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News
Trump Administration to Test AI-Powered Prior Authorization in Medicare
09/25/2025
Grace Taylor, MS, MA
The Trump administration is set to launch a decade-long Medicare pilot that uses artificial intelligence (AI)-driven prior authorization to curb costs, sparking bipartisan concern over access to care and patient safety.
The Trump administration is set to launch a decade-long Medicare pilot that uses artificial intelligence (AI)-driven prior authorization to curb costs, sparking bipartisan concern over access to care and patient safety.
The Trump administration is set...
09/25/2025
First Report Managed Care
News
No Surprises Act Cuts Patient Out-of-Pocket Costs but Leaves Premiums Unchanged
09/16/2025
Lisa Kuhns, PhD, MD
The No Surprises Act (NSA) has succeeded in lowering out-of-pocket spending for privately insured adults in states that previously lacked protections from surprise medical bills, though it has not significantly reduced premiums or overall...
The No Surprises Act (NSA) has succeeded in lowering out-of-pocket spending for privately insured adults in states that previously lacked protections from surprise medical bills, though it has not significantly reduced premiums or overall...
The No Surprises Act (NSA) has...
09/16/2025
First Report Managed Care
News
DOJ and HHS Form Working Group to Intensify Health Care Fraud Enforcement
07/02/2025
Juliet Gallagher
The US Department of Health and Human Services (HHS) and the US Department of Justice (DOJ) announced the formation of the DOJ-HHS False Claims Act (FCA) Working Group, a joint initiative designed to strengthen enforcement efforts against...
The US Department of Health and Human Services (HHS) and the US Department of Justice (DOJ) announced the formation of the DOJ-HHS False Claims Act (FCA) Working Group, a joint initiative designed to strengthen enforcement efforts against...
The US Department of Health and...
07/02/2025
First Report Managed Care
News
FDA Grants Accelerated Approval for Asciminib as First-Line Treatment in Ph+CML-CP
11/01/2024
Juliet Gallagher
Novartis received accelerated approval by the US Food and Drug Administration (FDA) for asciminib, a medication for adult patients with newly diagnosed Philadelphia chromosome-positive chronic myeloid leukemia in chronic phase (Ph+CML-CP).
Novartis received accelerated approval by the US Food and Drug Administration (FDA) for asciminib, a medication for adult patients with newly diagnosed Philadelphia chromosome-positive chronic myeloid leukemia in chronic phase (Ph+CML-CP).
Novartis received accelerated...
11/01/2024
First Report Managed Care
News
HHS Faces Legal Action From 10 Hospitals Over 2023 Medicare Advantage Rule and Reimbursement Calculations
10/30/2024
Juliet Gallagher
Ten hospitals sued the US Department of Health and Human Services (HHS), claiming that they were underpaid Medicare reimbursements for serving low-income patients.
Ten hospitals sued the US Department of Health and Human Services (HHS), claiming that they were underpaid Medicare reimbursements for serving low-income patients.
Ten hospitals sued the US...
10/30/2024
First Report Managed Care
News
HHS Unveils Comprehensive Healthcare Reforms to Boost Equity and Quality
09/13/2024
Lisa Kuhns, PhD, MD
The US Department of Health and Human Services (HHS) has announced updates to Medicare payments and policies to improve healthcare accessibility, equity, and quality for millions of Americans, according to a press release by the HHS.
The US Department of Health and Human Services (HHS) has announced updates to Medicare payments and policies to improve healthcare accessibility, equity, and quality for millions of Americans, according to a press release by the HHS.
The US Department of Health and...
09/13/2024
First Report Managed Care
News
Ryan White HIV/AIDS Program to Improve Access to HIV Care for Women, Children, and Youth
08/09/2024
Lisa Kuhns, PhD, MD
The Biden-Harris Administration has announced more than $68 million in funding to improve access to HIV care for women, infants, children, and youth through the Ryan White HIV/AIDS Program.
The Biden-Harris Administration has announced more than $68 million in funding to improve access to HIV care for women, infants, children, and youth through the Ryan White HIV/AIDS Program.
The Biden-Harris Administration...
08/09/2024
First Report Managed Care
News
Debate Emerges Over FDA's Plan to Regulate Laboratory Medical Tests
05/03/2024
Hannah Musick
The FDA's new regulations on laboratory-developed tests have sparked debate over access to innovative tests and patient care in the medical field, with opponents arguing that increased oversight could hinder the development of crucial new...
The FDA's new regulations on laboratory-developed tests have sparked debate over access to innovative tests and patient care in the medical field, with opponents arguing that increased oversight could hinder the development of crucial new...
The FDA's new regulations on...
05/03/2024
First Report Managed Care
News
PhRMA Maps Provide State-by-State Look at 340B Drug Program
04/05/2024
Paul Nicolaus
An interactive map made available by the Pharmaceutical Research and Manufacturers of America (PhRMA), a drugmaker advocacy group, shares state-specific data on the 340B Drug Pricing Program. The federal program, initially created over 30...
An interactive map made available by the Pharmaceutical Research and Manufacturers of America (PhRMA), a drugmaker advocacy group, shares state-specific data on the 340B Drug Pricing Program. The federal program, initially created over 30...
An interactive map made...
04/05/2024
First Report Managed Care
News
Justice Department Launches UnitedHealth Antitrust Investigation
03/05/2024
Hannah Musick
The Justice Department is investigating UnitedHealth’s ownership of the largest US health care insurer and its relationship with doctor groups and drug benefits amid concerns of potential antitrust violations.
The Justice Department is investigating UnitedHealth’s ownership of the largest US health care insurer and its relationship with doctor groups and drug benefits amid concerns of potential antitrust violations.
The Justice Department is...
03/05/2024
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

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Trending Articles

News
Identifying Large-Vessel Vasculitis in Polymyalgia Rheumatica: Key Clinical and Laboratory Red Flags
04/05/2024
Lisa Kuhns, PhD, MD
Potential red flags for large-vessel vasculitis in isolated polymyalgia rheumatica (PMR) include inflammatory back pain, significant pelvic involvement, widespread lower extremity pain, marked inflammatory response indicated by specific lab...
Potential red flags for large-vessel vasculitis in isolated polymyalgia rheumatica (PMR) include inflammatory back pain, significant pelvic involvement, widespread lower extremity pain, marked inflammatory response indicated by specific lab...
Potential red flags for...
04/05/2024
First Report Managed Care
Jay Ackerman Headshot
Interview
AI's Impact on Value-Based Care Outcomes
05/07/2024
Artificial intelligence (AI)-powered workflows and prospective analytics are advancing value-based care by improving patient outcomes and reducing costs. In a recent interview, an expert emphasizes that leveraging AI technologies enables...
Artificial intelligence (AI)-powered workflows and prospective analytics are advancing value-based care by improving patient outcomes and reducing costs. In a recent interview, an expert emphasizes that leveraging AI technologies enables...
Artificial intelligence...
05/07/2024
First Report Managed Care
News
Patient Diagnosed With Clinically Isolated Syndrome After Traumatic Brain Injury: Case Study
05/30/2024
Grace Taylor, MS, MA
Researchers presented a case study of a 71-year-old White man who was diagnosed with clinically isolated syndrome (CIS) after experiencing a traumatic brain injury.
Researchers presented a case study of a 71-year-old White man who was diagnosed with clinically isolated syndrome (CIS) after experiencing a traumatic brain injury.
Researchers presented a case...
05/30/2024
First Report Managed Care
FY2025
Behind the Bill
Budget Squeeze for FY 2025: What It Means for HHS and Public Health
07/17/2024
Katie Hayes, MJ
FY 2025 planning shows potential budget cuts for HHS and FDA, which could limit their ability to enforce regulations and address key issues.
FY 2025 planning shows potential budget cuts for HHS and FDA, which could limit their ability to enforce regulations and address key issues.
FY 2025 planning shows potential...
07/17/2024
First Report Managed Care
Venkatgiri Vandali
Interview
Maximizing Efficiency and Patient Care With Generative AI
08/12/2024
Venkatgiri Vandali
The role of generative AI in managing data is explored and the potential impact of payers, providers, and patients in this interview with industry expert Venkatgiri Vandali of Firstsource.
The role of generative AI in managing data is explored and the potential impact of payers, providers, and patients in this interview with industry expert Venkatgiri Vandali of Firstsource.
The role of generative AI in...
08/12/2024
First Report Managed Care

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