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November 2018 - First Report Managed Care

Managed Care Q&A
Concerns With Payment, Administration of Car-T Therapies
11/28/2018
Zachary Bessette
Gary Goldstein, business manager of the Blood and Marrow Transplant Program at Stanford Health Care, discusses the changes needed for increased CAR-T administration in the outpatient setting as well as commercial and provider concerns about...
Gary Goldstein, business manager of the Blood and Marrow Transplant Program at Stanford Health Care, discusses the changes needed for increased CAR-T administration in the outpatient setting as well as commercial and provider concerns about...
Gary Goldstein, business manager...
11/28/2018
First Report Managed Care
News Connection
Amazon, Arcadia Group Partner, Offer Exclusive Brand of Medical Devices
11/28/2018
Amazon will begin selling an exclusive brand of medical devices for diabetes and hypertension management straight to consumers in a partnership with Arcadia Group.
Amazon will begin selling an exclusive brand of medical devices for diabetes and hypertension management straight to consumers in a partnership with Arcadia Group.
Amazon will begin selling an...
11/28/2018
First Report Managed Care
News Connection
Improving Population Health Efforts With Updated AMA Tool
11/28/2018
The American Medical Association (AMA) has launched a newly enhanced version of its Health Workforce Mapper—a tool that provides information on a variety of population health factors—which now includes updated data to help physicians and...
The American Medical Association (AMA) has launched a newly enhanced version of its Health Workforce Mapper—a tool that provides information on a variety of population health factors—which now includes updated data to help physicians and...
The American Medical Association...
11/28/2018
First Report Managed Care
News Connection
Express Scripts Diabetes Program Saves Millions in First Year
11/28/2018
The Express Scripts SafeGuardRx Diabetes Care Value program saved participating health plan sponsors a total $42.6 million during its first year, the company announced in a press release.
The Express Scripts SafeGuardRx Diabetes Care Value program saved participating health plan sponsors a total $42.6 million during its first year, the company announced in a press release.
The Express Scripts SafeGuardRx...
11/28/2018
First Report Managed Care
News Connection
CMS Proposes Drug Manufacturers Post Drug Prices in Television Ads
11/28/2018
The Centers for Medicare & Medicaid Services (CMS) recently proposed a new rule aimed at lowering prescription drug prices.
The Centers for Medicare & Medicaid Services (CMS) recently proposed a new rule aimed at lowering prescription drug prices.
The Centers for Medicare &...
11/28/2018
First Report Managed Care
News Connection
CMS to Expand Telehealth Services, Modernize MA Plans
11/28/2018
The Centers for Medicare & Medicaid Services (CMS) has proposed a new rule that aims at building upon the Administration’s ongoing efforts to modernize both the Medicare Advantage (MA) and Part D programs.
The Centers for Medicare & Medicaid Services (CMS) has proposed a new rule that aims at building upon the Administration’s ongoing efforts to modernize both the Medicare Advantage (MA) and Part D programs.
The Centers for Medicare &...
11/28/2018
First Report Managed Care
News Connection
Star Ratings Show Quality Improvements Among VA Medical Centers
11/28/2018
In an effort to be continually transparent and hold Veteran Affairs (VA) facilities accountable, the VA has released end of fiscal year 2018 hospital Star ratings. 
In an effort to be continually transparent and hold Veteran Affairs (VA) facilities accountable, the VA has released end of fiscal year 2018 hospital Star ratings. 
In an effort to be continually...
11/28/2018
First Report Managed Care
News Connection
Barriers to Caring for Veterans Among Non-VA Providers
11/28/2018
Due to a limited knowledge of resources and coordination problems, health care providers that are outside of the Department of Veteran Affairs (VA) are uncertain how to address veterans’ needs, according to a recent study published online in...
Due to a limited knowledge of resources and coordination problems, health care providers that are outside of the Department of Veteran Affairs (VA) are uncertain how to address veterans’ needs, according to a recent study published online in...
Due to a limited knowledge of...
11/28/2018
First Report Managed Care
Pharmacy Insight
Competition, Preferences Within a New Class of Drugs
11/28/2018
Russell J. Spjut, PharmD
A few months ago, I wrote an article about my initial impressions of the landscape of calcitonin gene-related peptide (CGRP) receptor antagonists for the treatment of migraines just after the launch of the first drug approved in this class,...
A few months ago, I wrote an article about my initial impressions of the landscape of calcitonin gene-related peptide (CGRP) receptor antagonists for the treatment of migraines just after the launch of the first drug approved in this class,...
A few months ago, I wrote an...
11/28/2018
First Report Managed Care
Conference Insider
Common Diabetes Medication Lowered Rates of Age-Related Macular Degeneration
11/28/2018
Researchers recently found that patients with type 2 diabetes taking metformin, a common diabetes medication, had a much lower rate of age-related macular degeneration (AMD). 
Researchers recently found that patients with type 2 diabetes taking metformin, a common diabetes medication, had a much lower rate of age-related macular degeneration (AMD). 
Researchers recently found that...
11/28/2018
First Report Managed Care
Conference Insider
Chronic Noninfectious Uveitis Safely Treated With Newly Approved Drug
11/28/2018
The efficacy and safety of EyePoint Pharmaceuticals Yutiq (fluocinolone acetonide intravitreal implant) 0.18 mg 3-year micro-insert for the treatment of chronic noninfectious uveitis affecting the posterior segment of the eye was supported by...
The efficacy and safety of EyePoint Pharmaceuticals Yutiq (fluocinolone acetonide intravitreal implant) 0.18 mg 3-year micro-insert for the treatment of chronic noninfectious uveitis affecting the posterior segment of the eye was supported by...
The efficacy and safety of...
11/28/2018
First Report Managed Care
Conference Insider
Detecting Early Alzheimer Disease With Noninvasive Imaging Device
11/28/2018
Currently, detecting Alzheimer disease (AD) is a challenge. However, a new, noninvasive imaging device—which examines the smallest veins in the back of the eye, including the red blood cells moving through the retina—can be used to detect...
Currently, detecting Alzheimer disease (AD) is a challenge. However, a new, noninvasive imaging device—which examines the smallest veins in the back of the eye, including the red blood cells moving through the retina—can be used to detect...
Currently, detecting Alzheimer...
11/28/2018
First Report Managed Care
Conference Insider
Treatment Effective for Resolving Ocular Inflammation, Pain Following Cataract Surgery
11/28/2018
According to a poster presented at the Annual Meeting of the American Academy of Ophthalmology, ocular inflammation and pain in patients following cataract surgery was effectively treated with KPI-121 1%. 
According to a poster presented at the Annual Meeting of the American Academy of Ophthalmology, ocular inflammation and pain in patients following cataract surgery was effectively treated with KPI-121 1%. 
According to a poster presented...
11/28/2018
First Report Managed Care
Conference Insider
The Impact of Copay Accumulator Programs on Autoimmune Specialty Drug Use
11/28/2018
A team of researchers found that patients with health savings accounts (HSAs) who are on autoimmune drugs had a significantly higher risk for discontinuation, lower proportion of days covered, and lower monthly fill rates after implementation...
A team of researchers found that patients with health savings accounts (HSAs) who are on autoimmune drugs had a significantly higher risk for discontinuation, lower proportion of days covered, and lower monthly fill rates after implementation...
A team of researchers found that...
11/28/2018
First Report Managed Care
Conference Insider
How Payers Are Using ICER Reports
11/28/2018
Despite the late timing of reports and less-than-transparent evaluation process, the Institute for Clinical and Economic Review (ICER) has potential to provide unbiased clinical and economic evaluations, according to a recent survey of...
Despite the late timing of reports and less-than-transparent evaluation process, the Institute for Clinical and Economic Review (ICER) has potential to provide unbiased clinical and economic evaluations, according to a recent survey of...
Despite the late timing of...
11/28/2018
First Report Managed Care
Conference Insider
Manufacturers Becoming More Proactive to ICER Assessments
11/28/2018
Manufacturers believe payers will begin to use the Institute for Clinical and Economic Review (ICER) assessments more frequently and that payers are also becoming more proactive by integrating ICER requirements into their evidence generation...
Manufacturers believe payers will begin to use the Institute for Clinical and Economic Review (ICER) assessments more frequently and that payers are also becoming more proactive by integrating ICER requirements into their evidence generation...
Manufacturers believe payers...
11/28/2018
First Report Managed Care
Conference Insider
Transparent Cost Information Positively Impacts Prescribing Trends
11/28/2018
According to a recent study presented at AMCP Nexus 2018, providing transparent cost information to prescribers resulted in a positive impact on prescribing trends, and researchers found that prescribers were willing to make retroactive...
According to a recent study presented at AMCP Nexus 2018, providing transparent cost information to prescribers resulted in a positive impact on prescribing trends, and researchers found that prescribers were willing to make retroactive...
According to a recent study...
11/28/2018
First Report Managed Care
Conference Insider
CAR-T Cost-Effectiveness Similar to Other Regimens
11/28/2018
Despite their high price tag, CAR-T regimens were found to be cost-effective compared with other recently approved novel anticancer regimens, according to recent research presented at AMCP Nexus 2018. 
Despite their high price tag, CAR-T regimens were found to be cost-effective compared with other recently approved novel anticancer regimens, according to recent research presented at AMCP Nexus 2018. 
Despite their high price tag,...
11/28/2018
First Report Managed Care
Department
Outcomes-Based Contracting Use Among Payers
11/28/2018
Outcomes-based contracting (OBC) is gaining traction as a tactic to reduce high drug costs, according to a recent study presented at AMCP Nexus 2018.
Outcomes-based contracting (OBC) is gaining traction as a tactic to reduce high drug costs, according to a recent study presented at AMCP Nexus 2018.
Outcomes-based contracting (OBC)...
11/28/2018
First Report Managed Care
Conference Insider
State Legislative Measures: Payer Familiarity With Efforts to Control Drug Costs
11/28/2018
According to the findings, where were presented at AMCP Nexus 2018, generic substitution (GS) and step-therapy (ST) were top concerns for payers, while manufacturer-sponsored drug coupons or copay cards (CB) and pricing transparency (PT)...
According to the findings, where were presented at AMCP Nexus 2018, generic substitution (GS) and step-therapy (ST) were top concerns for payers, while manufacturer-sponsored drug coupons or copay cards (CB) and pricing transparency (PT)...
According to the findings, where...
11/28/2018
First Report Managed Care
Conference Insider
Medication Therapy Management Program Cost-Effectiveness
11/28/2018
According to an analysis of pharmacy and medical claims among patients who received Medication Therapy Management (MTM)—a range of services provided to individual members to optimize therapeutic outcomes and to detect and prevent costly...
According to an analysis of pharmacy and medical claims among patients who received Medication Therapy Management (MTM)—a range of services provided to individual members to optimize therapeutic outcomes and to detect and prevent costly...
According to an analysis of...
11/28/2018
First Report Managed Care
Conference Insider
How a Payer-Provider Partnership Impacts Care
11/28/2018
According to recent research, a payer-provider collaboration allowed providers access to timely, actionable patient data related to Healthcare Effectiveness Data and Information Set (HEDIS) quality gaps.
According to recent research, a payer-provider collaboration allowed providers access to timely, actionable patient data related to Healthcare Effectiveness Data and Information Set (HEDIS) quality gaps.
According to recent research, a...
11/28/2018
First Report Managed Care
Conference Insider
How a Person-Centered Approach to Care Planning Improves Outcomes
11/28/2018
Katherine Tardiff, MSN, RN, GNP-BC, vice president of clinical operations at Seniorlink, discussed the impact that a person-centered care planning initiative had on satisfaction outcomes in complex populations, during a session at Health Care...
Katherine Tardiff, MSN, RN, GNP-BC, vice president of clinical operations at Seniorlink, discussed the impact that a person-centered care planning initiative had on satisfaction outcomes in complex populations, during a session at Health Care...
Katherine Tardiff, MSN, RN,...
11/28/2018
First Report Managed Care
Conference Insider
Care for Special Populations Requires Identifying Barriers, Solutions
11/28/2018
During a general session at Health Care Quality Congress, Pamela Riley, MD, MPH, medical director of the Department of Health Care Finance at the Government of the District of Columbia, discussed the health care needs of vulnerable...
During a general session at Health Care Quality Congress, Pamela Riley, MD, MPH, medical director of the Department of Health Care Finance at the Government of the District of Columbia, discussed the health care needs of vulnerable...
During a general session at...
11/28/2018
First Report Managed Care
Conference Insider
How Improved Population Health Can Lead to Better Care
11/28/2018
During a session at Health Care Quality Congress 2018, David Nash, MD, MBA, dean of Jefferson College of Population Health at Thomas Jefferson University, discussed how managing population health can help improve health care quality.
During a session at Health Care Quality Congress 2018, David Nash, MD, MBA, dean of Jefferson College of Population Health at Thomas Jefferson University, discussed how managing population health can help improve health care quality.
During a session at Health Care...
11/28/2018
First Report Managed Care
Conference Insider
Improving Care Quality Through Clinical Integration
11/28/2018
Patrick J Brennan, MD, senior vice president and chief medical officer of the Perelman Center for Advanced Medicine at Penn Medicine, discussed approaches taken by Penn Medicine to integrate and collaborate with payers.
Patrick J Brennan, MD, senior vice president and chief medical officer of the Perelman Center for Advanced Medicine at Penn Medicine, discussed approaches taken by Penn Medicine to integrate and collaborate with payers.
Patrick J Brennan, MD, senior...
11/28/2018
First Report Managed Care
Conference Insider
Understanding Current Providers, Health Plans, and the Government
11/28/2018
Nathan Bays, JD, managing director of Cain Brothers & Company, LLC, discussed the current policy environment and regulatory landscape during a session called, “Tightening the Beltway: Providers, Health Plans, the Government, and Making Sense...
Nathan Bays, JD, managing director of Cain Brothers & Company, LLC, discussed the current policy environment and regulatory landscape during a session called, “Tightening the Beltway: Providers, Health Plans, the Government, and Making Sense...
Nathan Bays, JD, managing...
11/28/2018
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 2018 Volume 15 Issue 11

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