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News
Co-occurring ADHD Associated With Poorer Health Outcomes in Adults With Autism on Medicaid
02/02/2026
Grace Taylor, MS, MA
A large US Medicaid study finds that co-occurring attention-deficit/hyperactivity disorder (ADHD) is common among adults with autism and is linked to higher rates of substance use, cardiovascular conditions, and injury, while ADHD medication...
A large US Medicaid study finds that co-occurring attention-deficit/hyperactivity disorder (ADHD) is common among adults with autism and is linked to higher rates of substance use, cardiovascular conditions, and injury, while ADHD medication...
A large US Medicaid study finds...
02/02/2026
First Report Managed Care
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
Medicare Part D Formularies Remain Broad for IRA-Negotiated Drugs
01/20/2026
Grace Taylor, MS, MA
Despite broad Medicare Part D coverage for Inflation Reduction Act (IRA)-negotiated drugs, data suggest formulary access is narrowing for non-selected therapies—particularly orphan drugs—raising concerns about patient access as price...
Despite broad Medicare Part D coverage for Inflation Reduction Act (IRA)-negotiated drugs, data suggest formulary access is narrowing for non-selected therapies—particularly orphan drugs—raising concerns about patient access as price...
Despite broad Medicare Part D...
01/20/2026
First Report Managed Care
News
AI Navigator Launched to Support Medicaid and SNAP Members Amid Policy Shifts
12/22/2025
Hannah Musick
Social health platform Pyx Health has launched an AI-driven navigator aimed at helping US Medicaid and Supplemental Nutrition Assistance Program (SNAP) beneficiaries comply with new policy requirements under the One Big Beautiful Bill Act...
Social health platform Pyx Health has launched an AI-driven navigator aimed at helping US Medicaid and Supplemental Nutrition Assistance Program (SNAP) beneficiaries comply with new policy requirements under the One Big Beautiful Bill Act...
Social health platform Pyx...
12/22/2025
First Report Managed Care
News
CMS Unveils LEAD Model to Succeed ACO REACH in 2027
12/19/2025
Grace Taylor, MS, MA
The Centers for Medicare & Medicaid Services (CMS) is set to replace the Accountable Care Organization (ACO) REACH model with its longest-ever accountable care demonstration, a 10-year Long-Term Enhanced ACO Design (LEAD) model aimed at...
The Centers for Medicare & Medicaid Services (CMS) is set to replace the Accountable Care Organization (ACO) REACH model with its longest-ever accountable care demonstration, a 10-year Long-Term Enhanced ACO Design (LEAD) model aimed at...
The Centers for Medicare &...
12/19/2025
First Report Managed Care
News
A New Era for Medicaid: CMS Unveils the Blueprint for Engagement, Integrity, and Sustainability
12/09/2025
Danielle Sposato
The Centers for Medicare & Medicaid Services (CMS) released new guidance detailing how states should implement major Medicaid reforms included in the Working Families Tax Cut (WFTC) legislation (Public Law 119-21). These reforms mark some of...
The Centers for Medicare & Medicaid Services (CMS) released new guidance detailing how states should implement major Medicaid reforms included in the Working Families Tax Cut (WFTC) legislation (Public Law 119-21). These reforms mark some of...
The Centers for Medicare &...
12/09/2025
First Report Managed Care
News
CMS Issues New Guidance to Tighten Oversight of Medicaid Financing
11/18/2025
Juliet Gallagher
The Centers for Medicare & Medicaid Services (CMS) released preliminary guidance to states on implementing new federal limits on Medicaid health care-related taxes and closing financing loopholes. The guidance, stemming from the Working...
The Centers for Medicare & Medicaid Services (CMS) released preliminary guidance to states on implementing new federal limits on Medicaid health care-related taxes and closing financing loopholes. The guidance, stemming from the Working...
The Centers for Medicare &...
11/18/2025
First Report Managed Care
News
CMS Announces 2026 Medicare Premiums and Deductibles: Moderate Increases Across Parts A, B, and D
11/17/2025
Juliet Gallagher
On November 14, 2025, the Centers for Medicare & Medicaid Services (CMS) announced the 2026 Medicare Parts A and B premiums, deductibles, and coinsurance rates, along with the updated income-related monthly adjustment amounts for Part D. The...
On November 14, 2025, the Centers for Medicare & Medicaid Services (CMS) announced the 2026 Medicare Parts A and B premiums, deductibles, and coinsurance rates, along with the updated income-related monthly adjustment amounts for Part D. The...
On November 14, 2025, the...
11/17/2025
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
News
Medicaid Work Requirements Under HR 1 Could Affect 5 Million Adults, Many With Chronic Illnesses
10/28/2025
Grace Taylor, MS, MA
A national study found that many adults who could lose Medicaid coverage under HR 1’s work requirements are managing multiple chronic illnesses, highlighting potential risks for patients and payers alike.
A national study found that many adults who could lose Medicaid coverage under HR 1’s work requirements are managing multiple chronic illnesses, highlighting potential risks for patients and payers alike.
A national study found that many...
10/28/2025
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

Trending Articles

News
Who Will Benefit Under the Medicare Part D Out-of-Pocket Spending Cap?
02/27/2024
Dean Celia
Starting in 2024, Medicare Part D enrollees could benefit from a cap placed on out-of-pocket drug spending, thanks to a provision in the Inflation Reduction Act of 2022 (IRA).
Starting in 2024, Medicare Part D enrollees could benefit from a cap placed on out-of-pocket drug spending, thanks to a provision in the Inflation Reduction Act of 2022 (IRA).
Starting in 2024, Medicare Part...
02/27/2024
First Report Managed Care
News
The Impact of Inhibitors on Surgical Management in Patients With Hemophilia
04/04/2024
Hannah Musick
The development of inhibitors in patients with hemophilia poses challenges for achieving perioperative hemostasis and may result in complications and deviations from the surgical plan, highlighting the need for strategies to address inhibitor...
The development of inhibitors in patients with hemophilia poses challenges for achieving perioperative hemostasis and may result in complications and deviations from the surgical plan, highlighting the need for strategies to address inhibitor...
The development of inhibitors in...
04/04/2024
First Report Managed Care
Conference Coverage
Expanding Pharmacists’ Role in Providing Clinical Care: Addressing Public Health Challenges
05/02/2024
Danielle Sposato
Panelists from various backgrounds discuss the critical role of pharmacists in addressing public health challenges such as HIV/AIDS and advocating for expanded clinical care and reimbursement pathways to improve health outcomes in communities.
Panelists from various backgrounds discuss the critical role of pharmacists in addressing public health challenges such as HIV/AIDS and advocating for expanded clinical care and reimbursement pathways to improve health outcomes in communities.
Panelists from various...
05/02/2024
First Report Managed Care
Managed Care Q&A
Prioritizing Patient Voices in Drug Development and Coverage
05/27/2024
In this interview, guest experts discuss the importance of incorporating patient voices into health care decision-making, highlighting opportunities for collaboration and enhancement in drug development and patient coverage.
In this interview, guest experts discuss the importance of incorporating patient voices into health care decision-making, highlighting opportunities for collaboration and enhancement in drug development and patient coverage.
In this interview, guest experts...
05/27/2024
First Report Managed Care
Blog
The Clash Over Medicare: Key Lawsuits Challenging the IRA’s Drug Negotiation Provisions
07/11/2024
Katie Hayes, MJ
The IRA has spawned a series of lawsuits from pharmaceutical companies. Here, we provide the latest status updates on several of them.
The IRA has spawned a series of lawsuits from pharmaceutical companies. Here, we provide the latest status updates on several of them.
The IRA has spawned a series of...
07/11/2024
First Report Managed Care

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