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News
Aetna Reaches $117.7M Settlement in False Claims Act Violation
03/11/2026
Danielle Sposato
Aetna Inc. has agreed to pay $117.7 million to resolve allegations that it violated the False Claims Act by submitting or failing to withdraw inaccurate diagnosis codes for Medicare Advantage (MA) enrollees, resulting in inflated payments...
Aetna Inc. has agreed to pay $117.7 million to resolve allegations that it violated the False Claims Act by submitting or failing to withdraw inaccurate diagnosis codes for Medicare Advantage (MA) enrollees, resulting in inflated payments...
Aetna Inc. has agreed to pay...
03/11/2026
First Report Managed Care
News
TrumpRx.gov Launch Targets Lower Prescription Drug Prices in United States
02/06/2026
Juliet Gallagher
The Trump Administration has announced the launch of TrumpRx.gov, a new website designed to provide American patients with access to prescription drug prices aligned with the lowest paid in other developed nations. The initiative applies...
The Trump Administration has announced the launch of TrumpRx.gov, a new website designed to provide American patients with access to prescription drug prices aligned with the lowest paid in other developed nations. The initiative applies...
The Trump Administration has...
02/06/2026
First Report Managed Care
News
CMS Establishes Office of Rural Health Transformation Nationwide
01/09/2026
Grace Taylor, MS, MA
The Centers for Medicare & Medicaid Services (CMS) has formally launched the Office of Rural Health Transformation, creating a dedicated hub to oversee a $50 billion, 5-year effort to strengthen rural health systems and expand access to care...
The Centers for Medicare & Medicaid Services (CMS) has formally launched the Office of Rural Health Transformation, creating a dedicated hub to oversee a $50 billion, 5-year effort to strengthen rural health systems and expand access to care...
The Centers for Medicare &...
01/09/2026
First Report Managed Care
News
NIH Oversight Gaps Raise Fraud Risks in $1.9B Other Transaction Portfolio
11/26/2025
Juliet Gallagher
A new report from the Office of Inspector General (OIG) warns that gaps in NIH oversight have heightened fraud, waste, and abuse risks across its Other Transaction (OT) awards. The findings come amid a rapid expansion of OT use—from under...
A new report from the Office of Inspector General (OIG) warns that gaps in NIH oversight have heightened fraud, waste, and abuse risks across its Other Transaction (OT) awards. The findings come amid a rapid expansion of OT use—from under...
A new report from the Office of...
11/26/2025
First Report Managed Care
News
Independent Dispute Resolution Abuse Threatens No Surprise Act’s Success and Drives Up System Costs
11/25/2025
Lisa Kuhns, PhD, MD
The No Surprises Act (NSA) is shielding Americans from nearly 20 million surprise medical bills each year, but the federal arbitration system intended to resolve payment disputes is being overwhelmed and undermined by large volumes of...
The No Surprises Act (NSA) is shielding Americans from nearly 20 million surprise medical bills each year, but the federal arbitration system intended to resolve payment disputes is being overwhelmed and undermined by large volumes of...
The No Surprises Act (NSA) is...
11/25/2025
First Report Managed Care
News
CMS Finalizes 2026 Rule to Strengthen Hospital Price Transparency Nationwide
11/24/2025
Grace Taylor, MS, MA
The Centers for Medicare & Medicaid Services (CMS) has finalized new 2026 hospital price transparency rules requiring hospitals nationwide to publish verified, standardized pricing data to empower patients and payers with clearer cost...
The Centers for Medicare & Medicaid Services (CMS) has finalized new 2026 hospital price transparency rules requiring hospitals nationwide to publish verified, standardized pricing data to empower patients and payers with clearer cost...
The Centers for Medicare &...
11/24/2025
First Report Managed Care
News
Trump Announces Plan to Expand Medicare Coverage for GLP-1s, Aligning With MFN Pricing
11/06/2025
Danielle Sposato
WASHINGTON, DC — November 6, 2025 — Speaking from the Oval Office, President Donald J. Trump unveiled a sweeping new plan aimed at lowering prescription drug costs and expanding coverage for millions of Americans. The initiative includes...
WASHINGTON, DC — November 6, 2025 — Speaking from the Oval Office, President Donald J. Trump unveiled a sweeping new plan aimed at lowering prescription drug costs and expanding coverage for millions of Americans. The initiative includes...
WASHINGTON, DC — November 6,...
11/06/2025
First Report Managed Care
News
Medicaid Unwinding Led to Millions Losing Coverage but Modest Increases in Uninsurance, Study Finds
10/31/2025
Grace Taylor, MS, MA
A new analysis shows that the end of Medicaid’s pandemic-era protections triggered massive disenrollments but only modest rises in uninsurance, revealing sharp differences across states and demographic groups.
A new analysis shows that the end of Medicaid’s pandemic-era protections triggered massive disenrollments but only modest rises in uninsurance, revealing sharp differences across states and demographic groups.
A new analysis shows that the...
10/31/2025
First Report Managed Care
Conference Coverage
H.R. 1, Medicaid Cuts, and Market Uncertainty: Federal Policy in Focus at AMCP Nexus 2025
10/28/2025
Juliet Gallagher
At AMCP Nexus 2025, policy experts Geni Tunstall, JD, and Adam Colborn, JD, provided an in-depth look at the political, legal, and regulatory developments shaping health care over the past year.
At AMCP Nexus 2025, policy experts Geni Tunstall, JD, and Adam Colborn, JD, provided an in-depth look at the political, legal, and regulatory developments shaping health care over the past year.
At AMCP Nexus 2025, policy...
10/28/2025
First Report Managed Care
News
CBO Projects Nearly $9 Billion Hit to Medicare from Orphan Drug Loophole
10/23/2025
Juliet Gallagher
A new report from the Congressional Budget Office (CBO) projects that expanded exemptions for orphan drugs under the One Big Beautiful Bill Act could cost Medicare an estimated $8.8 billion over 10 years.
A new report from the Congressional Budget Office (CBO) projects that expanded exemptions for orphan drugs under the One Big Beautiful Bill Act could cost Medicare an estimated $8.8 billion over 10 years.
A new report from the...
10/23/2025
First Report Managed Care

Pipeline Projections

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
Pipeline Projections
Examining Newly FDA-Approved Anticoagulants and Upcoming Drugs in the Approval Pipeline
02/12/2025
Roy Moore
In this episode of Pipeline Projections, Roy Moore—Senior Healthcare Research & Data Analyst at Clarivate and Editorial Board Member of First Report Managed Care—explores newly approved and existing anticoagulant therapies. He analyzes...
In this episode of Pipeline Projections, Roy Moore—Senior Healthcare Research & Data Analyst at Clarivate and Editorial Board Member of First Report Managed Care—explores newly approved and existing anticoagulant therapies. He analyzes...
In this episode of Pipeline...
02/12/2025
First Report Managed Care

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

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