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July/Aug/Sep Volume 22, Issue 3, First Report Managed Care

Interview
From Promise to Practice: Evaluating the Impact of the Prior Authorization Reform Pledge
08/21/2025
Gordon Jaye
With more than 50 payers committing to faster, more transparent prior authorization processes, Gordon Jaye, executive director, RCM policy and industry engagement at EnableComp explores what the pledge could mean for turnaround times,...
With more than 50 payers committing to faster, more transparent prior authorization processes, Gordon Jaye, executive director, RCM policy and industry engagement at EnableComp explores what the pledge could mean for turnaround times,...
With more than 50 payers...
08/21/2025
First Report Managed Care
Commentary
The Case for Aligning Behavioral and Primary Care in Managed Care
08/22/2025
Lynn Carroll
The Centers for Medicare & Medicaid Services PC Flex Model is accelerating behavioral health integration by giving accountable care organizations the financial flexibility to deliver whole-person care, bridging longstanding gaps in access,...
The Centers for Medicare & Medicaid Services PC Flex Model is accelerating behavioral health integration by giving accountable care organizations the financial flexibility to deliver whole-person care, bridging longstanding gaps in access,...
The Centers for Medicare &...
08/22/2025
First Report Managed Care
Regulatory Insights
Five Things to Know About HR 1
08/25/2025
Adam Colborn, JD
HR 1 marks a major shift in health care policy, reshaping Medicaid and insurance marketplaces in ways that increase churn, reduce coverage, and cut funding—changes that managed care organizations must navigate amid rising political and...
HR 1 marks a major shift in health care policy, reshaping Medicaid and insurance marketplaces in ways that increase churn, reduce coverage, and cut funding—changes that managed care organizations must navigate amid rising political and...
HR 1 marks a major shift in...
08/25/2025
First Report Managed Care
Interview
Invisible Technology and AI: The Future of Scaling Virtual Care
08/27/2025
Kent Dicks
Kent Dicks, CEO of Life365, shares how artificial intelligence (AI), “invisible technology,” and smarter reimbursement models can overcome barriers to virtual care and remote patient monitoring, transforming health care into a more proactive,...
Kent Dicks, CEO of Life365, shares how artificial intelligence (AI), “invisible technology,” and smarter reimbursement models can overcome barriers to virtual care and remote patient monitoring, transforming health care into a more proactive,...
Kent Dicks, CEO of Life365,...
08/27/2025
First Report Managed Care
Cell & Gene Watch
Scaling CGT Capacity for a Growing Pipeline: Current Progress and Ongoing Hurdles
08/28/2025
Joe DePinto
The cell and gene therapy pipeline is rapidly expanding into new disease areas, but realizing its full potential will require manufacturing innovation, value chain coordination, and new pricing models to balance cost, access, and scale.
The cell and gene therapy pipeline is rapidly expanding into new disease areas, but realizing its full potential will require manufacturing innovation, value chain coordination, and new pricing models to balance cost, access, and scale.
The cell and gene therapy...
08/28/2025
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

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Trending Articles

News
Addressing Duchenne Muscular Dystrophy Challenges: Potential Benefits of Gene Transfer Therapy
10/02/2023
Danielle Sposato
Duchenne muscular dystrophy (DMD) is a genetic disorder characterized by the absence or near absence of functional dystrophin protein, leading to severe muscle weakness and early mortality, often before age 30. Current treatments, such as...
Duchenne muscular dystrophy (DMD) is a genetic disorder characterized by the absence or near absence of functional dystrophin protein, leading to severe muscle weakness and early mortality, often before age 30. Current treatments, such as...
Duchenne muscular dystrophy...
10/02/2023
First Report Managed Care
Videos
AVAHO 2023: Andrew Brunner, MD, Discusses Updates in MDS
10/20/2023
Andrew Brunner, MD
In this video, Dr Brunner reviews his recent discussion he held at the 2023 AVAHO Annual Meeting, and provides treatment updates in the treatment of MDS.
In this video, Dr Brunner reviews his recent discussion he held at the 2023 AVAHO Annual Meeting, and provides treatment updates in the treatment of MDS.
In this video, Dr Brunner...
10/20/2023
First Report Managed Care
News
Patients With MS Switching to Teriflunomide: Characteristics, Utilization, and Relapses
11/09/2023
Hannah Musick
“Switching to teriflunomide from existing DMTs in patients with relapsing MS resulted in a reduction in outpatient HCRU in this analysis of US claims data,” said researchers.
“Switching to teriflunomide from existing DMTs in patients with relapsing MS resulted in a reduction in outpatient HCRU in this analysis of US claims data,” said researchers.
“Switching to teriflunomide from...
11/09/2023
First Report Managed Care
Commentary
The Role of JAK Inhibitors in the Treatment of Autoimmune and Autoinflammatory Diseases
12/14/2023
Yvette C. Terrie, BS Pharm, RPh
While the majority of Janus kinase inhibitors (JAKs) are available in oral formulations, in July 2022, the FDA approved ruxolitinib cream 1.5% as the only topical formulation of a selective JAK (JAK1/JAK2) inhibitor approved in the US,...
While the majority of Janus kinase inhibitors (JAKs) are available in oral formulations, in July 2022, the FDA approved ruxolitinib cream 1.5% as the only topical formulation of a selective JAK (JAK1/JAK2) inhibitor approved in the US,...
While the majority of Janus...
12/14/2023
First Report Managed Care
Commentary
Request for FDA Approval: Prescription Digital Therapeutic Targeting Liver Disease With Breakthrough Device Designation
01/24/2024
Lisa Kuhns, PhD, MD
In January 2024, Better Therapeutics, Inc submitted a request to the US Food and Drug Administration (FDA) for Breakthrough Device Designation for its new prescription digital therapeutic (PDT) designed to treat metabolic...
In January 2024, Better Therapeutics, Inc submitted a request to the US Food and Drug Administration (FDA) for Breakthrough Device Designation for its new prescription digital therapeutic (PDT) designed to treat metabolic...
In January 2024, Better...
01/24/2024
First Report Managed Care

September 2025 Volume 22 Issue 3

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