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Volume 17, Issue 3, March 2020 - First Report Managed Care

Featured Article

Stakeholders Still Searching for Solutions to Lower Costs of Gene Therapy
03/31/2020
Jeff Craven
With more therapies than ever moving through the pipeline, developers and payers are looking at new ways to lower costs while ramping up gene therapy production.
With more therapies than ever moving through the pipeline, developers and payers are looking at new ways to lower costs while ramping up gene therapy production.
With more therapies than ever...
03/31/2020
First Report Managed Care
Veterans Health Today
History of Mental Health Conditions Increases Risk of Chronic Opioid Use Among Vets With RA
03/31/2020
Veterans with rheumatoid arthritis (RA) who had a history of mental health conditions were at an increased risk of developing chronic opioid therapy, according to study findings published online in Clinical Rheumatology.
Veterans with rheumatoid arthritis (RA) who had a history of mental health conditions were at an increased risk of developing chronic opioid therapy, according to study findings published online in Clinical Rheumatology.
Veterans with rheumatoid...
03/31/2020
First Report Managed Care
Veterans Health Today
Rollout of New EHR System Delayed by VA
03/31/2020
A $16 billion electronic health record (EHR) system that was set to launch in March will not go live due to a delay by the Department of Veteran Affairs (VA).  
A $16 billion electronic health record (EHR) system that was set to launch in March will not go live due to a delay by the Department of Veteran Affairs (VA).  
A $16 billion electronic health...
03/31/2020
First Report Managed Care
Veterans Health Today
Nearly Half of Veterans With Mental Health Troubles Report Adversity While Younger
03/31/2020
Veterans seeking treatment for mental health problems compared with the general military population had higher rates of adversity when they were younger in life according to a study published online in the journal Psychological Trauma:Theory,...
Veterans seeking treatment for mental health problems compared with the general military population had higher rates of adversity when they were younger in life according to a study published online in the journal Psychological Trauma:Theory,...
Veterans seeking treatment for...
03/31/2020
First Report Managed Care
Veterans Health Today
Interview: A Look Into the Value of Bariatric Surgery Among Vets
03/31/2020
Julie Gould
Veterans Health Today spoke with Matt Maciejewski, PhD, research career scientist for the Center of Innovation to Accelerate Discovery and Practice Transformation (ADAPT) at the Durham VA Medical Center, about his recent study and the...
Veterans Health Today spoke with Matt Maciejewski, PhD, research career scientist for the Center of Innovation to Accelerate Discovery and Practice Transformation (ADAPT) at the Durham VA Medical Center, about his recent study and the...
Veterans Health Today spoke with...
03/31/2020
First Report Managed Care
Interview
Blockchain Technology has a Role to Play in Pharma
03/31/2020
Edan Stanley
During a recent presentation at PBMI’s National Conference, Gregory O Callahan, MBA, consultant, and Brian N Anderson, MBA, principal, both from Milliman, a consulting and actuarial firm, discussed how blockchain technology will disrupt the...
During a recent presentation at PBMI’s National Conference, Gregory O Callahan, MBA, consultant, and Brian N Anderson, MBA, principal, both from Milliman, a consulting and actuarial firm, discussed how blockchain technology will disrupt the...
During a recent presentation at...
03/31/2020
First Report Managed Care
Integrated Healthcare Executive
Addressing Organizational Quality, Communication Improves Clinician Satisfaction, Stress
03/31/2020
Julie Gould
Mark Linzer, MD, vice chief of the Department of Medicine for mentoring and research at Hennepin Healthcare and Professor of Medicine at the University of Minnesota, explains why stress, a strong predictor of burnout, was reduced when trust...
Mark Linzer, MD, vice chief of the Department of Medicine for mentoring and research at Hennepin Healthcare and Professor of Medicine at the University of Minnesota, explains why stress, a strong predictor of burnout, was reduced when trust...
Mark Linzer, MD, vice chief of...
03/31/2020
First Report Managed Care
More Americans Stuggle to See a Doctor Despite Gains in Coverage
03/31/2020
Paul Nicolaus
Although health coverage has improved over the past two decades, new research reveals that a growing proportion of US adults are missing out on medical care due to its high costs.
Although health coverage has improved over the past two decades, new research reveals that a growing proportion of US adults are missing out on medical care due to its high costs.
Although health coverage has...
03/31/2020
First Report Managed Care
Conference Insider
Warfarin Patients Incurred Higher Post-Stroke Care Costs Compared with Rivaroxaban
03/31/2020
Researchers presented data comparing total healthcare cost in pre- and post-stroke periods between rivaroxaban- and warfarin-treated non-valvular atrial fibrillation NVAF patients at the International Stroke Conference 2020.
Researchers presented data comparing total healthcare cost in pre- and post-stroke periods between rivaroxaban- and warfarin-treated non-valvular atrial fibrillation NVAF patients at the International Stroke Conference 2020.
Researchers presented data...
03/31/2020
First Report Managed Care
Conference Insider
Implementing Palliative Care for Stroke Patients Across Health System
03/31/2020
According to study presented at the International Stroke Conference 2020, implementing a hospice service at tertiary academic centers to enhance palliative care delivery for high mortality stroke volume and developing an end-of-life Stroke...
According to study presented at the International Stroke Conference 2020, implementing a hospice service at tertiary academic centers to enhance palliative care delivery for high mortality stroke volume and developing an end-of-life Stroke...
According to study presented at...
03/31/2020
First Report Managed Care
Conference Insider
IV Alteplase Administration Care Improves With Maryland Stroke Coalition Program
03/31/2020
The Maryland Stroke Coalition’s (MSC) coordinated cooperative approach to performance improvement was associated with increased intravenous (IV) alteplase administration rates and decreased median door to IV alteplase administration times,...
The Maryland Stroke Coalition’s (MSC) coordinated cooperative approach to performance improvement was associated with increased intravenous (IV) alteplase administration rates and decreased median door to IV alteplase administration times,...
The Maryland Stroke Coalition’s...
03/31/2020
First Report Managed Care
Formulary Frontlines®
Using Biologics to Manage Rheumatoid Arthritis
03/31/2020
Edan Stanley
RA has a significant negative impact on the ability to perform daily activities and on health-related quality of life, conferring a substantial health care and economic burden. Costs attributable to RA are expected to further increase as the...
RA has a significant negative impact on the ability to perform daily activities and on health-related quality of life, conferring a substantial health care and economic burden. Costs attributable to RA are expected to further increase as the...
RA has a significant negative...
03/31/2020
First Report Managed Care
Drug Pricing Round Table, Continued
03/31/2020
Dean Celia
In our second installment of the expert roundtable on drug pricing, our experts weigh in on what progress can be made in 2020, when it will impact managed care stakeholders, and what that impact will be.
In our second installment of the expert roundtable on drug pricing, our experts weigh in on what progress can be made in 2020, when it will impact managed care stakeholders, and what that impact will be.
In our second installment of the...
03/31/2020
First Report Managed Care
News Connection
Aetna Launches Value-Based Primary Care Model With New Partnership
03/31/2020
Aetna will be partnering with Atlanta-based Emory Healthcare and Northside Hospital System to provide a fully insured and self-insured health care options for employers.
Aetna will be partnering with Atlanta-based Emory Healthcare and Northside Hospital System to provide a fully insured and self-insured health care options for employers.
Aetna will be partnering with...
03/31/2020
First Report Managed Care
News Connection
Relationship Between High Utilization and Changes in PCMH Implementation
03/31/2020
Changes in patient-centered medical home (PCMH) implementation had no consistent association with changes in high cost health care utilization, according to a study results published in JAMA Network Open.
Changes in patient-centered medical home (PCMH) implementation had no consistent association with changes in high cost health care utilization, according to a study results published in JAMA Network Open.
Changes in patient-centered...
03/31/2020
First Report Managed Care
News Connection
Pharma Spends Billions on Lobbying, Campaign Contributions
03/31/2020
From 1999 to 2018, the United States pharmaceutical and health product industry spent $4.7 billion on lobbying expenditures and campaign contributions, according to a recent JAMA Internal Medicine study.
From 1999 to 2018, the United States pharmaceutical and health product industry spent $4.7 billion on lobbying expenditures and campaign contributions, according to a recent JAMA Internal Medicine study.
From 1999 to 2018, the United...
03/31/2020
First Report Managed Care
News Connection
Humana Announces Program Focused on Social Determinants of Health
03/31/2020
Humana is launching a new value-based care payment initiative that will focus on social determinants of health to help clinicians better address nonmedical health risk factors.
Humana is launching a new value-based care payment initiative that will focus on social determinants of health to help clinicians better address nonmedical health risk factors.
Humana is launching a new...
03/31/2020
First Report Managed Care
News Connection
High Insurance Costs Dissuade US Adults From Seeking Medical Care
03/31/2020
As the number of US adults reaching retirement age continues to grow, researchers of a recent JAMA Network Open study sought to measure the association between high health insurance costs and potential avoidance of medical care, and found a...
As the number of US adults reaching retirement age continues to grow, researchers of a recent JAMA Network Open study sought to measure the association between high health insurance costs and potential avoidance of medical care, and found a...
As the number of US adults...
03/31/2020
First Report Managed Care
News Connection
ICER Partners With Aetion, Expands Use of Real-World Evidence
03/31/2020
The Institute for Clinical and Economic Review (ICER) announced a new partnership with health care technology company Aetion in a continued effort to expand its use of real-world evidence (RWE) in patient data.
The Institute for Clinical and Economic Review (ICER) announced a new partnership with health care technology company Aetion in a continued effort to expand its use of real-world evidence (RWE) in patient data.
The Institute for Clinical and...
03/31/2020
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

March 2020 Volume 17 Issue 3

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