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Volume 17, Issue 10, November 2020 - First Report Managed Care

Featured Article

An Expert Look at Presidential Pandemic Plans
11/20/2020
Dean Celia
In the waning days before the election, President Trump and President-elect Biden laid out their thoughts on the pandemic. President Trump touted that COVID was all the media could speak about and added that talk of the virus would disappear...
In the waning days before the election, President Trump and President-elect Biden laid out their thoughts on the pandemic. President Trump touted that COVID was all the media could speak about and added that talk of the virus would disappear...
In the waning days before the...
11/20/2020
First Report Managed Care
Formulary Frontlines®
New Options Available for Treatment-Resistant Depression
11/20/2020
Jeff Craven
Over the past 30 years, few new pharmacologic therapies have been developed for mood disorders, including depression. However, for patients who do not respond to conventional pharmacologic treatments for MDD, new answers for...
Over the past 30 years, few new pharmacologic therapies have been developed for mood disorders, including depression. However, for patients who do not respond to conventional pharmacologic treatments for MDD, new answers for...
Over the past 30 years, few new...
11/20/2020
First Report Managed Care
Conference Insider
Reducing Opioid Utilization, Costs Through Provider Outreach, Coordination
11/20/2020
Study findings from a poster presented at AMCP Nexus 2020 suggest that when providers perform outreach and coordination across both prescribers and patients, opioid utilization and costs are reduced.
Study findings from a poster presented at AMCP Nexus 2020 suggest that when providers perform outreach and coordination across both prescribers and patients, opioid utilization and costs are reduced.
Study findings from a poster...
11/20/2020
First Report Managed Care
Conference Insider
Advancing Health Equity by Addressing SDoH, Health Disparities
11/20/2020
As much as 80% of health outcomes are driven by social determinants of health (SDoH) which are defined as the community-level conditions and environments in which people live, work, learn, worship, and age. 
As much as 80% of health outcomes are driven by social determinants of health (SDoH) which are defined as the community-level conditions and environments in which people live, work, learn, worship, and age. 
As much as 80% of health...
11/20/2020
First Report Managed Care
Conference Insider
Examining Definition Discrepancies for Curative Therapies From a Payer Perspective
11/20/2020
Coverage decisions for curative therapies can vary greatly due to their extended benefit/risk profiles and differing definitions by payers, according to research presented at AMCP Nexus 2020. 
Coverage decisions for curative therapies can vary greatly due to their extended benefit/risk profiles and differing definitions by payers, according to research presented at AMCP Nexus 2020. 
Coverage decisions for curative...
11/20/2020
First Report Managed Care
Conference Insider
Cost vs Utility: Weighing Benefits and Challenges of Gene Therapies
11/20/2020
As gene therapies continue to grow in popularity for the treatment of rare diseases, stakeholders are navigating the benefits and challenges associated with these expensive treatments. 
As gene therapies continue to grow in popularity for the treatment of rare diseases, stakeholders are navigating the benefits and challenges associated with these expensive treatments. 
As gene therapies continue to...
11/20/2020
First Report Managed Care
Managed Care Q&A
Improving Care Quality Through Meaningful Partnerships
11/20/2020
Edan Stanley
Ben Park, MD, president and CEO, American Health Network, part of Optum Care, discusses a recent partnership with Suburban Health Organization that will improve health care quality for Medicare Advantage members and reduce costs, and shares...
Ben Park, MD, president and CEO, American Health Network, part of Optum Care, discusses a recent partnership with Suburban Health Organization that will improve health care quality for Medicare Advantage members and reduce costs, and shares...
Ben Park, MD, president and CEO,...
11/20/2020
First Report Managed Care
Managed Care Q&A
Analyzing What the Health Care System Will Be Like Under a New Administration
11/20/2020
Julie Gould
Ben Isgur, Health Research Institute Leader, PwC, leads PwC’s Health Research Institute, the think tank within the firm that looks at health industry trends that affect pharma, life sciences, payers, providers, and large employers through...
Ben Isgur, Health Research Institute Leader, PwC, leads PwC’s Health Research Institute, the think tank within the firm that looks at health industry trends that affect pharma, life sciences, payers, providers, and large employers through...
Ben Isgur, Health Research...
11/20/2020
First Report Managed Care
Pharmacy Insight
New Walgreens Survey Identifies Flu-Related Knowledge Gaps Among Patient Groups
11/20/2020
Julie Gould
Tasha Polster, BSPharm, vice president, pharmacy quality compliance and patient safety, Walgreens, discusses misconceptions that often keep patients from getting a flu shot, and what age group is often less knowledgeable about the flu and the...
Tasha Polster, BSPharm, vice president, pharmacy quality compliance and patient safety, Walgreens, discusses misconceptions that often keep patients from getting a flu shot, and what age group is often less knowledgeable about the flu and the...
Tasha Polster, BSPharm, vice...
11/20/2020
First Report Managed Care
Integrated Healthcare Executive
Solutions for Organizations Suffering from a Lack of Data Insights
11/20/2020
Julie Gould
Michael Simmons, CEO and founder of andros, explains how the use of technology, including his new solution CredSimple, helps leverage data-enabled learnings and an AI-powered process that streamlines health care organizations’ entire...
Michael Simmons, CEO and founder of andros, explains how the use of technology, including his new solution CredSimple, helps leverage data-enabled learnings and an AI-powered process that streamlines health care organizations’ entire...
Michael Simmons, CEO and founder...
11/20/2020
First Report Managed Care
Veterans Health Today
VA-Specific Primary Care Clinicians Say E-Consultations Are Valuable, But May Increase Workload
11/20/2020
Julie Gould
In this interview with Veterans Health Today, Joseph Simonetti, MD, MPH, assistant professor of medicine in the Division of Hospital Medicine, University of Colorado School of Medicine, discusses his recent study examining the pros and cons...
In this interview with Veterans Health Today, Joseph Simonetti, MD, MPH, assistant professor of medicine in the Division of Hospital Medicine, University of Colorado School of Medicine, discusses his recent study examining the pros and cons...
In this interview with Veterans...
11/20/2020
First Report Managed Care
Veterans Health Today
If No PTSD Symptom Improvement by Week 6, Veterans Likely to Quit CPT
11/20/2020
Military veterans undergoing cognitive processing therapy with written trauma account (CPT-A) for post-traumatic stress disorder (PTSD) tend to quit therapy if they have not experienced any improvement by the end of the sixth session,...
Military veterans undergoing cognitive processing therapy with written trauma account (CPT-A) for post-traumatic stress disorder (PTSD) tend to quit therapy if they have not experienced any improvement by the end of the sixth session,...
Military veterans undergoing...
11/20/2020
First Report Managed Care
Veterans Health Today
Women Survivors of Military Sexual Trauma at Greater Risk of PTSD, Depression Than Men
11/20/2020
The effect of military sexual trauma on subsequent increased risk of certain mental health outcomes differs with the victim’s gender, according to a study published in the Journal of Affective Disorders.
The effect of military sexual trauma on subsequent increased risk of certain mental health outcomes differs with the victim’s gender, according to a study published in the Journal of Affective Disorders.
The effect of military sexual...
11/20/2020
First Report Managed Care
Veterans Health Today
ACT Workshop Shows Promise for Veterans With TBI, Distress, and Pain
11/20/2020
A day-long Acceptance and Commitment Therapy (ACT) workshop tailored to US military veterans with mild traumatic brain injury, psychological distress, and pain showed therapeutic promise in a pilot study published in the journal Contemporary...
A day-long Acceptance and Commitment Therapy (ACT) workshop tailored to US military veterans with mild traumatic brain injury, psychological distress, and pain showed therapeutic promise in a pilot study published in the journal Contemporary...
A day-long Acceptance and...
11/20/2020
First Report Managed Care
News Connection
Physician Membership in Health Systems Linked With Higher Patient Costs
11/20/2020
Commercially insured patients had higher average costs from primary care physicians who were members of health systems compared with primary care physicians not in health systems, according to findings published online in Health Services...
Commercially insured patients had higher average costs from primary care physicians who were members of health systems compared with primary care physicians not in health systems, according to findings published online in Health Services...
Commercially insured patients...
11/20/2020
First Report Managed Care
News Connection
CMS Announces Reduced Premiums, Improved Insulin Benefits for Medicare Beneficiaries
11/20/2020
The Centers for Medicare & Medicaid Services (CMS) announced recently that 2021 Medicare enrollment period has officially begun and beneficiaries will have added benefits in the form of new resources, reduced premium options, and improved...
The Centers for Medicare & Medicaid Services (CMS) announced recently that 2021 Medicare enrollment period has officially begun and beneficiaries will have added benefits in the form of new resources, reduced premium options, and improved...
The Centers for Medicare &...
11/20/2020
First Report Managed Care
News Connection
HHS Issues Final Rule for Pricing Transparency
11/20/2020
The US Department of Health and Human Services (HHS), in collaboration with the Department of Labor and the Department of the Treasury, announced the final rule requiring health insurers to disclose price and cost-sharing information.
The US Department of Health and Human Services (HHS), in collaboration with the Department of Labor and the Department of the Treasury, announced the final rule requiring health insurers to disclose price and cost-sharing information.
The US Department of Health and...
11/20/2020
First Report Managed Care
News Connection
Higher Costs, Utilization Linked With Emergency Department Use Among Patients With Functional Neurological Diseases
11/20/2020
According to new research published online in JAMA Neurology, patients with functional neurological disorders have increased health care use, including treatment costs that are comparable to those of care-intensive neurological disorders. 
According to new research published online in JAMA Neurology, patients with functional neurological disorders have increased health care use, including treatment costs that are comparable to those of care-intensive neurological disorders. 
According to new research...
11/20/2020
First Report Managed Care
News Connection
Ohio Medicaid Creates Specialized Managed Care Program for Children, Requests Bids
11/20/2020
The Ohio Department of Medicaid is officially inviting bidders to submit proposals for its specialized, child-focused managed care plan OhioRISE (Ohio Resilience through Integrated Systems and Excellence), which serves Ohio youth with complex...
The Ohio Department of Medicaid is officially inviting bidders to submit proposals for its specialized, child-focused managed care plan OhioRISE (Ohio Resilience through Integrated Systems and Excellence), which serves Ohio youth with complex...
The Ohio Department of Medicaid...
11/20/2020
First Report Managed Care
News Connection
HHS Improves HIV/AIDS Care, Support, Access With More Than $2 Billion in Grants
11/20/2020
The US Department of Health and Human Services (HHS), in collaboration with the Health Resources and Services Administration (HRSA), announced $2.24 billion in Ryan White HIV/AIDS Program grants awarded to cities, counties, states, and local...
The US Department of Health and Human Services (HHS), in collaboration with the Health Resources and Services Administration (HRSA), announced $2.24 billion in Ryan White HIV/AIDS Program grants awarded to cities, counties, states, and local...
The US Department of Health and...
11/20/2020
First Report Managed Care
News Connection
Costs Lower, Switching Higher With Oral Immunotherapy for Inflammatory Joint, Skin Disease
11/20/2020
Patients who used oral immunotherapies for chronic inflammatory joint and skin diseases were more likely to switch medications than those who used injectable immunotherapies, but total health care costs were lower with oral therapies,...
Patients who used oral immunotherapies for chronic inflammatory joint and skin diseases were more likely to switch medications than those who used injectable immunotherapies, but total health care costs were lower with oral therapies,...
Patients who used oral...
11/20/2020
First Report Managed Care
News Connection
Examining Trends in Contraception, Birth Rates Under ACA
11/20/2020
Previously published data shows that reducing out-of-pocket costs is associated with improved contraception use, but researchers sought to better understand how the elimination of cost sharing under the Affordable Care Act (ACA) affected...
Previously published data shows that reducing out-of-pocket costs is associated with improved contraception use, but researchers sought to better understand how the elimination of cost sharing under the Affordable Care Act (ACA) affected...
Previously published data shows...
11/20/2020
First Report Managed Care
News Connection
BlueCross BlueShield Expands Value-Based Program, Improves Rural Care
11/20/2020
BlueCross BlueShield (BCBS) of North Carolina and Caravan Health announced plans to expand Blue Premier, the insurers value-based care program, into more communities throughout the state.
BlueCross BlueShield (BCBS) of North Carolina and Caravan Health announced plans to expand Blue Premier, the insurers value-based care program, into more communities throughout the state.
BlueCross BlueShield (BCBS) of...
11/20/2020
First Report Managed Care
News Connection
Magnetic Seizure Therapy Effective Treatment Option for MDD
11/20/2020
Compared with electroconvulsive therapy, magnetic seizure therapy offered similar antidepressant efficacy but fewer cognitive side effects in patients with major depressive disorder (MDD), according to a study published in the Annals of...
Compared with electroconvulsive therapy, magnetic seizure therapy offered similar antidepressant efficacy but fewer cognitive side effects in patients with major depressive disorder (MDD), according to a study published in the Annals of...
Compared with electroconvulsive...
11/20/2020
First Report Managed Care
Pandemic Presents New Possibilities for Cardiac Rehab Programs
11/20/2020
Paul Nicolaus
COVID-19 has thrown traditional cardiac rehabilitation programs a major curveball, but some experts say this crisis is also creating new opportunities to reimagine care delivery and payment for the long haul.
COVID-19 has thrown traditional cardiac rehabilitation programs a major curveball, but some experts say this crisis is also creating new opportunities to reimagine care delivery and payment for the long haul.
COVID-19 has thrown traditional...
11/20/2020
First Report Managed Care
Integrating Social Determinants of Health Into Clinical Care
11/20/2020
Mary Beth Nierengarten
A newly launched program to integrate social determinants of health into clinical care is putting into practice what many health policymakers, plans, and providers are increasingly trying to get their heads around—how to more fully and...
A newly launched program to integrate social determinants of health into clinical care is putting into practice what many health policymakers, plans, and providers are increasingly trying to get their heads around—how to more fully and...
A newly launched program to...
11/20/2020
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 2020 Volume 17 Issue 10

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