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Volume 18, Issue 1, January/February 2021 - First Report Managed Care

Featured Article

Cover Story
Online Crowdfunding for Health-Related Expenses Trends Upward
02/12/2021
Dean Celia
What does this say about the affordability of health care, and are there solutions to minimize reliance on this ubiquitous tool?
What does this say about the affordability of health care, and are there solutions to minimize reliance on this ubiquitous tool?
What does this say about the...
02/12/2021
First Report Managed Care
Feature
Drug Repurposing: Expediting Discovery Through a Novel Algorithmic Framework
02/12/2021
Mary Beth Nierengarten
As the COVID-19 pandemic continues to stretch the ability and capacity of health care systems—from curbing infection rates, treating severe illness, understanding new variants, to distributing and administering limited vaccine doses—gaps and...
As the COVID-19 pandemic continues to stretch the ability and capacity of health care systems—from curbing infection rates, treating severe illness, understanding new variants, to distributing and administering limited vaccine doses—gaps and...
As the COVID-19 pandemic...
02/12/2021
First Report Managed Care
Literature Review
Examining Lasmiditan for the Acute Treatment of Migraine Compared With Triptans
02/12/2021
Edan Stanley
Per the American Migraine foundation, oral and intranasal triptan therapy has proven consistently effective when used to treat migraine earlier in the attack; however, triptan therapy is not effective for all patients with migraine and cannot...
Per the American Migraine foundation, oral and intranasal triptan therapy has proven consistently effective when used to treat migraine earlier in the attack; however, triptan therapy is not effective for all patients with migraine and cannot...
Per the American Migraine...
02/12/2021
First Report Managed Care
Commentary
Four Health Care Predictions for 2021
02/12/2021
Steve Wigginton
What should we expect in health care in 2021? Get a jump on the new year with these informed predictions for health plans and members based on what we learned in 2020. As we reflect on an eventful year nobody was expecting, and as we look...
What should we expect in health care in 2021? Get a jump on the new year with these informed predictions for health plans and members based on what we learned in 2020. As we reflect on an eventful year nobody was expecting, and as we look...
What should we expect in health...
02/12/2021
First Report Managed Care
Commentary
The Impact of the Supreme Court’s Pending ACA Decision on Health Plans
02/12/2021
Robin Figueroa
On November 10, 2020, the Supreme Court of the United States heard arguments from both sides on California v Texas, which deals with the constitutionality of the 2010 Affordable Care Act (ACA) following the passage of the Tax Cuts and Jobs...
On November 10, 2020, the Supreme Court of the United States heard arguments from both sides on California v Texas, which deals with the constitutionality of the 2010 Affordable Care Act (ACA) following the passage of the Tax Cuts and Jobs...
On November 10, 2020, the...
02/12/2021
First Report Managed Care
News Connection
Amazon Ends Joint Health Care Venture With Berkshire Hathaway, JP Morgan
02/12/2021
Amazon, Berkshire Hathaway, and JPMorgan Chase & Co, announced plans to dissolve their joint health care venture, Haven, a firm launched in January 2018, focused on finding solutions to a range of problematic health care trends.
Amazon, Berkshire Hathaway, and JPMorgan Chase & Co, announced plans to dissolve their joint health care venture, Haven, a firm launched in January 2018, focused on finding solutions to a range of problematic health care trends.
Amazon, Berkshire Hathaway, and...
02/12/2021
First Report Managed Care
News Connection
CMS, Part D Capping Out-of-Pocket Insulin Spend Could Improve Adherence
02/12/2021
The Centers for Medicare & Medicaid Services (CMS) recently launched the Senior Savings Model through Part D, which caps insulin out-of-pocket spend at no more than $35 per month for beneficiaries. Researchers of a recent JAMA Network Open...
The Centers for Medicare & Medicaid Services (CMS) recently launched the Senior Savings Model through Part D, which caps insulin out-of-pocket spend at no more than $35 per month for beneficiaries. Researchers of a recent JAMA Network Open...
The Centers for Medicare &...
02/12/2021
First Report Managed Care
News Connection
Medicare Advantage Plans See Enrollment Boosts During Pandemic
02/12/2021
Survey data collected by MedicareAdvantagePlans.org shows that Medicare Advantage (MA) plans are seeing increased enrollment amid the pandemic.
Survey data collected by MedicareAdvantagePlans.org shows that Medicare Advantage (MA) plans are seeing increased enrollment amid the pandemic.
Survey data collected by...
02/12/2021
First Report Managed Care
News Connection
Aetna, CVS Health Expand Transgender Surgery Coverage Offerings
02/12/2021
Aetna, a CVS Health company, announced recently that it is updating policies to expand coverage offerings of gender-affirming surgery to include breast augmentation for transfeminine beneficiaries.
Aetna, a CVS Health company, announced recently that it is updating policies to expand coverage offerings of gender-affirming surgery to include breast augmentation for transfeminine beneficiaries.
Aetna, a CVS Health company,...
02/12/2021
First Report Managed Care
News Connection
Lower Health Care Costs: Survey Shows Consumers Are Not Optimistic
02/12/2021
Prior to the inauguration of President Biden, West Health and Gallup conducted a survey to better understand how Americans feel about the state of health care and the new administration’s promises of reform, but results show that most...
Prior to the inauguration of President Biden, West Health and Gallup conducted a survey to better understand how Americans feel about the state of health care and the new administration’s promises of reform, but results show that most...
Prior to the inauguration of...
02/12/2021
First Report Managed Care
News Connection
ACA Fee Increase Effect on Primary Care Access for Dual-Eligible Beneficiaries
02/12/2021
In an effort to accommodate potential increases in demand for care under the Affordable Care Act (ACA), a fee bump was implemented in 2013 and 2014, increasing Medicaid payments to Medicare levels for certain services for primary care...
In an effort to accommodate potential increases in demand for care under the Affordable Care Act (ACA), a fee bump was implemented in 2013 and 2014, increasing Medicaid payments to Medicare levels for certain services for primary care...
In an effort to accommodate...
02/12/2021
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 2021 Volume 18 Issue 1

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