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September 2016 - FRMC

Hospital Star Wars: Sounding Off on the New CMS Star Ratings
02/09/2017
Dean Celia
In an interview last year, Gary Owens, MD, noted that "star ratings work better for restaurants and movies.”
In an interview last year, Gary Owens, MD, noted that "star ratings work better for restaurants and movies.”
In an interview last year, Gary...
02/09/2017
First Report Managed Care
Department
Autoimmune Diseases: Rheumatoid Arthritis and Psoriatic Arthritis
09/16/2016
The First Report Managed Care Trends Report serves as a resource for managed care professionals making management decisions addressing the spectrum of disease states that continue to challenge health care providers.
The First Report Managed Care Trends Report serves as a resource for managed care professionals making management decisions addressing the spectrum of disease states that continue to challenge health care providers.
The First Report Managed Care...
09/16/2016
First Report Managed Care
Department
Featured Speaker: Former White House Health Care Advisor Chris Jennings
09/15/2016
On Tuesday October 4, 2016, Chris Jennings, president of Jennings Policy Strategies, and Mike Leavitt, former Utah Governor and HHS secretary, will discuss the future of health care under the next President of the United States during the...
On Tuesday October 4, 2016, Chris Jennings, president of Jennings Policy Strategies, and Mike Leavitt, former Utah Governor and HHS secretary, will discuss the future of health care under the next President of the United States during the...
On Tuesday October 4, 2016,...
09/15/2016
First Report Managed Care
Department
Meeting Preview: AMCP Nexus 2016
09/15/2016
The upcoming AMCP Nexus 2016 Meeting (October 3-6 at the Gaylord National Hotel & Convention Center in National Harbor, Maryland) will bring together thousands of managed care professionals from all across the United States.
The upcoming AMCP Nexus 2016 Meeting (October 3-6 at the Gaylord National Hotel & Convention Center in National Harbor, Maryland) will bring together thousands of managed care professionals from all across the United States.
The upcoming AMCP Nexus 2016...
09/15/2016
First Report Managed Care
California Bill Falters Amidst Drug Price Transparency Dispute
09/15/2016
Paul Nicolaus
All eyes are on California’s prescription drug price battle as this heavily contested issue of national importance plays out.
All eyes are on California’s prescription drug price battle as this heavily contested issue of national importance plays out.
All eyes are on California’s...
09/15/2016
First Report Managed Care
Payer Roundtable: Going Beyond Oncology Clinical Pathways
09/15/2016
Dean Celia
Clinical care pathways have the most traction in cancer management, but that hasn’t stopped some stakeholders from venturing into other areas. Atul Dhir, MD, and Bruce A Feinberg, DO, share their experiences adopting the pathways process to...
Clinical care pathways have the most traction in cancer management, but that hasn’t stopped some stakeholders from venturing into other areas. Atul Dhir, MD, and Bruce A Feinberg, DO, share their experiences adopting the pathways process to...
Clinical care pathways have the...
09/15/2016
First Report Managed Care
Opioid Addiction Treatment: Can Managed Care Make an Impact?
09/15/2016
Jill Sederstorm
As opioid misuse and addiction reach a boiling point in the United States, legislators, providers, and payers are taking steps to prevent abuse and improve treatment.
As opioid misuse and addiction reach a boiling point in the United States, legislators, providers, and payers are taking steps to prevent abuse and improve treatment.
As opioid misuse and addiction...
09/15/2016
First Report Managed Care
Formulary Frontlines®
Insulin Therapies: What is Behind the Escalating Cost?
09/15/2016
Eileen Koutnik-Fotopoulos
Understanding the factors driving diabetes treatment costs higher and higher.
Understanding the factors driving diabetes treatment costs higher and higher.
Understanding the factors...
09/15/2016
First Report Managed Care
Department
Study: Economic Burden of Skin Cancer Increasing in the US
09/15/2016
Recent research presented at the Summer Annual Meeting found that the amount of patients being screened and treated for skin cancer is substantial and increasing.
Recent research presented at the Summer Annual Meeting found that the amount of patients being screened and treated for skin cancer is substantial and increasing.
Recent research presented at the...
09/15/2016
First Report Managed Care
Department
Psoriasis Treatments May Improve Cardiovascular Symptoms
09/15/2016
According to research presented at the 2016 AAD Summer Annual Meeting, treating patients for psoriasis may help to reduce related cardiovascular symptoms by reducing overall inflammation.  
According to research presented at the 2016 AAD Summer Annual Meeting, treating patients for psoriasis may help to reduce related cardiovascular symptoms by reducing overall inflammation.  
According to research presented...
09/15/2016
First Report Managed Care
Department
Enbrel Effective, Safe Among Patients Who Lost Response to Humira
09/15/2016
Using Enbrel (etanercept; Amgen) for treatment of plaque psoriasis was safe and effective among patients who lost response to Humira (adalimumab; AbbVie), according to recent data presented at the 2016 AAD Summer Annual Meeting.
Using Enbrel (etanercept; Amgen) for treatment of plaque psoriasis was safe and effective among patients who lost response to Humira (adalimumab; AbbVie), according to recent data presented at the 2016 AAD Summer Annual Meeting.
Using Enbrel (etanercept; Amgen)...
09/15/2016
First Report Managed Care
Managed Care Q&A
Evaluating the Effectiveness of the Choosing Wisely Initiative
09/15/2016
David Costill
An interview with Daniel B Wolfson, MBA, executive vice president and COO of the ABIM Foundation.
An interview with Daniel B Wolfson, MBA, executive vice president and COO of the ABIM Foundation.
An interview with Daniel B...
09/15/2016
First Report Managed Care
News Connection
Pharmacists Weigh in On Preferences for Naming Biosimilars
09/15/2016
Recent results from a survey of pharmacists showed that they prefer naming a biosimilar using the nonproprietary name with a designated suffix; however, many pharmacists believe dispensing these drugs would be higher if a biosimilar and...
Recent results from a survey of pharmacists showed that they prefer naming a biosimilar using the nonproprietary name with a designated suffix; however, many pharmacists believe dispensing these drugs would be higher if a biosimilar and...
Recent results from a survey of...
09/15/2016
First Report Managed Care
News Connection
New Payment Models Needed For Financial Viability of Team-Based Care
09/15/2016
Implementation of a team-based care system in a primary care practice for managing patients with coronary heart disease (CHD) improved patient outcomes but had a negative financial impact on primary care under a fee-for-service (FFS) payment...
Implementation of a team-based care system in a primary care practice for managing patients with coronary heart disease (CHD) improved patient outcomes but had a negative financial impact on primary care under a fee-for-service (FFS) payment...
Implementation of a team-based...
09/15/2016
First Report Managed Care
News Connection
Medicare Advantage Plans Pay Less to Hospitals than Traditional Medicare Plans
09/15/2016
According to a recent study, Medicare Advantage plans pay less for hospital services than traditional fee-for-service Medicare.
According to a recent study, Medicare Advantage plans pay less for hospital services than traditional fee-for-service Medicare.
According to a recent study,...
09/15/2016
First Report Managed Care
News Connection
Magnitude of Non-Rare Disease Use of Orphan Drugs May Inflate Prices
09/15/2016
A recent report by the American Health Insurance Plans determined that of the orphan drugs developed between 2012 and 2014, approximately half were used for non-orphan diseases.
A recent report by the American Health Insurance Plans determined that of the orphan drugs developed between 2012 and 2014, approximately half were used for non-orphan diseases.
A recent report by the American...
09/15/2016
First Report Managed Care
News Connection
Low-Value Services Still Costing Insurers Millions
09/15/2016
Nearly 8% of patients out of a national sample of almost 1.5 million commercially insured adults received health services considered low-value in 2013, according to a study in JAMA Internal Medicine. The cost of those services totaled $32.8...
Nearly 8% of patients out of a national sample of almost 1.5 million commercially insured adults received health services considered low-value in 2013, according to a study in JAMA Internal Medicine. The cost of those services totaled $32.8...
Nearly 8% of patients out of a...
09/15/2016
First Report Managed Care
News Connection
Opioid Dependence Claims Soar Among Privately Insured
09/15/2016
Recent data from the nonprofit FAIR Health discovered that private health insurance claims for opioid dependence increased 3203% as well claims for opioids misuse which increased by 317%, between 2007 and 2014. 
Recent data from the nonprofit FAIR Health discovered that private health insurance claims for opioid dependence increased 3203% as well claims for opioids misuse which increased by 317%, between 2007 and 2014. 
Recent data from the nonprofit...
09/15/2016
First Report Managed Care
News Connection
ACA Coverage Leads to More Prescriptions, Less Out-of-Pocket Costs
09/15/2016
People who gained insurance coverage following the Patient Protection and Affordable Care Act (ACA) coverage expansion filled more prescriptions and paid significantly less out-of-pocket compared with those who lacked health coverage,...
People who gained insurance coverage following the Patient Protection and Affordable Care Act (ACA) coverage expansion filled more prescriptions and paid significantly less out-of-pocket compared with those who lacked health coverage,...
People who gained insurance...
09/15/2016
First Report Managed Care
News Connection
Cash Incentives Fail to Improve Care for Complex Patients
09/15/2016
Recent research determined that paying primary care physicians a $315 per-complex-patient annual fee did not improve care, decrease hospitalizations, or save costs. 
Recent research determined that paying primary care physicians a $315 per-complex-patient annual fee did not improve care, decrease hospitalizations, or save costs. 
Recent research determined that...
09/15/2016
First Report Managed Care
News Connection
NHS England Limits Hepatitis C Drug Access Due to High Costs
09/15/2016
England’s National Health Service (NHS) is intentionally hindering access to the pricey hepatitis C drugs Sovaldi (sofosbuvir; Gilead) and Harvoni (ledipasvir/sofosbuvir; Gilead) due to worries over how it will afford them, according to an...
England’s National Health Service (NHS) is intentionally hindering access to the pricey hepatitis C drugs Sovaldi (sofosbuvir; Gilead) and Harvoni (ledipasvir/sofosbuvir; Gilead) due to worries over how it will afford them, according to an...
England’s National Health...
09/15/2016
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

September 2016 Volume 13 Issue 9

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