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News
CNS-Active Polypharmacy Affects 10 Percent of Medicare MTM Enrollees in the US
03/06/2026
Hannah Musick
In a nationally representative Medicare Medication Therapy Management (MTM) cohort, 10.7% of enrollees experienced central nervous system (CNS)-active polypharmacy, yet only about one-third completed a comprehensive medication review,...
In a nationally representative Medicare Medication Therapy Management (MTM) cohort, 10.7% of enrollees experienced central nervous system (CNS)-active polypharmacy, yet only about one-third completed a comprehensive medication review,...
In a nationally representative...
03/06/2026
First Report Managed Care
News
CMS Extends GENEROUS Model Drug Pricing Deadline to April 2026
03/03/2026
Grace Taylor, MS, MA
The Centers for Medicare & Medicaid Services (CMS) has extended the extended the Generating Cost Reductions for U.S. Medicaid (GENEROUS) Model application deadline to April 30, 2026, giving drug manufacturers more time to participate in the...
The Centers for Medicare & Medicaid Services (CMS) has extended the extended the Generating Cost Reductions for U.S. Medicaid (GENEROUS) Model application deadline to April 30, 2026, giving drug manufacturers more time to participate in the...
The Centers for Medicare &...
03/03/2026
First Report Managed Care
News
Medicare Advantage Overpayments Persist Despite New Efforts to Curb Costs
02/13/2026
Lisa Kuhns, PhD, MD
The federal government is on track to spend tens of billions more on Medicare Advantage (MA) than traditional Medicare this year, reigniting concerns that the privatized program’s payment system rewards insurers more for coding intensity than...
The federal government is on track to spend tens of billions more on Medicare Advantage (MA) than traditional Medicare this year, reigniting concerns that the privatized program’s payment system rewards insurers more for coding intensity than...
The federal government is on...
02/13/2026
First Report Managed Care
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
Yuri Fesko, MD, PAMA, Health Care Policy, Medicare
Interview
PAMA and the Downstream Impact of Lab Reimbursement on Cancer Care Access
01/22/2026
Yuri Fesko, MD
In this interview, senior vice president and chief medical officer at Quest Diagnostics, Yuri Fesko, MD, discusses how Medicare laboratory reimbursement under PAMA threatens access to precision cancer diagnostics—particularly for rural and...
In this interview, senior vice president and chief medical officer at Quest Diagnostics, Yuri Fesko, MD, discusses how Medicare laboratory reimbursement under PAMA threatens access to precision cancer diagnostics—particularly for rural and...
In this interview, senior vice...
01/22/2026
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
Rural Hospitals, Behavioral Health, Coverage Gaps
Interview
Rural Hospitals on the Front Lines of Behavioral Health Coverage Gaps
01/15/2026
Shannon Werb
Shannon Werb, CEO of Array Behavioral Care, explains how uncertainty around Affordable Care Act (ACA) subsidies and Medicaid eligibility threatens to disrupt behavioral health care first—fueling treatment gaps, increased emergency department...
Shannon Werb, CEO of Array Behavioral Care, explains how uncertainty around Affordable Care Act (ACA) subsidies and Medicaid eligibility threatens to disrupt behavioral health care first—fueling treatment gaps, increased emergency department...
Shannon Werb, CEO of Array...
01/15/2026
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
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