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Oct/Nov/Dec Volume 22, Issue 4, First Report Managed Care

Regulatory Insights
Subsidies, Savings, and Stalemates: What Congress's Year-End Gridlock Means for Health Plans in 2026
12/05/2025
Adam Colborn, JD
As health policy debates resurface in Washington, unresolved battles over ACA subsidies, health savings accounts, and PBM reform are shaping a high-stakes landscape for payers heading into the new year.
As health policy debates resurface in Washington, unresolved battles over ACA subsidies, health savings accounts, and PBM reform are shaping a high-stakes landscape for payers heading into the new year.
As health policy debates...
12/05/2025
First Report Managed Care
Cell & Gene Watch
Reaching Patients Where They Are: Moving CGT Care into the Community
12/05/2025
Joe DePinto
As cell and gene therapies rapidly advance, shrinking the nation’s growing “CGT deserts” by expanding capabilities in community care settings is essential to ensure that breakthrough treatments reach patients equitably—not just those living...
As cell and gene therapies rapidly advance, shrinking the nation’s growing “CGT deserts” by expanding capabilities in community care settings is essential to ensure that breakthrough treatments reach patients equitably—not just those living...
As cell and gene therapies...
12/05/2025
First Report Managed Care
MANAGED CARE Q&A
SDOH Interventions and Managed Care Performance: A Roadmap for Health Plans
12/05/2025
Karen Iapoce, RNC, MSN, CPHQ, LSSBB
Karen Iapoce explains how integrating social determinants of health into managed care workflows can drive measurable improvements in outcomes and Stars performance.
Karen Iapoce explains how integrating social determinants of health into managed care workflows can drive measurable improvements in outcomes and Stars performance.
Karen Iapoce explains how...
12/05/2025
First Report Managed Care
MANAGED CARE Q&A
Turning Data into Equity: How Advanced Analytics and SDOH Integration Are Redefining Value-Based Care
11/25/2025
Michael Hoxter
Michael Hoxter, Chief Technology Officer at Lightbeam Health Solutions, discusses how advanced analytics, artificial intelligence (AI), and social determinants of health data are transforming population health management, driving efficiency,...
Michael Hoxter, Chief Technology Officer at Lightbeam Health Solutions, discusses how advanced analytics, artificial intelligence (AI), and social determinants of health data are transforming population health management, driving efficiency,...
Michael Hoxter, Chief Technology...
11/25/2025
First Report Managed Care
MANAGED CARE Q&A
Right-Sizing Star Ratings: How Health Plans Can Adapt to a Changing Landscape
11/25/2025
Marge Ciancetta
Cotiviti’s Marge Ciancetta highlights how mid-sized Medicare Advantage plans leverage local insight, operational agility, and innovation to outperform larger national competitors.
Cotiviti’s Marge Ciancetta highlights how mid-sized Medicare Advantage plans leverage local insight, operational agility, and innovation to outperform larger national competitors.
Cotiviti’s Marge Ciancetta...
11/25/2025
First Report Managed Care
MANAGED CARE Q&A
The Potential of AI as a Clinical Co‑Pilot
11/24/2025
Gregory Whisman, MD, MBA
A guest expert explores how artificial intelligence is emerging as a clinical co-pilot by streamlining administrative burdens, enhancing patient targeting and engagement, and supporting predictive care strategies to improve quality, reduce...
A guest expert explores how artificial intelligence is emerging as a clinical co-pilot by streamlining administrative burdens, enhancing patient targeting and engagement, and supporting predictive care strategies to improve quality, reduce...
A guest expert explores how...
11/24/2025
First Report Managed Care
Commentary
Biologics: Combating Big Spend in Small Doses
11/24/2025
Krithika Srivats
A guest expert discusses how biologic drugs like monoclonal antibodies are driving soaring health care costs, but data-driven strategies and greater use of biosimilars may offer payers a powerful path to rein in spending without compromising...
A guest expert discusses how biologic drugs like monoclonal antibodies are driving soaring health care costs, but data-driven strategies and greater use of biosimilars may offer payers a powerful path to rein in spending without compromising...
A guest expert discusses how...
11/24/2025
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

December 2025 Volume 22 Issue 4

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