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News
Optum Rx Eases Access by Dropping Reauthorization for Key Drugs
07/03/2025
Grace Taylor, MS, MA
Optum Rx has eliminated reauthorization requirements for over 140 medications, aiming to reduce care delays and improve access for patients with chronic conditions.
Optum Rx has eliminated reauthorization requirements for over 140 medications, aiming to reduce care delays and improve access for patients with chronic conditions.
Optum Rx has eliminated...
07/03/2025
First Report Managed Care
News
HHS, CMS, and Major Insurers Unite to Announce Voluntary Prior Authorization Reform Pledge
06/23/2025
Hannah Musick
At a landmark press conference, the US Department of Health and Human Services announced that top health officials and major insurers—representing 75% of insured Americans—have signed a voluntary pledge to overhaul the prior authorization...
At a landmark press conference, the US Department of Health and Human Services announced that top health officials and major insurers—representing 75% of insured Americans—have signed a voluntary pledge to overhaul the prior authorization...
At a landmark press conference,...
06/23/2025
First Report Managed Care
News
CVS Health’s Aetna and Blue Cross Blue Shield Among Insurers Pledging to Reform Criticized Prior Authorization Process
06/23/2025
Hannah Musick
Major insurers have pledged to streamline the prior authorization process by 2027, aiming to reduce care delays and administrative burdens while facing ongoing scrutiny from clinicians and patients.
Major insurers have pledged to streamline the prior authorization process by 2027, aiming to reduce care delays and administrative burdens while facing ongoing scrutiny from clinicians and patients.
Major insurers have pledged to...
06/23/2025
First Report Managed Care
News
North Dakota Enacts Prior Authorization Law to Curb Health Coverage Delays
04/28/2025
Grace Taylor, MS, MA
North Dakota has enacted a new law to streamline the prior authorization process and prevent delays in patient care.
North Dakota has enacted a new law to streamline the prior authorization process and prevent delays in patient care.
North Dakota has enacted a new...
04/28/2025
First Report Managed Care
News
Increased Scrutiny of Prior Authorization: Are Payers Fully to Blame, and Can AI Improve the Process?
04/05/2024
Dean Celia
The increased scrutiny of prior authorization, highlighted by media reports and government actions, prompts debate over payer responsibility while exploring the potential for AI to enhance the process.
The increased scrutiny of prior authorization, highlighted by media reports and government actions, prompts debate over payer responsibility while exploring the potential for AI to enhance the process.
The increased scrutiny of prior...
04/05/2024
First Report Managed Care
News
Impact of Patient Cost Sharing on Specialty Drug Utilization, Prior Authorization
05/26/2023
Julie Gould
“Higher levels of patient cost sharing reduce specialty drug use by increasing medication abandonment while generally decreasing initiation and persistence," researchers said.
“Higher levels of patient cost sharing reduce specialty drug use by increasing medication abandonment while generally decreasing initiation and persistence," researchers said.
“Higher levels of patient cost...
05/26/2023
First Report Managed Care
News
ICER Report: Price Transparency, Prior Authorization Process Need Improvements
01/17/2023
Maria Asimopoulos
In addition to illuminating ongoing barriers, the report showed payers’ drug coverage policies largely were aligned with fair access criteria.
In addition to illuminating ongoing barriers, the report showed payers’ drug coverage policies largely were aligned with fair access criteria.
In addition to illuminating...
01/17/2023
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

Shannon Smith, RN, BSN
Commentary
Navigating the CY 2025 CMS Physician Fee Schedule Proposals: Strategic Insights for Health Care Leaders
09/30/2024
Shannon Smith, RN, BSN
The Centers for Medicare & Medicaid Services (CMS) has released its calendar year (CY) 2025 physician fee schedule proposals. In this commentary, an expert breaks down the key components and their implications for health care organizations.
The Centers for Medicare & Medicaid Services (CMS) has released its calendar year (CY) 2025 physician fee schedule proposals. In this commentary, an expert breaks down the key components and their implications for health care organizations.
The Centers for Medicare &...
09/30/2024
First Report Managed Care
Behind the Bill
Unpredictable Polls and Uncharted Policies in the 2024 Elections
10/23/2024
Katie Hayes, MJ
With the 2024 elections just 13 days away, everyone has one question: What happens next? The stakes are particularly high for health policy, but there’s a cloud of uncertainty hanging over the predictions—especially when it comes to polling...
With the 2024 elections just 13 days away, everyone has one question: What happens next? The stakes are particularly high for health policy, but there’s a cloud of uncertainty hanging over the predictions—especially when it comes to polling...
With the 2024 elections just 13...
10/23/2024
First Report Managed Care
News
Latest Formulary Exclusions from Top PBMs Demonstrate Issues in the Drug Pricing Landscape
02/21/2024
Dean Celia
Experts highlight the impact of the "warped incentives" in drug pricing's gross-to-net bubble, revealing that despite significant discounts, certain biosimilars are excluded from the formularies of major pharmacy benefit managers, leading to...
Experts highlight the impact of the "warped incentives" in drug pricing's gross-to-net bubble, revealing that despite significant discounts, certain biosimilars are excluded from the formularies of major pharmacy benefit managers, leading to...
Experts highlight the impact of...
02/21/2024
First Report Managed Care
Owens
Podcasts
Understanding the Impact of Formulary Exclusions on Medication Adherence
03/28/2024

Featuring Gary Owens, MD, president of Gary Owens Associates

Featuring Gary Owens, MD, presid...
Join us as guest expert Gary Owens discusses how formulary exclusions can impact patient medication adherence and lead to adverse economic outcomes, making the need for non-medical switching and formulary exception requests an important issue...
Join us as guest expert Gary Owens discusses how formulary exclusions can impact patient medication adherence and lead to adverse economic outcomes, making the need for non-medical switching and formulary exception requests an important issue...
Join us as guest expert Gary...
03/28/2024
First Report Managed Care
Conference Coverage
Pharmaceutical Industry Trend and Prediction Highlights from AMCP 2024
04/26/2024
Hannah Musick
A keynote session at AMCP 2024 outlined pharmaceutical industry trends and predictions for pharmacy benefits management (PBMs), including challenges and disruptors like the Inflation Reduction Act (IRA), changing consumer preferences, rising...
A keynote session at AMCP 2024 outlined pharmaceutical industry trends and predictions for pharmacy benefits management (PBMs), including challenges and disruptors like the Inflation Reduction Act (IRA), changing consumer preferences, rising...
A keynote session at AMCP 2024...
04/26/2024
First Report Managed Care

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