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October 2017 - FRMC

Featured Article

News
Health Care Goes to Silicon Valley: The Future of Managed Care Part 2
10/26/2017
Dean Celia
Amazon is eyeing the pharmaceutical business; Apple has the attention of a big insurer; Google’s sister company is aiming to produce data-driven interventions— but what does it all mean for payers?
Amazon is eyeing the pharmaceutical business; Apple has the attention of a big insurer; Google’s sister company is aiming to produce data-driven interventions— but what does it all mean for payers?
Amazon is eyeing the...
10/26/2017
First Report Managed Care
News
Advances in HIV Treatment: Better Control For Higher Prices
10/26/2017
Mary Beth Nierengarten
Research and development in HIV treatment over the last decade has turned what was once a deadly disease into a treatable chronic condition. However, while groundbreaking new regimens are continually coming to the market in fewer daily doses,...
Research and development in HIV treatment over the last decade has turned what was once a deadly disease into a treatable chronic condition. However, while groundbreaking new regimens are continually coming to the market in fewer daily doses,...
Research and development in HIV...
10/26/2017
First Report Managed Care
Formulary Frontlines®
Breakthroughs in Acute Myeloid Leukemia
10/26/2017
Russell J. Spjut, PharmD
S Russell Spjut, PharmD, discusses current first-line therapies and new treatment opions used to treat acute myeloid leukemia and their associated costs. 
S Russell Spjut, PharmD, discusses current first-line therapies and new treatment opions used to treat acute myeloid leukemia and their associated costs. 
S Russell Spjut, PharmD,...
10/26/2017
First Report Managed Care
News
Brands Over Generics: Some Formularies Break The Golden Rule
10/26/2017
Eileen Koutnik-Fotopoulos
Some formularies are pushing patients away from cheaper generics in favor of high cost generics. We spoke with some managed care experts to understand why this practice is in place for some insurers.
Some formularies are pushing patients away from cheaper generics in favor of high cost generics. We spoke with some managed care experts to understand why this practice is in place for some insurers.
Some formularies are pushing...
10/26/2017
First Report Managed Care
Managed Care Q&A
New Payment Models Needed to Handle Gene Therapies
10/26/2017
Julie Gould; Zachary Bessette
Steve Miller, MD, MBA, chief medical officer of Express Scripts, discusses how payers are going to have to become innovative in order to pay the high prices associated with gene therapy.
Steve Miller, MD, MBA, chief medical officer of Express Scripts, discusses how payers are going to have to become innovative in order to pay the high prices associated with gene therapy.
Steve Miller, MD, MBA, chief...
10/26/2017
First Report Managed Care
News
Health Care Goes to Silicon Valley: The Future of Managed Care Part 1
10/26/2017
Dean Celia
Amazon is eyeing the pharmaceutical business; Apple has the attention of a big insurer; Google’s sister company is aiming to produce data-driven interventions— but what does it all mean for payers?
Amazon is eyeing the pharmaceutical business; Apple has the attention of a big insurer; Google’s sister company is aiming to produce data-driven interventions— but what does it all mean for payers?
Amazon is eyeing the...
10/26/2017
First Report Managed Care
Conference Insider
Can Clinical Pathways Support Person-Centered Care and Improve Outcomes?
10/25/2017
During a presentation at the 2017 Clinical Pathways Congress, Alan Balch, PhD, explained that clinical pathway development needs to do a better job at taking the patient perspective into account when providing cancer care.
During a presentation at the 2017 Clinical Pathways Congress, Alan Balch, PhD, explained that clinical pathway development needs to do a better job at taking the patient perspective into account when providing cancer care.
During a presentation at the...
10/25/2017
First Report Managed Care
Conference Insider
Biosimilars: The Next Big Thing in Oncology Clinical Pathways?
10/25/2017
Biosimilars occupy a huge place in the oncology treatment conversation these days. But what are they exactly, and how will they impact clinical pathways?
Biosimilars occupy a huge place in the oncology treatment conversation these days. But what are they exactly, and how will they impact clinical pathways?
Biosimilars occupy a huge place...
10/25/2017
First Report Managed Care
Conference Insider
FDA Commissioner: Agency Focused on Reducing Inefficiencies and Costs of New Drug Development
10/25/2017
During the keynote speech at the RAPS 2017 Regulatory Convergence, Scott Gottlieb, MD, commissioner of the FDA, explained that the agency is focused on making drug development more efficient and cheaper in order to expedite approvals and...
During the keynote speech at the RAPS 2017 Regulatory Convergence, Scott Gottlieb, MD, commissioner of the FDA, explained that the agency is focused on making drug development more efficient and cheaper in order to expedite approvals and...
During the keynote speech at the...
10/25/2017
First Report Managed Care
Conference Insider
Diabetes Research Finds Hypoglycemia Increases Death Risk Four-Fold
10/25/2017
Researcher presented at the European Association for the Study of Diabetes 2017 (EASD) in Lisbon, Portugal, highlighted the significant risk of death caused by hypoglycemia among patients with diabetes.
Researcher presented at the European Association for the Study of Diabetes 2017 (EASD) in Lisbon, Portugal, highlighted the significant risk of death caused by hypoglycemia among patients with diabetes.
Researcher presented at the...
10/25/2017
First Report Managed Care
Conference Insider
Biosimilar Uptake Could Cut Specialty Pharmacy Costs
10/25/2017
In order for biosimilars to relieve the impact of high cost specialty pharmacy drugs, more uptake and education is need for patients, providers, and payers, according to a presentation at the National Association of Specialty Pharmacy Annual...
In order for biosimilars to relieve the impact of high cost specialty pharmacy drugs, more uptake and education is need for patients, providers, and payers, according to a presentation at the National Association of Specialty Pharmacy Annual...
In order for biosimilars to...
10/25/2017
First Report Managed Care
Conference Insider
Pharmacist Consultation Improved HIV Outcomes, Adherence
10/25/2017
A new medication therapy management and pharmacy consultation service, the Ubuntu Pharmacist Care Program, helped to improve the continuum of care for patients with HIV, according to a presentation at the National Association of Specialty...
A new medication therapy management and pharmacy consultation service, the Ubuntu Pharmacist Care Program, helped to improve the continuum of care for patients with HIV, according to a presentation at the National Association of Specialty...
A new medication therapy...
10/25/2017
First Report Managed Care
Conference Insider
Cost Management Crucial for Hemophilia Specialty Pharmacy
10/25/2017
According to recent research presented at the National Association of Specialty Pharmacy Annual Meeting & Expo 2017, engagement with stakeholders in quality improvement and cost management initiatives for hemophilia specialty medications are...
According to recent research presented at the National Association of Specialty Pharmacy Annual Meeting & Expo 2017, engagement with stakeholders in quality improvement and cost management initiatives for hemophilia specialty medications are...
According to recent research...
10/25/2017
First Report Managed Care
Conference Insider
Payers Must Adopt New Agents, Pathways in Order to Improve Oncology Care
10/25/2017
The emergence of new treatment options requires payers to expeditiously evaluate and adopt newer agents and pathways as they become available, according to research presented at the National Association of Specialty Pharmacy Annual Meeting &...
The emergence of new treatment options requires payers to expeditiously evaluate and adopt newer agents and pathways as they become available, according to research presented at the National Association of Specialty Pharmacy Annual Meeting &...
The emergence of new treatment...
10/25/2017
First Report Managed Care
Conference Insider
Trends in Cholesterol Management Show Payers Prefer Cheaper Generics
10/25/2017
According to a presentation by Richard Brook and colleagues, payers are likely to favor less expensive, generically available agents until real-world data provides justification for use of PCSK9 inhibitors. 
According to a presentation by Richard Brook and colleagues, payers are likely to favor less expensive, generically available agents until real-world data provides justification for use of PCSK9 inhibitors. 
According to a presentation by...
10/25/2017
First Report Managed Care
Conference Insider
Preview of PCMH Congress 2017
10/25/2017
The 2017 PCMH Congress, the NCQA’s annual meeting (November 3 – 5 at the Hyatt Regency in Orlando, Florida), is a chance for health care providers and decision makers to come together in order to gain a better understanding of the advances in...
The 2017 PCMH Congress, the NCQA’s annual meeting (November 3 – 5 at the Hyatt Regency in Orlando, Florida), is a chance for health care providers and decision makers to come together in order to gain a better understanding of the advances in...
The 2017 PCMH Congress, the...
10/25/2017
First Report Managed Care
News Connection
Tom Price Resigns as HHS Secretary After Private Jet Scandal
10/25/2017
HHS Secretary Tom Price, MD, has resigned following the controversy surrounding his use of private planes for government-related travel at a high cost to taxpayers.
HHS Secretary Tom Price, MD, has resigned following the controversy surrounding his use of private planes for government-related travel at a high cost to taxpayers.
HHS Secretary Tom Price, MD, has...
10/25/2017
First Report Managed Care
News Connection
CMS Expects Medicare Advantage to Enroll More Patients in 2018
10/25/2017
The CMS recently announced that Medicare Advantage is expected to enroll more members in 2018 and cost less than previous years.
The CMS recently announced that Medicare Advantage is expected to enroll more members in 2018 and cost less than previous years.
The CMS recently announced that...
10/25/2017
First Report Managed Care
News Connection
Cigna Drops OxyContin, Signs Value-Based Contract For Xtampza ER
10/25/2017
Cigna, one of the nation’s largest insurers, has announced it will stop covering OxyContin in favor of an abuse-derrent formulation, Xtampza ER (oxycodone, Collegium), according to a recent press release.
Cigna, one of the nation’s largest insurers, has announced it will stop covering OxyContin in favor of an abuse-derrent formulation, Xtampza ER (oxycodone, Collegium), according to a recent press release.
Cigna, one of the nation’s...
10/25/2017
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

Commentary
Next-Generation Utilization Management: Managing Utilization and Cost Without Denial of Service​​​
03/01/2024
Amit Gupta, MD
Utilization management is evolving from a cost-centric process to a focus on quality of care, with trends including exception-based authorization handling and value-based arrangements to reduce administrative burden and provider abrasion.
Utilization management is evolving from a cost-centric process to a focus on quality of care, with trends including exception-based authorization handling and value-based arrangements to reduce administrative burden and provider abrasion.
Utilization management is...
03/01/2024
First Report Managed Care
Shannon Smith Headshot
Commentary
Adapting to Change: Navigating the New CMS Prior Authorization Guidelines in Health Care
04/02/2024

Shannon Smith, RN, BSN

Shannon Smith, RN, BSN
As the health care industry prepares for the Centers for Medicare & Medicaid Services (CMS) to implement new guidelines to streamline prior authorization procedures, significant operational changes are on the horizon for health care payers....
As the health care industry prepares for the Centers for Medicare & Medicaid Services (CMS) to implement new guidelines to streamline prior authorization procedures, significant operational changes are on the horizon for health care payers....
As the health care industry...
04/02/2024
First Report Managed Care
Conference Coverage
Rare Orphan, Oncology, and Specialty Drugs in Development: Review of Therapeutic Areas, Designations, and Launch Projections
05/01/2024
Danielle Sposato
The specialty pharmacy pipeline was the subject of one of many informative sessions at the annual Asembia Summit this year. Key insights were shared about current drugs in the pipeline according to their drug designations, the phase of each...
The specialty pharmacy pipeline was the subject of one of many informative sessions at the annual Asembia Summit this year. Key insights were shared about current drugs in the pipeline according to their drug designations, the phase of each...
The specialty pharmacy pipeline...
05/01/2024
First Report Managed Care
News
Using Mindfulness-Based Intervention to Improve Fatigue, Mood Challenges in Adolescents With Neuroimmune Disease
05/28/2024
Grace Taylor, MS, MA
Study examines the effectiveness of the Learning to BREATHE mindfulness-based intervention in improving fatigue and mood challenges in a adolescent population with neuroimmune disease.
Study examines the effectiveness of the Learning to BREATHE mindfulness-based intervention in improving fatigue and mood challenges in a adolescent population with neuroimmune disease.
Study examines the effectiveness...
05/28/2024
First Report Managed Care
Leyla Henderson
Conference Coverage
Strategies for Enhancing Infusion Patient Experiences
07/10/2024
Leyla Henderson
An NICA 2024 session speaker shares innovative strategies for enhancing patient satisfaction and improving outcomes in health care settings, emphasizing the importance of patient-centered care and individualized experiences.
An NICA 2024 session speaker shares innovative strategies for enhancing patient satisfaction and improving outcomes in health care settings, emphasizing the importance of patient-centered care and individualized experiences.
An NICA 2024 session speaker...
07/10/2024
First Report Managed Care

October 2017 Volume 14 Issue 10

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