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Volume 17, Issue 2, February 2020 - First Report Managed Care

Featured Article

Measuring What Matters to Improve Health and Well-Being
02/20/2020
Mary Beth Nierengarten
With technology constantly evolving, the health care industry pushes forward developing new ways to look at and assess population health so that patients, providers, and payers alike will see improved outcomes and reduced costs.
With technology constantly evolving, the health care industry pushes forward developing new ways to look at and assess population health so that patients, providers, and payers alike will see improved outcomes and reduced costs.
With technology constantly...
02/20/2020
First Report Managed Care
Conference Insider
Penicillin Drug Class Substitutes Save Patients and Hospitals Money
02/21/2020
According to data presented at ASHP’s 54th Midyear Clinical Meeting and Exhibition, improved allergy documentation offers increased choices to patients and has the ability to save hospitals money.
According to data presented at ASHP’s 54th Midyear Clinical Meeting and Exhibition, improved allergy documentation offers increased choices to patients and has the ability to save hospitals money.
According to data presented at...
02/21/2020
First Report Managed Care
Conference Insider
Fish Antibiotics Consumed by Consumers Seeking Cheaper Options
02/21/2020
Patients seeking out the cheapest, fastest antibiotics have been consuming medication meant for fish instead of humans, according to research presented at ASHP’s 54th Midyear Clinical Meeting and Exhibition.
Patients seeking out the cheapest, fastest antibiotics have been consuming medication meant for fish instead of humans, according to research presented at ASHP’s 54th Midyear Clinical Meeting and Exhibition.
Patients seeking out the...
02/21/2020
First Report Managed Care
Conference Insider
Increased Pharmacist Interaction Improves Patient Satisfaction
02/21/2020
Reduced readmission rates and higher patient satisfaction were observed when patients had increased, focused interaction with pharmacists throughout their hospital stays, per a new study presented at ASHP’s 54th Midyear Clinical Meeting and...
Reduced readmission rates and higher patient satisfaction were observed when patients had increased, focused interaction with pharmacists throughout their hospital stays, per a new study presented at ASHP’s 54th Midyear Clinical Meeting and...
Reduced readmission rates and...
02/21/2020
First Report Managed Care
Conference Insider
What to Expect at PBMI’s 2020 National Conference
02/21/2020
PBMI is hosting its 25th Anniversary National Conference March 2 to March 4 at the Rosen Shingle Creek Hotel in Orlando, FL. PBMI’s yearly conference has been a staple to pharmacy benefit management (PBM), offering an open forum for the...
PBMI is hosting its 25th Anniversary National Conference March 2 to March 4 at the Rosen Shingle Creek Hotel in Orlando, FL. PBMI’s yearly conference has been a staple to pharmacy benefit management (PBM), offering an open forum for the...
PBMI is hosting its 25th...
02/21/2020
First Report Managed Care
Managed Care Q&A
Ensuring Members Utilize and Understand Their Benefits
02/21/2020
Edan Stanley
Beth Roberts, senior vice president, commercial business at Harvard Pilgrim Health Care, discusses the importance of communicating with members what is available to them through their plan, and how population health management is key in...
Beth Roberts, senior vice president, commercial business at Harvard Pilgrim Health Care, discusses the importance of communicating with members what is available to them through their plan, and how population health management is key in...
Beth Roberts, senior vice...
02/21/2020
First Report Managed Care
Integrated Healthcare Executive
Understanding the Value of Integrating Patient-Generated Health Data Into Practice
02/21/2020
Julie Gould
In a recent Integrated Healthcare Executive podcast, Drew Ivan, chief product and strategy officer, and Jessica Nisenbaum, chief people officer, both from Rhapsody & Corepoint Health, discuss the benefits and challenges of introducing...
In a recent Integrated Healthcare Executive podcast, Drew Ivan, chief product and strategy officer, and Jessica Nisenbaum, chief people officer, both from Rhapsody & Corepoint Health, discuss the benefits and challenges of introducing...
In a recent Integrated...
02/21/2020
First Report Managed Care
Veterans Health Today
Palliative Care Proves Beneficial for Veterans With Cancer
02/21/2020
Julie Gould
Donald Sullivan, MD, MA, MCR, and colleagues recently published a study in JAMA Oncology on the association between palliative care and survival rates, particularly among lung cancer patients in the veteran population. Veterans Health Today...
Donald Sullivan, MD, MA, MCR, and colleagues recently published a study in JAMA Oncology on the association between palliative care and survival rates, particularly among lung cancer patients in the veteran population. Veterans Health Today...
Donald Sullivan, MD, MA, MCR,...
02/21/2020
First Report Managed Care
Veterans Health Today
Veterans Group Seeks Apology From President Trump
02/21/2020
Following a remark from President Donald Trump stating that he does not consider potential traumatic brain injuries (TBI) to be a serious condition, the Veterans of Foreign Wars (VFW) is demanding he apologize.
Following a remark from President Donald Trump stating that he does not consider potential traumatic brain injuries (TBI) to be a serious condition, the Veterans of Foreign Wars (VFW) is demanding he apologize.
Following a remark from...
02/21/2020
First Report Managed Care
Veterans Health Today
Veterans Returning From Deployment Open to Family Guidance
02/21/2020
In a small survey, the majority of veterans returning from military deployment said they would be open to taking part in a program on parenting skills. Researchers published their findings online in Military Medicine. 
In a small survey, the majority of veterans returning from military deployment said they would be open to taking part in a program on parenting skills. Researchers published their findings online in Military Medicine. 
In a small survey, the majority...
02/21/2020
First Report Managed Care
Veterans Health Today
VA Deputy Secretary Dismissed
02/21/2020
According to a statement by Robert Wilkie, department of Veterans Affairs (VA) secretary, James Byrne, VA deputy secretary, has been fired.
According to a statement by Robert Wilkie, department of Veterans Affairs (VA) secretary, James Byrne, VA deputy secretary, has been fired.
According to a statement by...
02/21/2020
First Report Managed Care
News Connection
CMS to Cover New Chronic Lower Back Pain Therapy
02/21/2020
In a national coverage determination reconsideration, the Centers for Medicare & Medicaid Services (CMS) announced recently the decision to cover acupuncture for Medicare enrollees diagnosed with chronic low back pain.
In a national coverage determination reconsideration, the Centers for Medicare & Medicaid Services (CMS) announced recently the decision to cover acupuncture for Medicare enrollees diagnosed with chronic low back pain.
In a national coverage...
02/21/2020
First Report Managed Care
News Connection
Single-Payer System Could Reduce Health Care Expenditures
02/21/2020
As politicians continue to debate various approaches to health care, a recently published study shows that a single-payer system has the potential to reduce health care expenditures in as little as one year.
As politicians continue to debate various approaches to health care, a recently published study shows that a single-payer system has the potential to reduce health care expenditures in as little as one year.
As politicians continue to...
02/21/2020
First Report Managed Care
News Connection
Eli Lilly Prices New Class of Migraine Treatment
02/21/2020
Eli Lilly announced that its new acute migraine treatment, Reyvow (lasmiditan), will be priced at $640 for a pack of eight pills.
Eli Lilly announced that its new acute migraine treatment, Reyvow (lasmiditan), will be priced at $640 for a pack of eight pills.
Eli Lilly announced that its new...
02/21/2020
First Report Managed Care
News Connection
CMS Proposes Medicare Advantage and Part D Changes to Improve Transparency
02/21/2020
As part of President Trump’s executive order Protecting and Improving Medicare for Our Nation’s Seniors and Advancing American Kidney Health, the Centers for Medicare & Medicaid  (CMS) proposed changes to Medicare Advantage and Part D.
As part of President Trump’s executive order Protecting and Improving Medicare for Our Nation’s Seniors and Advancing American Kidney Health, the Centers for Medicare & Medicaid  (CMS) proposed changes to Medicare Advantage and Part D.
As part of President Trump’s...
02/21/2020
First Report Managed Care
News Connection
Adverse Events From Chronic Lymphocytic Leukemia Treatment Boost Costs
02/21/2020
Just 29% of adults underwent treatment for chronic lymphocytic leukemia (CLL) in the year and a half following diagnosis, according to a study published in Cancer Medicine. 
Just 29% of adults underwent treatment for chronic lymphocytic leukemia (CLL) in the year and a half following diagnosis, according to a study published in Cancer Medicine. 
Just 29% of adults underwent...
02/21/2020
First Report Managed Care
News Connection
California Bill Seeks to Improve Prenatal Care for Incarcerated Women
02/21/2020
Following a recent a lawsuit alleging the maltreatment of pregnant women in a Californian county jail, lawmakers propose a bill that would offer more protection and improve prenatal care.
Following a recent a lawsuit alleging the maltreatment of pregnant women in a Californian county jail, lawmakers propose a bill that would offer more protection and improve prenatal care.
Following a recent a lawsuit...
02/21/2020
First Report Managed Care
News Connection
Some LTC Patients Have Inadequate or No Drug Coverage
02/21/2020
According to new study findings, which were published online in Medical Care, Medicare enrollees in long-term care (LTC) were found to have inadequate or no drug coverage.
According to new study findings, which were published online in Medical Care, Medicare enrollees in long-term care (LTC) were found to have inadequate or no drug coverage.
According to new study findings,...
02/21/2020
First Report Managed Care
News Connection
Congress Revisits Surprise Billing With New Mediation Proposal
02/21/2020
The latest attempt to reach resolution on the controversial practice of surprise billing comes from the House Ways & Means Committee, who propose a two-step mediation process to resolve disputes and eliminate the problem. 
The latest attempt to reach resolution on the controversial practice of surprise billing comes from the House Ways & Means Committee, who propose a two-step mediation process to resolve disputes and eliminate the problem. 
The latest attempt to reach...
02/21/2020
First Report Managed Care
News Connection
Why Diabetes Lifestyle Interventions Changed to a Medicare-Covered Service
02/21/2020
Collaboration, national standards, and public input were key in converting the evidence-based lifestyle intervention from the 2002 Diabetes Prevention Program trial into a service reimbursed by Medicare, according to a study published online...
Collaboration, national standards, and public input were key in converting the evidence-based lifestyle intervention from the 2002 Diabetes Prevention Program trial into a service reimbursed by Medicare, according to a study published online...
Collaboration, national...
02/21/2020
First Report Managed Care
News Connection
CVS Health Publishes Methods to Reduce Gene Therapy Costs
02/21/2020
According to CVS Health, extending the National Medical Excellence (NME) program model, evolving the role of specialty pharmacy, value-based contracting, and financial protection programs are key approaches to reducing the cost impact of gene...
According to CVS Health, extending the National Medical Excellence (NME) program model, evolving the role of specialty pharmacy, value-based contracting, and financial protection programs are key approaches to reducing the cost impact of gene...
According to CVS Health,...
02/21/2020
First Report Managed Care
News Connection
ACP Publishes Support of Single-Payer System
02/21/2020
The American College of Physicians (ACP) endorsed a single-payer reformed system of United States health care in a broad proposal published in an Annals of Internal Medicine supplement.
The American College of Physicians (ACP) endorsed a single-payer reformed system of United States health care in a broad proposal published in an Annals of Internal Medicine supplement.
The American College of...
02/21/2020
First Report Managed Care
Expert Roundtable: Drug Pricing
02/18/2020
Dean Celia
Our experts analyze pending legislation, branded drug price increase trends, the real impact of the record number of generic drug approvals, and the value of presidential executive action.
Our experts analyze pending legislation, branded drug price increase trends, the real impact of the record number of generic drug approvals, and the value of presidential executive action.
Our experts analyze pending...
02/18/2020
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

February 2020 Volume 17 Issue 2

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