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Volume 16, Issue 8, August 2019 - First Report Managed Care

Featured Article

Will New Guidance Improve Outcomes in Patients With Chronic Conditions?
08/26/2019
Dean Celia
The IRS, with input from HHS, expands list of preventive care options for HSA participants with high deductible health plans; our experts offer insights, predict the level of adoption, and address potential downsides.
The IRS, with input from HHS, expands list of preventive care options for HSA participants with high deductible health plans; our experts offer insights, predict the level of adoption, and address potential downsides.
The IRS, with input from HHS,...
08/26/2019
First Report Managed Care
Ensuring Access to Primary Care for Medicare Beneficiaries
08/26/2019
Mary Beth Nierengarten
The June MEDPAC report outlines areas where improvement is needed, emphasizing the importance of Medicare beneficiaries’ access to primary care and increasing incentive for medical students to choose primary care as a career choice.
The June MEDPAC report outlines areas where improvement is needed, emphasizing the importance of Medicare beneficiaries’ access to primary care and increasing incentive for medical students to choose primary care as a career choice.
The June MEDPAC report outlines...
08/26/2019
First Report Managed Care
Formulary Frontlines®
Innovations in Managing Hemophilia
08/26/2019
Eileen Koutnik-Fotopoulos
Although hemophilia is designated an orphan disease by the FDA because it affects fewer than 200,000 people in the United States, it imposes a significant financial and burden on patients, caregivers, and society.
Although hemophilia is designated an orphan disease by the FDA because it affects fewer than 200,000 people in the United States, it imposes a significant financial and burden on patients, caregivers, and society.
Although hemophilia is...
08/26/2019
First Report Managed Care
Formulary Frontlines®
Innovations in Managing Hemophilia
08/26/2019
Eileen Koutnik-Fotopoulos
Although hemophilia is designated an orphan disease by the FDA because it affects fewer than 200,000 people in the United States, it imposes a significant financial and burden on patients, caregivers, and society.
Although hemophilia is designated an orphan disease by the FDA because it affects fewer than 200,000 people in the United States, it imposes a significant financial and burden on patients, caregivers, and society.
Although hemophilia is...
08/26/2019
First Report Managed Care
Commentary
ACOs Matter More Than Ever Despite Uneven Growth
08/26/2019
Robin Lloyd
Robin Lloyd, chief commercial officer, Health Fidelity, discusses the latest trends and policy changes impacting ACOs and reflects on new federal policies, highlighting future opportunities in value-based care.
Robin Lloyd, chief commercial officer, Health Fidelity, discusses the latest trends and policy changes impacting ACOs and reflects on new federal policies, highlighting future opportunities in value-based care.
Robin Lloyd, chief commercial...
08/26/2019
First Report Managed Care
Managed Care Q&A
Discussing Biosimilars: Barriers and Cost Effectiveness, Part 1
08/26/2019
Edan Stanley
Scott Vogel, partner and PBM executive, Confidio, recently spoke about the many challenges biosimilars face coming to market and where the market might be heading.
Scott Vogel, partner and PBM executive, Confidio, recently spoke about the many challenges biosimilars face coming to market and where the market might be heading.
Scott Vogel, partner and PBM...
08/26/2019
First Report Managed Care
Managed Care Q&A
Discussing Biosimilars: Barriers and Cost Effectiveness, Part 2
08/26/2019
Edan Stanley
Sonja Quale, PharmD, chief clinical officer and vice president of informatics, Confidio, recently spoke about the many challenges biosimilars face coming to market and where the market might be heading
Sonja Quale, PharmD, chief clinical officer and vice president of informatics, Confidio, recently spoke about the many challenges biosimilars face coming to market and where the market might be heading
Sonja Quale, PharmD, chief...
08/26/2019
First Report Managed Care
Conference Insider
PBMI Specialty Rx Forum: Getting the Most from Your Specialty Contract
08/26/2019
Edan Stanley
Gregory O Callahan, MBA, consultant, and Brian N Anderson, MBA, principal, both from Milliman, a consulting and actuarial firm, offer expertise on how to maximize the effectiveness of specialty contracts.
Gregory O Callahan, MBA, consultant, and Brian N Anderson, MBA, principal, both from Milliman, a consulting and actuarial firm, offer expertise on how to maximize the effectiveness of specialty contracts.
Gregory O Callahan, MBA,...
08/26/2019
First Report Managed Care
Conference Insider
Preparing Payers for the New Therapies in the Pipeline
08/26/2019
Edan Stanley
Susan Trieu, PharmD, director of enterprise specialty clinical solutions at MedImpact Health Systems, discusses new therapies in the pipeline and what payers should focus on.
Susan Trieu, PharmD, director of enterprise specialty clinical solutions at MedImpact Health Systems, discusses new therapies in the pipeline and what payers should focus on.
Susan Trieu, PharmD, director of...
08/26/2019
First Report Managed Care
News Connection
CMS to Expand Coverage for Ambulatory Blood Pressure Monitoring
08/26/2019
The Centers for Medicare & Medicaid Services announced a plan to expand coverage for ambulatory blood pressure monitoring (ABPM) in response to a request from stakeholders.
The Centers for Medicare & Medicaid Services announced a plan to expand coverage for ambulatory blood pressure monitoring (ABPM) in response to a request from stakeholders.
The Centers for Medicare &...
08/26/2019
First Report Managed Care
News Connection
Public Charge Rule Change Threatens Coverage for Millions of Children
08/26/2019
In October 2018, the Trump administration proposed rule changes to the criteria immigration officials use to determine whether an immigrant becomes a public charge and a recent study shows that these changes could result in over 8 million...
In October 2018, the Trump administration proposed rule changes to the criteria immigration officials use to determine whether an immigrant becomes a public charge and a recent study shows that these changes could result in over 8 million...
In October 2018, the Trump...
08/26/2019
First Report Managed Care
News Connection
Reduced Hep C Treatment Costs, Increased Manufacturer Revenue Under 340B
08/26/2019
According to a recent JAMA Network Open study, reduced list prices for hepatitis C treatments might have increased net revenue for drug manufacturers, due to lower discounts in the 340B program, as well as the higher share of sales using the...
According to a recent JAMA Network Open study, reduced list prices for hepatitis C treatments might have increased net revenue for drug manufacturers, due to lower discounts in the 340B program, as well as the higher share of sales using the...
According to a recent JAMA...
08/26/2019
First Report Managed Care
News Connection
MedPAC Urges Congress to Adopt Reforms to Improve Medicare Advantage
08/26/2019
The Medicare Payment Advisory Commission (MedPAC) recently submitted its 2019 annual report on Medicare payment policy to Congress with recommendations on billing reform in primary care, creating better access including eliminating “incident...
The Medicare Payment Advisory Commission (MedPAC) recently submitted its 2019 annual report on Medicare payment policy to Congress with recommendations on billing reform in primary care, creating better access including eliminating “incident...
The Medicare Payment Advisory...
08/26/2019
First Report Managed Care
News Connection
AbbVie Set to Acquire Allergan in $63 Billion Deal
08/26/2019
In a time of mounting pressure from stakeholders to diversify its portfolio, AbbVie recently announced that the company has entered into a transaction agreement to acquire Allergan in a cash and stock deal worth approximately $63 billion.  
In a time of mounting pressure from stakeholders to diversify its portfolio, AbbVie recently announced that the company has entered into a transaction agreement to acquire Allergan in a cash and stock deal worth approximately $63 billion.  
In a time of mounting pressure...
08/26/2019
First Report Managed Care
News Connection
CMS Proposes Updates to Electronic Prescribing Standards
08/26/2019
The Centers for Medicare & Medicaid Services (CMS) has issued a proposed rule aimed at providing patients better access to needed medications and reducing administrative burden by revising the prior authorization process for Medicare Part D.
The Centers for Medicare & Medicaid Services (CMS) has issued a proposed rule aimed at providing patients better access to needed medications and reducing administrative burden by revising the prior authorization process for Medicare Part D.
The Centers for Medicare &...
08/26/2019
First Report Managed Care
News Connection
Uncontrolled Asthma Increases Economic Burden by Billions
08/26/2019
According to a recent study, despite numerous effective treatments for asthma, a significant faction of patients do not achieve sustained asthma control and could be faced with increased financial burden and decreased quality-adjusted life...
According to a recent study, despite numerous effective treatments for asthma, a significant faction of patients do not achieve sustained asthma control and could be faced with increased financial burden and decreased quality-adjusted life...
According to a recent study,...
08/26/2019
First Report Managed Care
News Connection
CMS Approves Rebate Negotiation, Subscription Model for Hep C Therapy
08/26/2019
The Centers for Medicare & Medicaid Services (CMS) announced that a state plan amendment (SPA) for supplemental rebate agreements utilizing subscription model for hepatitis C therapies in Medicaid has been approved in Lousiana.
The Centers for Medicare & Medicaid Services (CMS) announced that a state plan amendment (SPA) for supplemental rebate agreements utilizing subscription model for hepatitis C therapies in Medicaid has been approved in Lousiana.
The Centers for Medicare &...
08/26/2019
First Report Managed Care
News Connection
New CMS Guidance Issued to Enhance Medicaid Programs’ Integrity
08/26/2019
The Centers for Medicare & Medicaid Services (CMS) recently issued guidance for state Medicaid agencies in an effort to continue enhancing the financial and programmatic integrity of each program.
The Centers for Medicare & Medicaid Services (CMS) recently issued guidance for state Medicaid agencies in an effort to continue enhancing the financial and programmatic integrity of each program.
The Centers for Medicare &...
08/26/2019
First Report Managed Care
Improving Cardiovascular and Renal Outcomes in T2D Patients: GLP-1 Agonists, SGLT2 Inhibitors
08/26/2019
Jeff Craven
Recent trials of GLP-1 receptor agonists and SGLT2 inhibitors have shown these drug classes could reduce or prevent cardiovascular and renal disease, improving outcomes despite their high cost.
Recent trials of GLP-1 receptor agonists and SGLT2 inhibitors have shown these drug classes could reduce or prevent cardiovascular and renal disease, improving outcomes despite their high cost.
Recent trials of GLP-1 receptor...
08/26/2019
First Report Managed Care

Behind the Bill

Behind the Bill
The Senate’s $3 Trillion Deal. Tax Relief Now, Medicaid Coverage Loss Later?
07/02/2025
Katie Hayes, MJ
The Senate has done it. After weeks of behind-the-scenes wrangling and last-minute amendments, lawmakers have passed a sprawling tax-and-spending megabill that makes good on a long-standing Republican goal: making the 2017 Trump tax cuts...
The Senate has done it. After weeks of behind-the-scenes wrangling and last-minute amendments, lawmakers have passed a sprawling tax-and-spending megabill that makes good on a long-standing Republican goal: making the 2017 Trump tax cuts...
The Senate has done it. After...
07/02/2025
First Report Managed Care
Behind the Bill
When a Cap Isn’t Just a Cap: How a Provider Tax Proposal Could Reshape Medicaid Financing
06/25/2025
Katie Hayes, MJ
In Washington, the most consequential policies are often buried in the fine print. One such detail in the Senate Finance Committee’s latest tax and spending proposal would gradually cap provider taxes—a core funding tool states use to pull in...
In Washington, the most consequential policies are often buried in the fine print. One such detail in the Senate Finance Committee’s latest tax and spending proposal would gradually cap provider taxes—a core funding tool states use to pull in...
In Washington, the most...
06/25/2025
First Report Managed Care
Behind the Bill
Rewriting the Safety Net? Inside the Senate’s Changes to Medicaid and the ACA
06/18/2025
Katie Hayes, MJ
Over the past few weeks, I’ve been following the progress of the One Big Beautiful Bill Act (OBBBA), which started in the House with sweeping tax reforms and some eye-catching health care proposals. Now, the Senate has released its (highly...
Over the past few weeks, I’ve been following the progress of the One Big Beautiful Bill Act (OBBBA), which started in the House with sweeping tax reforms and some eye-catching health care proposals. Now, the Senate has released its (highly...
Over the past few weeks, I’ve...
06/18/2025
First Report Managed Care
Behind the Bill
How States Might Respond to the One Big Beautiful Bill Act
06/11/2025
Katie Hayes, MJ
With the One Big Beautiful Bill Act (OBBBA) still in the hands of the Senate, much of the national conversation has centered on what this legislation would do to federal coverage programs. But regardless of how the federal process unfolds,...
With the One Big Beautiful Bill Act (OBBBA) still in the hands of the Senate, much of the national conversation has centered on what this legislation would do to federal coverage programs. But regardless of how the federal process unfolds,...
With the One Big Beautiful Bill...
06/11/2025
First Report Managed Care
Behind the Bill
Is the Affordable Care Act on the Chopping Block? What the One Big Beautiful Bill Act Tells Us.
06/04/2025
Katie Hayes, MJ
It’s been weeks of headline-grabbing debate over Medicaid work requirements, and the “One Big Beautiful Bill Act” remains in the Senate as they deliberate over several health care provisions. While the Medicaid provisions sparked most of the...
It’s been weeks of headline-grabbing debate over Medicaid work requirements, and the “One Big Beautiful Bill Act” remains in the Senate as they deliberate over several health care provisions. While the Medicaid provisions sparked most of the...
It’s been weeks of...
06/04/2025
First Report Managed Care
Behind the Bill
From House to Senate: The Journey of Cutting Medicaid
05/28/2025
Katie Hayes, MJ
Last week, the House of Representatives narrowly passed the One Big Beautiful Bill Act (HR 1, 119th Congress) by a single vote, sending the sweeping tax and spending reconciliation package, backed by President Trump, to the Senate. With its...
Last week, the House of Representatives narrowly passed the One Big Beautiful Bill Act (HR 1, 119th Congress) by a single vote, sending the sweeping tax and spending reconciliation package, backed by President Trump, to the Senate. With its...
Last week, the House of...
05/28/2025
First Report Managed Care
Behind the Bill
Eligibility, Paperwork, and Penalties: The Not-So-Hidden Costs of Medicaid ‘Reform’
05/21/2025
Katie Hayes, MJ
It’s been another eventful week in health policy—a phrase that’s quickly becoming routine. This time, House Republicans advanced a sweeping budget reconciliation bill, designed to implement elements of the March budget resolution, with a...
It’s been another eventful week in health policy—a phrase that’s quickly becoming routine. This time, House Republicans advanced a sweeping budget reconciliation bill, designed to implement elements of the March budget resolution, with a...
It’s been another eventful week...
05/21/2025
First Report Managed Care
Behind the Bill
A Busy Week in Drug Pricing Policy: Aligning US Drug Prices With Global Standards?
05/14/2025
Katie Hayes, MJ
It’s been a busy few days for drug pricing policy. While I’d love to dig into the details of both President Trump’s latest executive order and the newest Republican bill that would cut Medicaid spending, we don’t have the time—and this isn’t...
It’s been a busy few days for drug pricing policy. While I’d love to dig into the details of both President Trump’s latest executive order and the newest Republican bill that would cut Medicaid spending, we don’t have the time—and this isn’t...
It’s been a busy few days for...
05/14/2025
First Report Managed Care
BEHIND THE BILL
When Agencies Lose Power: How 3 Seismic Shifts are Transforming Pharmaceutical Regulation
05/07/2025
Katie Hayes, MJ
In the span of just 9 months, the landscape of administrative law has undergone a transformation so profound that pharmaceutical executives, health care providers, and patients alike are struggling to navigate the new terrain. The Supreme...
In the span of just 9 months, the landscape of administrative law has undergone a transformation so profound that pharmaceutical executives, health care providers, and patients alike are struggling to navigate the new terrain. The Supreme...
In the span of just 9 months,...
05/07/2025
First Report Managed Care
Behind the Bill
The Medicare Paradox, Part 3: Strategic Trade Doesn’t Have to be a Zero-Sum Game
05/07/2025
Katie Hayes, MJ
Over the past 2 weeks, I’ve examined the growing friction between the Section 232 pharmaceutical tariff investigations and the Medicare drug pricing reforms authorized by the Inflation Reduction Act (IRA). These 2 policy agendas—industrial...
Over the past 2 weeks, I’ve examined the growing friction between the Section 232 pharmaceutical tariff investigations and the Medicare drug pricing reforms authorized by the Inflation Reduction Act (IRA). These 2 policy agendas—industrial...
Over the past 2 weeks, I’ve...
05/07/2025
First Report Managed Care

Trending Articles

News
Dairy, Gluten Show No Major Effect on MS Activity and Quality of Life
02/15/2024
Jolynn Tumolo
Dairy and gluten intake had no substantial effects on disease activity and quality of life in a retrospective study of 186 patients with multiple sclerosis (MS). Researchers published their findings online in Multiple Sclerosis Journal –...
Dairy and gluten intake had no substantial effects on disease activity and quality of life in a retrospective study of 186 patients with multiple sclerosis (MS). Researchers published their findings online in Multiple Sclerosis Journal –...
Dairy and gluten intake had no...
02/15/2024
First Report Managed Care
News
Health Care Administration Inefficiencies: Lessons from the 2024 Medallion Report
03/26/2024
Hannah Musick
Discover the impact of manual processes and staffing challenges on payer enrollment and credentialing workflows in the 2024 State of Payer Enrollment and Credentialing Report by Medallion.
Discover the impact of manual processes and staffing challenges on payer enrollment and credentialing workflows in the 2024 State of Payer Enrollment and Credentialing Report by Medallion.
Discover the impact of manual...
03/26/2024
First Report Managed Care
IPF letters
Formulary Frontlines®
New Therapies in Development for Idiopathic Pulmonary Fibrosis (IPF) Address Existing Challenges With Diagnosis and Management
05/13/2024

Reviewed by Elizabeth Volkmann, MD, MS

Reviewed by Elizabeth Volkmann, MD, M...
IPF is a chronic, progressive interstitial lung disease that presents a significant burden to ~3 million patients worldwide. Despite ongoing challenges with IPF diagnosis and management, new therapies in development are showing promise.
IPF is a chronic, progressive interstitial lung disease that presents a significant burden to ~3 million patients worldwide. Despite ongoing challenges with IPF diagnosis and management, new therapies in development are showing promise.
IPF is a chronic, progressive...
05/13/2024
First Report Managed Care
Conference Coverage
Immune Colitis Associated With Rituximab Therapy in Relapsing Multiple Sclerosis
05/24/2024
Hannah Musick
A case study highlighted rare immune colitis associated with rituximab therapy in a patient with relapsing multiple sclerosis (RMS) and emphasizes the need for increased awareness and monitoring of this potential adverse effect in clinical...
A case study highlighted rare immune colitis associated with rituximab therapy in a patient with relapsing multiple sclerosis (RMS) and emphasizes the need for increased awareness and monitoring of this potential adverse effect in clinical...
A case study highlighted rare...
05/24/2024
First Report Managed Care
Katie Devlin
Interview
Strategies for Adjusting With Health Care Interoperability
07/01/2024
Katie Devlin, DHSc, MS, CPHIMS
In this interview, Katie Devlin, VP of Interoperability at Cotiviti, discusses the impact of major shifts like TEFCA and the CMS Interoperability Rule on health plans, emphasizing the importance of joining a QHIN to increase data...
In this interview, Katie Devlin, VP of Interoperability at Cotiviti, discusses the impact of major shifts like TEFCA and the CMS Interoperability Rule on health plans, emphasizing the importance of joining a QHIN to increase data...
In this interview, Katie Devlin,...
07/01/2024
First Report Managed Care

August 2019 Volume 16 Issue 8

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