC

Viewpoint
Selling Health Insurance Across State Lines Is Not the Change We Need
11/28/2017
Greg Borca
Greg Borca, co-founder of SKYGEN USA, discusses the future competition that will enable full coverage and drive down costs following President Donald Trump's executive order to allow health insurance to be sold across state lines.
Greg Borca, co-founder of SKYGEN USA, discusses the future competition that will enable full coverage and drive down costs following President Donald Trump's executive order to allow health insurance to be sold across state lines.
Greg Borca, co-founder of SKYGEN...
11/28/2017
First Report Managed Care
Formulary Frontlines®
Formulary Decisions For HIV Prevention: Pre-Exposure Prophylaxis
11/28/2017
Julia Jarmoszko, PharmD, MBA
Julia Jarmoszko, PharmD, discusses how PrEP is an effective preventative HIV measure that should be available for individuals at high risk of acquiring the virus.
Julia Jarmoszko, PharmD, discusses how PrEP is an effective preventative HIV measure that should be available for individuals at high risk of acquiring the virus.
Julia Jarmoszko, PharmD,...
11/28/2017
First Report Managed Care
Viewpoint
Reducing the Burden of Cardiovascular Disease with Precision Medicine
11/28/2017
Jim Cross
Jim Cross, former Vice President and Head of National Medical Policy and Operations, Aetna, discusses how precision medicine is the new and emerging approach to treating patients cardiovascular disease.
Jim Cross, former Vice President and Head of National Medical Policy and Operations, Aetna, discusses how precision medicine is the new and emerging approach to treating patients cardiovascular disease.
Jim Cross, former Vice President...
11/28/2017
First Report Managed Care
Conference Insider
Pradaxa Shows Added Cost Benefits Compared to Warfarin, Xarelto
11/27/2017
A poster presentation at AMCP Nexus 2017 compared Pradaxa (dabigatran; Boehringer Ingelheim) to warfarin and Xarelto (rivaroxaban; Janssen) for prevention of stroke and bleed-related hospitalization, and costs. 
A poster presentation at AMCP Nexus 2017 compared Pradaxa (dabigatran; Boehringer Ingelheim) to warfarin and Xarelto (rivaroxaban; Janssen) for prevention of stroke and bleed-related hospitalization, and costs. 
A poster presentation at AMCP...
11/27/2017
First Report Managed Care
Conference Insider
Short-Acting Beta-Agonist Inhalers Reduce COPD Budget Impact
11/27/2017
A poster at AMCP Nexus 2017 found that use of short-acting beta-agonist inhalers with an integrated dose counter could reduce the budget impact of COPD.
A poster at AMCP Nexus 2017 found that use of short-acting beta-agonist inhalers with an integrated dose counter could reduce the budget impact of COPD.
A poster at AMCP Nexus 2017...
11/27/2017
First Report Managed Care
Conference Insider
Medicare Patients With Diabetes Incur Significantly Higher Costs Due to CVD Death
11/27/2017
Patients with diabetes who died as a result of comorbid cardiovascular disease incurred significantly higher direct costs before their death, according to a recent poster presentation at AMCP Nexus 2017.
Patients with diabetes who died as a result of comorbid cardiovascular disease incurred significantly higher direct costs before their death, according to a recent poster presentation at AMCP Nexus 2017.
Patients with diabetes who died...
11/27/2017
First Report Managed Care
Conference Insider
Value-Based Care for Diabetes Does Not Increase Costs
11/27/2017
A poster presented at AMCP Nexus 2017 found that implementation of a value-based plan design did not significantly impact costs compared to standard benefit design. 
A poster presented at AMCP Nexus 2017 found that implementation of a value-based plan design did not significantly impact costs compared to standard benefit design. 
A poster presented at AMCP Nexus...
11/27/2017
First Report Managed Care
Conference Insider
Opioid Management Program Helped Cut Misuse Among Medicaid Enrollees
11/27/2017
According to a poster presentation at AMCP Nexus 2017, a managed care pharmacy program tailored to Medicaid members helped to cut opioid utilization.
According to a poster presentation at AMCP Nexus 2017, a managed care pharmacy program tailored to Medicaid members helped to cut opioid utilization.
According to a poster...
11/27/2017
First Report Managed Care
Conference Insider
Switching Biologics Could Increase Costs
11/27/2017
A poster presented at AMCP Nexus 2017 found that switching biologic products was associated with greater health care costs among patients with rheumatoid arthritis. 
A poster presented at AMCP Nexus 2017 found that switching biologic products was associated with greater health care costs among patients with rheumatoid arthritis. 
A poster presented at AMCP Nexus...
11/27/2017
First Report Managed Care
Conference Insider
Breaking Down the Current State of the ACA
11/27/2017
Melissa Andel, MPP, director of health policy at Applied Policy outlined the most up to date policy changes that could impact how insurers participate in ACA marketplaces in 2018.
Melissa Andel, MPP, director of health policy at Applied Policy outlined the most up to date policy changes that could impact how insurers participate in ACA marketplaces in 2018.
Melissa Andel, MPP, director of...
11/27/2017
First Report Managed Care
Conference Insider
Specialty Pharmacy Pipeline Session Highlights Upcoming Approvals
11/27/2017
During a session at AMCP Nexus 2017, Amiee Tharaldson, PharmD, senior clinical consultant of emerging therapeutics at Express Scripts, outline the upcoming specialty pharmacy pipeline drugs.
During a session at AMCP Nexus 2017, Amiee Tharaldson, PharmD, senior clinical consultant of emerging therapeutics at Express Scripts, outline the upcoming specialty pharmacy pipeline drugs.
During a session at AMCP Nexus...
11/27/2017
First Report Managed Care
News
The Arrival of Gene Therapy: Will High Prices Force Payment Innovation?
11/14/2017
Paul Nicolaus
A newly approved treatment carries a jaw-dropping price tag of nearly half a million dollars, but some argue that amounts to a bargain when considering the bigger picture.
A newly approved treatment carries a jaw-dropping price tag of nearly half a million dollars, but some argue that amounts to a bargain when considering the bigger picture.
A newly approved treatment...
11/14/2017
First Report Managed Care
Treating Infectious Diseases In Prisons: Controlling Epidemics and Reducing Costs
11/07/2017
Mary Beth Nierengarten
Infectious diseases in prisons present a unique opportunity for epidemic control; however, costs keep all prisoners from receiving expensive treatments.
Infectious diseases in prisons present a unique opportunity for epidemic control; however, costs keep all prisoners from receiving expensive treatments.
Infectious diseases in prisons...
11/07/2017
First Report Managed Care
Conference Insider
AMCP General Session: What is Value? And What is it Worth?
11/03/2017
Value is the cornerstone of managed care—but is value worth the cost? And are high priced treatments worth their value? A panel of experts discussed the many facets of this issue at AMCP Nexus 2017.
Value is the cornerstone of managed care—but is value worth the cost? And are high priced treatments worth their value? A panel of experts discussed the many facets of this issue at AMCP Nexus 2017.
Value is the cornerstone of...
11/03/2017
First Report Managed Care
News
Provider Network Consolidation: Does it Help or Hurt Payers
11/03/2017
Dean Celia
Two years ago, large health insurers sought to consolidate in response to mergers among health systems and providers. The DOJ said no, and now payers are watching other stakeholders gain more bargaining power. But are insurers as helpless as...
Two years ago, large health insurers sought to consolidate in response to mergers among health systems and providers. The DOJ said no, and now payers are watching other stakeholders gain more bargaining power. But are insurers as helpless as...
Two years ago, large health...
11/03/2017
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 2017 Volume 14 Issue 11

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