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News
Study Projects Billions in Savings From Site-Neutral Payments for Routine Services
01/23/2026
Grace Taylor, MS, MA
A national analysis of 2022 commercial claims data suggests that capping payments for routine services at site-neutral Medicare-based rates could save purchasers and patients $10.8 billion annually with only modest effects on hospital margins.
A national analysis of 2022 commercial claims data suggests that capping payments for routine services at site-neutral Medicare-based rates could save purchasers and patients $10.8 billion annually with only modest effects on hospital margins.
A national analysis of 2022...
01/23/2026
First Report Managed Care
News
DEA Extends Telemedicine Flexibilities for Prescribing Controlled Medications Through 2026
01/13/2026
Danielle Sposato
The Drug Enforcement Administration (DEA), jointly with the Department of Health and Human Services (HHS), has issued a Fourth Temporary Extension of COVID-19 Telemedicine Flexibilities for the Prescription of Controlled Medications. The...
The Drug Enforcement Administration (DEA), jointly with the Department of Health and Human Services (HHS), has issued a Fourth Temporary Extension of COVID-19 Telemedicine Flexibilities for the Prescription of Controlled Medications. The...
The Drug Enforcement...
01/13/2026
First Report Managed Care
News
Rising Denials and Payer Audits Intensify Financial Strain on Hospitals in 2025
12/16/2025
Lisa Kuhns, PhD, MD
Hospitals are facing rising financial pressure as denial amounts and payer audits continue to climb in 2025, signaling an unsustainable trend for many health systems, according to a new report from billing compliance and revenue integrity...
Hospitals are facing rising financial pressure as denial amounts and payer audits continue to climb in 2025, signaling an unsustainable trend for many health systems, according to a new report from billing compliance and revenue integrity...
Hospitals are facing rising...
12/16/2025
First Report Managed Care
News
Survey Signals Turning Point in Public Opinion on Health Insurance and Debt Reform
11/20/2025
Lisa Kuhns, PhD, MD
Americans across political party lines overwhelmingly support stronger protections against medical debt, signaling rare consensus in a politically polarized era, according to a survey conducted by Undue Medical Debt. That is the clear...
Americans across political party lines overwhelmingly support stronger protections against medical debt, signaling rare consensus in a politically polarized era, according to a survey conducted by Undue Medical Debt. That is the clear...
Americans across political party...
11/20/2025
First Report Managed Care
News
HRSA Approves 340B Rebate Models, Reshaping Drug Discounts and Hospital Financing
11/03/2025
Juliet Gallagher
The Health Resources and Services Administration (HRSA) has approved 8 pharmaceutical manufacturer proposals to issue rebates under the 340B Drug Pricing Program, marking a significant departure from the long-standing model of upfront...
The Health Resources and Services Administration (HRSA) has approved 8 pharmaceutical manufacturer proposals to issue rebates under the 340B Drug Pricing Program, marking a significant departure from the long-standing model of upfront...
The Health Resources and...
11/03/2025
First Report Managed Care
CONFERENCE COVERAGE
AMCP Nexus 2025: New Data Reveal Access Delays and Clinical Risks in Alternative Funding Programs
10/28/2025
Juliet Gallagher
At AMCP Nexus 2025, Autumn D. Zuckerman, PharmD, BCPS, CSP, joined by Amy Niles, MBA, and Ashira Vantrees, Esq., unpacked 3 cost-shifting strategies that are reshaping access to specialty medicines: copay accumulators, copay maximizers, and...
At AMCP Nexus 2025, Autumn D. Zuckerman, PharmD, BCPS, CSP, joined by Amy Niles, MBA, and Ashira Vantrees, Esq., unpacked 3 cost-shifting strategies that are reshaping access to specialty medicines: copay accumulators, copay maximizers, and...
At AMCP Nexus 2025, Autumn D....
10/28/2025
First Report Managed Care
News
UnitedHealthcare Launches Digital Marketplace to Expand Member Engagement Options
10/14/2025
Lisa Kuhns, PhD, MD
UnitedHealthcare is reimagining the member experience with the launch of UHC Store, a new digital marketplace designed to help more than 6 million commercial members shop for personalized health and wellness offerings, a number expected to...
UnitedHealthcare is reimagining the member experience with the launch of UHC Store, a new digital marketplace designed to help more than 6 million commercial members shop for personalized health and wellness offerings, a number expected to...
UnitedHealthcare is reimagining...
10/14/2025
First Report Managed Care
News
Simplifying CLL Therapy: When Less May Truly Be More
10/09/2025
Juliet Gallagher
The therapeutic landscape of chronic lymphocytic leukemia (CLL) continues to expand, offering patients and providers more flexibility than ever before. In a recent discussion with First Report Managed Care, Sameh Gaballa, MD, associate member...
The therapeutic landscape of chronic lymphocytic leukemia (CLL) continues to expand, offering patients and providers more flexibility than ever before. In a recent discussion with First Report Managed Care, Sameh Gaballa, MD, associate member...
The therapeutic landscape of...
10/09/2025
First Report Managed Care
News
What the Potential Expiration of ACA Subsidies Means for Health Plan Costs in 2026
10/07/2025
Juliet Gallagher
A new analysis from the Kaiser Family Foundation (KFF) warns that premiums for Affordable Care Act (ACA) marketplace plans could more than double in 2026 if enhanced federal subsidies expire at the end of this year. The report highlights the...
A new analysis from the Kaiser Family Foundation (KFF) warns that premiums for Affordable Care Act (ACA) marketplace plans could more than double in 2026 if enhanced federal subsidies expire at the end of this year. The report highlights the...
A new analysis from the Kaiser...
10/07/2025
First Report Managed Care
News
PSAO Market Insights: Highlights from the 2025–26 DCI Economic Report
10/03/2025
Juliet Gallagher
Adam J. Fein, PhD, founder and President of Drug Channels Institute, has previewed highlights from the forthcoming 2025–26 Economic Report on Pharmaceutical Wholesalers and Specialty Distributors in his blog post, Inside the 2025 PSAO Market:...
Adam J. Fein, PhD, founder and President of Drug Channels Institute, has previewed highlights from the forthcoming 2025–26 Economic Report on Pharmaceutical Wholesalers and Specialty Distributors in his blog post, Inside the 2025 PSAO Market:...
Adam J. Fein, PhD, founder and...
10/03/2025
First Report Managed Care

Behind the Bill

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
BEHIND THE BILL
When Agencies Lose Power: How 3 Seismic Shifts are Transforming Pharmaceutical Regulation
05/07/2025
Katie Hayes, MJ
In the span of just 9 months, the landscape of administrative law has undergone a transformation so profound that pharmaceutical executives, health care providers, and patients alike are struggling to navigate the new terrain. The Supreme...
In the span of just 9 months, the landscape of administrative law has undergone a transformation so profound that pharmaceutical executives, health care providers, and patients alike are struggling to navigate the new terrain. The Supreme...
In the span of just 9 months,...
05/07/2025
First Report Managed Care
Behind the Bill
The Medicare Paradox, Part 3: Strategic Trade Doesn’t Have to be a Zero-Sum Game
05/07/2025
Katie Hayes, MJ
Over the past 2 weeks, I’ve examined the growing friction between the Section 232 pharmaceutical tariff investigations and the Medicare drug pricing reforms authorized by the Inflation Reduction Act (IRA). These 2 policy agendas—industrial...
Over the past 2 weeks, I’ve examined the growing friction between the Section 232 pharmaceutical tariff investigations and the Medicare drug pricing reforms authorized by the Inflation Reduction Act (IRA). These 2 policy agendas—industrial...
Over the past 2 weeks, I’ve...
05/07/2025
First Report Managed Care

Trending Articles

Feature Story
A Better Way to Pay for Primary Care
05/31/2024
Mary Beth Nierengarten
A push for a hybrid payment model for primary care is gaining momentum, with advocates urging the CMS to implement changes to increase funding and improve outcomes for patients.
A push for a hybrid payment model for primary care is gaining momentum, with advocates urging the CMS to implement changes to increase funding and improve outcomes for patients.
A push for a hybrid payment...
05/31/2024
First Report Managed Care
Conference Coverage
Mepolizumab Treatment May Reduce Health Care Resource Utilization and OCS in Patients With CRSwNP
04/10/2024
Hannah Musick
Research that will be presented at AMCP 2024 suggests that mepolizumab treatment reduces health care costs and resource utilization in patients with chronic rhinosinusitis with nasal polyps.
Research that will be presented at AMCP 2024 suggests that mepolizumab treatment reduces health care costs and resource utilization in patients with chronic rhinosinusitis with nasal polyps.
Research that will be presented...
04/10/2024
First Report Managed Care
News
Keratoconus Appears to be Associated With Demodex Mites
05/16/2024
Jolynn Tumolo
Keratoconus, an eye disorder that leads to gradual curvature of the cornea, may be associated with Demodex infestation, suggests a small study published in the Oman Journal of Ophthalmology.
Keratoconus, an eye disorder that leads to gradual curvature of the cornea, may be associated with Demodex infestation, suggests a small study published in the Oman Journal of Ophthalmology.
Keratoconus, an eye disorder...
05/16/2024
First Report Managed Care
Alison Lum Headshot
Interview
Transforming Pharmacy Care and Drug Payment Models: Expert Insights From Asembia 2024
06/06/2024
Alison Lum, PharmD
In this interview, Alison Lum, PharmD, vice president of Pharmacy Services at Blue Shield, discussed the panel she moderated at Asembia 2024 and delved into drug payment options' challenges, including the limitations of copay cards and the...
In this interview, Alison Lum, PharmD, vice president of Pharmacy Services at Blue Shield, discussed the panel she moderated at Asembia 2024 and delved into drug payment options' challenges, including the limitations of copay cards and the...
In this interview, Alison Lum,...
06/06/2024
First Report Managed Care
Ashley Joseph
Conference Coverage
The Impact of AI on Infusion Patient Care and Operational Efficiency
07/22/2024
Ashley Joseph
NICA 2024 session speaker Ashley Joseph of LeanTaas shares insights on how AI technologies are revolutionizing infusion therapy operations, improving care coordination, and ultimately enhancing the patient experience in these critical care...
NICA 2024 session speaker Ashley Joseph of LeanTaas shares insights on how AI technologies are revolutionizing infusion therapy operations, improving care coordination, and ultimately enhancing the patient experience in these critical care...
NICA 2024 session speaker Ashley...
07/22/2024
First Report Managed Care

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