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October 2016 - FRMC

Featured Article

House of Cards: How Much Longer Can the ACA Hold Up?
10/20/2016
Paul Nicolaus
With insurers pulling out, premiums on the rise, and the presidential election on the way, the fate of Obamacare hangs in the balance. 
With insurers pulling out, premiums on the rise, and the presidential election on the way, the fate of Obamacare hangs in the balance. 
With insurers pulling out,...
10/20/2016
First Report Managed Care
News Connection
Alternative Management Strategies Achieve Comparable Clinical Outcomes
11/20/2016
A recently published review suggests that alternatives to inpatient hospitalization do not jeopardize the treatment of several acute medical conditions.
A recently published review suggests that alternatives to inpatient hospitalization do not jeopardize the treatment of several acute medical conditions.
A recently published review...
11/20/2016
First Report Managed Care
Orphan Drugs: Rare Disease Treatments Becoming Commonplace
10/20/2016
Mary Beth Nierengarten
As the popularity of rare-disease indicated orphan drugs increases, payers are becoming concerned about whether or not these prescriptions are entirely necessary.
As the popularity of rare-disease indicated orphan drugs increases, payers are becoming concerned about whether or not these prescriptions are entirely necessary.
As the popularity of...
10/20/2016
First Report Managed Care
Presidential Plans to Fix Drug Pricing: Would Either Work?
10/20/2016
Dean Celia
Recent controversy related to drug price gouging has pushed the issue onto the political stage in the midst of the 2016 Presidential election. Each candidate has taken a stance against allowing drug companies to unnecessarily raise prices to...
Recent controversy related to drug price gouging has pushed the issue onto the political stage in the midst of the 2016 Presidential election. Each candidate has taken a stance against allowing drug companies to unnecessarily raise prices to...
Recent controversy related to...
10/20/2016
First Report Managed Care
News
Untangling the Mylan EpiPen Controversy
10/20/2016
Dean Celia
After public backlash against exorbitant price increases for the EpiPen, industry leaders are weighing in on the practicality of the new price and the validity of possible solutions presented by its manufacturer.
After public backlash against exorbitant price increases for the EpiPen, industry leaders are weighing in on the practicality of the new price and the validity of possible solutions presented by its manufacturer.
After public backlash against...
10/20/2016
First Report Managed Care
Managed Care Q&A
Implementing Value-Based Care Through Clinically Integrated Organizations
10/20/2016
David Costill
An interview with Chad Johnson, senior vice president and executive director, Phoenix Children’s Care Network.
An interview with Chad Johnson, senior vice president and executive director, Phoenix Children’s Care Network.
An interview with Chad...
10/20/2016
First Report Managed Care
News Connection
Republican Lawmakers Warn of MACRA’s Impact on Small Practices
10/20/2016
A group of Republican lawmakers are urging the Centers for Medicare and Medicaid Services (CMS) to revise its proposed implementation of the Medicare Access and CHIP Reauthorization Act, or MACRA, of 2015, which they argue would complicate...
A group of Republican lawmakers are urging the Centers for Medicare and Medicaid Services (CMS) to revise its proposed implementation of the Medicare Access and CHIP Reauthorization Act, or MACRA, of 2015, which they argue would complicate...
A group of Republican lawmakers...
10/20/2016
First Report Managed Care
News Connection
Investigation Reveals "Gross Mismanagement" to Blame for Denver VA Facility`s Exorbitant Cost
10/20/2016
An internal investigation by the US Department of Veterans’ Affairs (VA) found that the bloated budget and costly delays for construction of a new VA medical campus near Denver, Colorado were caused by gross mismanagement.
An internal investigation by the US Department of Veterans’ Affairs (VA) found that the bloated budget and costly delays for construction of a new VA medical campus near Denver, Colorado were caused by gross mismanagement.
An internal investigation by the...
10/20/2016
First Report Managed Care
News Connection
Non-TNF-targeted Biologics Most Effective After RA Treatment Failure
10/20/2016
According to recent research, for rheumatoid arthritis patients who have failed initial anti-tumor necrosis factor therapy, care providers should consider a non–TNF-targeted biologic due to a an effictive clinical response.
According to recent research, for rheumatoid arthritis patients who have failed initial anti-tumor necrosis factor therapy, care providers should consider a non–TNF-targeted biologic due to a an effictive clinical response.
According to recent research,...
10/20/2016
First Report Managed Care
News Connection
Malnutrition Contributes $15.5 Billion to Nationwide Medical Spending Annually
10/20/2016
Malnutrition associated with disease is responsible for more than $15.5 billion in direct medical costs each year, and is disproportionately driven by patients aged 65 years or older, according to an economic analysis recently published in...
Malnutrition associated with disease is responsible for more than $15.5 billion in direct medical costs each year, and is disproportionately driven by patients aged 65 years or older, according to an economic analysis recently published in...
Malnutrition associated with...
10/20/2016
First Report Managed Care
News Connection
MI Survival Rates Extended at High-Performing Hospitals
10/20/2016
A recent analysis suggests myocardial infarction patients who were treated in health care institutions that demonstrated favorable 30-day risk-standardized mortality rates, also had longer life expectancies when compared to patients who were...
A recent analysis suggests myocardial infarction patients who were treated in health care institutions that demonstrated favorable 30-day risk-standardized mortality rates, also had longer life expectancies when compared to patients who were...
A recent analysis suggests...
10/20/2016
First Report Managed Care
News Connection
Payment Fears Drive Americans to Delay Emergency Care
10/20/2016
Approximately 1 in 4 Americans reported worsened medical conditions after postponing an ED visit due to cost and insurance coverage concerns.
Approximately 1 in 4 Americans reported worsened medical conditions after postponing an ED visit due to cost and insurance coverage concerns.
Approximately 1 in 4 Americans...
10/20/2016
First Report Managed Care
News Connection
Anthem Refuses To Cover Exondys 51 Citing Lack of Efficacy Evidence
10/20/2016
The largest US health insurer, Anthem Inc, recently announced it would not cover the first FDA-approved Duchenne muscular dystrophy drug (DMD), Exondys 51 (eteplirsen; Sarepta Therapeutics) due to concerns over clinical trial data.
The largest US health insurer, Anthem Inc, recently announced it would not cover the first FDA-approved Duchenne muscular dystrophy drug (DMD), Exondys 51 (eteplirsen; Sarepta Therapeutics) due to concerns over clinical trial data.
The largest US health insurer,...
10/20/2016
First Report Managed Care
News Connection
Random, Inconsistent Price Hikes Hitting Hospitals Hard
10/20/2016
Inpatient drug costs rose 38.7% per admission between 2013 and 2015, according to a new analysis from the National Opinion Research Center at the University of Chicago.
Inpatient drug costs rose 38.7% per admission between 2013 and 2015, according to a new analysis from the National Opinion Research Center at the University of Chicago.
Inpatient drug costs rose 38.7%...
10/20/2016
First Report Managed Care
News Connection
Statewide Programs Should Track All Prescriptions, Not Just Opiates
10/20/2016
A recent commentary in The American Journal of Managed Care suggests that policymakers should expand prescription drug monitoring programs to include all medications instead of opiates alone to help reduce outpatient medication errors.
A recent commentary in The American Journal of Managed Care suggests that policymakers should expand prescription drug monitoring programs to include all medications instead of opiates alone to help reduce outpatient medication errors.
A recent commentary in The...
10/20/2016
First Report Managed Care
News Connection
Payer Pressure on MBHOs Can Improve Psychiatric Care
10/20/2016
According to a recent editorial, pressure from a patient or payer often rectifies situations where managed behavioral health care organizations are providing poor psychiatric treatment.
According to a recent editorial, pressure from a patient or payer often rectifies situations where managed behavioral health care organizations are providing poor psychiatric treatment.
According to a recent editorial,...
10/20/2016
First Report Managed Care
Trends Report
Autoimmune Diseases: Psoriasis and Atopic Dermatitis
10/20/2016
This will serve as part 2 of the 3-part First Report Managed Care Trends Report on autoimmune diseases. This second part will report the findings from survey participants on psoriasis and atopic dermatitis.
This will serve as part 2 of the 3-part First Report Managed Care Trends Report on autoimmune diseases. This second part will report the findings from survey participants on psoriasis and atopic dermatitis.
This will serve as part 2 of the...
10/20/2016
First Report Managed Care
Formulary Frontlines®
Asthma Therapy: Understanding the Factors Contributing to the Cost Burden
10/20/2016
Eileen Koutnik-Fotopoulos; David Costill
According to the CDC, asthma affects approximately 26 million Americans at an incremental cost of $56 billion annually; while Medicaid spends over $10 billion per year treating asthma. Severe asthma caused by poor medication adherence leads...
According to the CDC, asthma affects approximately 26 million Americans at an incremental cost of $56 billion annually; while Medicaid spends over $10 billion per year treating asthma. Severe asthma caused by poor medication adherence leads...
According to the CDC, asthma...
10/20/2016
First Report Managed Care
Department
Better Coverage Needed for Increasing Trend of Genetic Testing Utilization
10/20/2016
An increase in genetic testing expenditures in specialty pharmacy requires improved coverage as utilization and expenditures are expected to grow in the coming years, according to recent research at the 2016 NASP Annual Meeting.
An increase in genetic testing expenditures in specialty pharmacy requires improved coverage as utilization and expenditures are expected to grow in the coming years, according to recent research at the 2016 NASP Annual Meeting.
An increase in genetic testing...
10/20/2016
First Report Managed Care
Department
Patient Assistance, Copay Assistance Increase Access to Specialty Pharmacy Drugs
10/20/2016
Implementation of patient assistance programs and copay assistance programs increased access to specialty medications.
Implementation of patient assistance programs and copay assistance programs increased access to specialty medications.
Implementation of patient...
10/20/2016
First Report Managed Care
Department
“Smart Pill-Bottle” Significantly Improves Medication Adherence
10/20/2016
Research showed that use of a “smart pill-bottle,” which provides additional reminders and instructions to patients, increased medication adherence.
Research showed that use of a “smart pill-bottle,” which provides additional reminders and instructions to patients, increased medication adherence.
Research showed that use of a...
10/20/2016
First Report Managed Care
Department
Specialty Pharmacy Collaboration Improves Access to Hepatitis C Drugs
10/20/2016
A coordination program between a specialty pharmacy and specialty clinics helped to promote and improve access to direct acting antiviral therapies for hepatitis C, according to an abstract presented at the 2016 NASP Annual Meeting.
A coordination program between a specialty pharmacy and specialty clinics helped to promote and improve access to direct acting antiviral therapies for hepatitis C, according to an abstract presented at the 2016 NASP Annual Meeting.
A coordination program between a...
10/20/2016
First Report Managed Care
Department
Lower Out-of-Pocket Costs, Treatment Satisfaction Linked to Improved Medication Adherence
10/20/2016
Recent research presented at the 2016 NASP Annual Meeting found that when out-of-pocket costs are lower and treatment satisfaction is high, patients with multiple sclerosis (MS) are more likely to adhere to disease-modifying drugs.
Recent research presented at the 2016 NASP Annual Meeting found that when out-of-pocket costs are lower and treatment satisfaction is high, patients with multiple sclerosis (MS) are more likely to adhere to disease-modifying drugs.
Recent research presented at the...
10/20/2016
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

October 2016 Volume 13 Issue 10

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