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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

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
Task Force Publishes Target-To-Treat Guidance for GCA and PMR
03/12/2024
Jolynn Tumolo
An international task force recently published the first target-to-treat (T2T) recommendations for patients with giant cell arteritis (GCA) and polymyalgia rheumatica (PMR) in the Annals of the Rheumatic Diseases.
An international task force recently published the first target-to-treat (T2T) recommendations for patients with giant cell arteritis (GCA) and polymyalgia rheumatica (PMR) in the Annals of the Rheumatic Diseases.
An international task force...
03/12/2024
First Report Managed Care
Asembia: More Than an Annual Conference
04/15/2024

Emry Lloyd

Emry Lloyd
Asembia, established in 2005, pioneered the recognition and promotion of specialty pharmacies, focusing on becoming a leader in the specialty pharmacy group purchasing organization sector. Offering scalable solutions, including prescription...
Asembia, established in 2005, pioneered the recognition and promotion of specialty pharmacies, focusing on becoming a leader in the specialty pharmacy group purchasing organization sector. Offering scalable solutions, including prescription...
Asembia, established in 2005,...
04/15/2024
First Report Managed Care
Conference Coverage
Addressing Suicidal Ideation in Persons With Multiple Sclerosis: Developing a Predictive Nomogram
05/22/2024
Hannah Musick
New research explored the development of a predictive nomogram to identify persons with multiple sclerosis at higher risk of suicidal ideation, emphasizing the importance of behavioral risk factors in this vulnerable population.
New research explored the development of a predictive nomogram to identify persons with multiple sclerosis at higher risk of suicidal ideation, emphasizing the importance of behavioral risk factors in this vulnerable population.
New research explored the...
05/22/2024
First Report Managed Care
News
Johnson & Johnson Expands Use of Prezcobix for Pediatric Patients in the US
06/21/2024
Hannah Musick
Johnson & Johnson aims to expand use of its HIV-1 therapy, Prezcobix, for younger patients in the US, potentially paving the way for improved treatment options for pediatric patients with the virus.
Johnson & Johnson aims to expand use of its HIV-1 therapy, Prezcobix, for younger patients in the US, potentially paving the way for improved treatment options for pediatric patients with the virus.
Johnson & Johnson aims to expand...
06/21/2024
First Report Managed Care
Brian Esterly Headshot
Interview
Insights on the 2024 Medicare Physician Fee Schedule: Implications and Opportunities for Virtual Care Management Services
07/26/2024
The current Medicare Physician Fee Schedule brought many significant changes to increase access to much needed virtual care management (VCM) services to underserved populations. Learn more about the potential implications of these fee...
The current Medicare Physician Fee Schedule brought many significant changes to increase access to much needed virtual care management (VCM) services to underserved populations. Learn more about the potential implications of these fee...
The current Medicare Physician...
07/26/2024
First Report Managed Care

November 2017 Volume 14 Issue 11

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