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Volume 17, Issue 8, September 2020 - First Report Managed Care

Featured Article

Health Care on the Ballot: Four More Years or a New Direction?
09/25/2020
Dean Celia
How is the health care landscape expected to look over the next four years? We consulted with managed care experts to analyze what has changed since 2016, what is likely to occur if the president is reelected, and how events might unfold...
How is the health care landscape expected to look over the next four years? We consulted with managed care experts to analyze what has changed since 2016, what is likely to occur if the president is reelected, and how events might unfold...
How is the health care landscape...
09/25/2020
First Report Managed Care
Formulary Frontlines®
Achieving Effective Motor Control for Patients With Parkinson Disease
09/25/2020
Edan Stanley
There is no definitive cure for PD but the main objective is reducing symptoms and achieving effective motor control through medication and surgical therapy. The cornerstone of symptomatic treatment for PD is dopamine replacement therapy.
There is no definitive cure for PD but the main objective is reducing symptoms and achieving effective motor control through medication and surgical therapy. The cornerstone of symptomatic treatment for PD is dopamine replacement therapy.
There is no definitive cure for...
09/25/2020
First Report Managed Care
Integrated Healthcare Executive
Benefits of New Cloud-Based Program for Health Plans
09/25/2020
Julie Gould
Eric Sullivan, senior vice president of innovation and data strategies, Inovalon, discusses the Consumer Health Gateway, a new portal that allows health plans to build their own Patient Access API to comply with the new requirement of the...
Eric Sullivan, senior vice president of innovation and data strategies, Inovalon, discusses the Consumer Health Gateway, a new portal that allows health plans to build their own Patient Access API to comply with the new requirement of the...
Eric Sullivan, senior vice...
09/25/2020
First Report Managed Care
Managed Care Q&A
Refocusing the Multiple Sclerosis Treatment Landscape
09/25/2020
Edan Stanley
Edmund Pezalla, MD, MPH, CEO of Enlightenment Bioconsult, formerly of Aetna, discusses treatment options for multiple sclerosis (MS), highlights results from the ASCLEPIOS I and II studies, and notes why this data can be useful for payers. Dr...
Edmund Pezalla, MD, MPH, CEO of Enlightenment Bioconsult, formerly of Aetna, discusses treatment options for multiple sclerosis (MS), highlights results from the ASCLEPIOS I and II studies, and notes why this data can be useful for payers. Dr...
Edmund Pezalla, MD, MPH, CEO of...
09/25/2020
First Report Managed Care
News Connection
Examining Access to Home Health Care During Pandemic
09/25/2020
In a recent study published in JAMA Network Open, researchers assessed patient access and utilization of home health care, post-hospital discharge. Results showed a number of barriers including socioeconomic disparities.
In a recent study published in JAMA Network Open, researchers assessed patient access and utilization of home health care, post-hospital discharge. Results showed a number of barriers including socioeconomic disparities.
In a recent study published in...
09/25/2020
First Report Managed Care
News Connection
Nearly 12 Million People Lost Employer-Sponsored Insurance Amid Pandemic
09/25/2020
It is no surprise that many Americans lost access to health insurance throughout the pandemic, but new data shows that nearly 12 million people have been cut off from employee-sponsored plans.
It is no surprise that many Americans lost access to health insurance throughout the pandemic, but new data shows that nearly 12 million people have been cut off from employee-sponsored plans.
It is no surprise that many...
09/25/2020
First Report Managed Care
News Connection
Hospitalization Predictors of Readmission for Psoriasis
09/25/2020
US patients hospitalized for psoriasis had high rates of hospital readmission overall, but low rates of readmission for psoriasis specifically, according to a study published in the Journal of the American Academy of Dermatology.
US patients hospitalized for psoriasis had high rates of hospital readmission overall, but low rates of readmission for psoriasis specifically, according to a study published in the Journal of the American Academy of Dermatology.
US patients hospitalized for...
09/25/2020
First Report Managed Care
News Connection
Examining Trends in ED Costs of Care for Medicare Beneficiaries
09/25/2020
According to results of a recent JAMA Network Open study, total 30-day costs of emergency department (ED) care for Medicare beneficiaries has decreased over the last several years, which the authors mostly attribute to declining rates of...
According to results of a recent JAMA Network Open study, total 30-day costs of emergency department (ED) care for Medicare beneficiaries has decreased over the last several years, which the authors mostly attribute to declining rates of...
According to results of a recent...
09/25/2020
First Report Managed Care
News Connection
Quality of Life Significantly Lower With Chronic Lymphocytic Leukemia
09/25/2020
Whether on watch-and-wait or treatment regimens, patients with chronic lymphocytic leukemia had significantly impaired quality of life compared with age-matched healthy control participants, according to a study published online in the...
Whether on watch-and-wait or treatment regimens, patients with chronic lymphocytic leukemia had significantly impaired quality of life compared with age-matched healthy control participants, according to a study published online in the...
Whether on watch-and-wait or...
09/25/2020
First Report Managed Care
News Connection
Over $1.4 Billion Wasted on Discarded Cancer Drugs According to Medicare Advantage, CMS Data
09/25/2020
According to a recent data analysis by the Centers for Medicare & Medicaid Services (CMS) and Medicare Advantage, more than $1.4 billion was wasted on discarded units of chemotherapy and other cancer-treating drugs in 2017 and 2018.
According to a recent data analysis by the Centers for Medicare & Medicaid Services (CMS) and Medicare Advantage, more than $1.4 billion was wasted on discarded units of chemotherapy and other cancer-treating drugs in 2017 and 2018.
According to a recent data...
09/25/2020
First Report Managed Care
News Connection
CMS Launches Digital Medicare Platform, Streamlines Resources
09/25/2020
Care Compare, a redesign of eight existing health care tools and platforms, was launched by the Centers of Medicare & Medicaid Services (CMS) recently in an effort to improve patient access to information and streamline health care service...
Care Compare, a redesign of eight existing health care tools and platforms, was launched by the Centers of Medicare & Medicaid Services (CMS) recently in an effort to improve patient access to information and streamline health care service...
Care Compare, a redesign of...
09/25/2020
First Report Managed Care
News Connection
CMS Unveils New Model to Improve Rural Health Care
09/25/2020
President Trump signed an executive order recently dedicated to improving rural health care systems through the implementation of the newly unveiled Community Health Access and Rural Transformation (CHART) model, which will be fund...
President Trump signed an executive order recently dedicated to improving rural health care systems through the implementation of the newly unveiled Community Health Access and Rural Transformation (CHART) model, which will be fund...
President Trump signed an...
09/25/2020
First Report Managed Care
Issues of Equity as COVID-19 Vaccines and Treatments Emerge
09/03/2020
Mary Beth Nierengarten
As the pandemic continues and clinical trials push forward searching for answers and a vaccine, health officials are recognizing that there are many challenges still to come—including vaccine distribution.
As the pandemic continues and clinical trials push forward searching for answers and a vaccine, health officials are recognizing that there are many challenges still to come—including vaccine distribution.
As the pandemic continues and...
09/03/2020
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

September 2020 Volume 17 Issue 8

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