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News
Optum Rx’s Cost-Based Pharmacy Payments Signal a Major Shift in Drug Reimbursement
01/27/2026
Lisa Kuhns, PhD, MD
Optum Rx’s full transition from community pharmacies to a cost-based reimbursement model marks a significant shift in how prescription drugs are paid for, aiming to stabilize pharmacy finances amid mounting industry pressures.
Optum Rx’s full transition from community pharmacies to a cost-based reimbursement model marks a significant shift in how prescription drugs are paid for, aiming to stabilize pharmacy finances amid mounting industry pressures.
Optum Rx’s full transition from...
01/27/2026
First Report Managed Care
News
Mobile Health Units Bridge Access Gaps Across the US, Georgetown Study Finds
11/11/2025
Grace Taylor, MS, MA
A Georgetown University report reveals how mobile health units are reshaping US care delivery, bringing primary, specialty, and emergency services directly to underserved communities while reducing costs and improving outcomes.
A Georgetown University report reveals how mobile health units are reshaping US care delivery, bringing primary, specialty, and emergency services directly to underserved communities while reducing costs and improving outcomes.
A Georgetown University report...
11/11/2025
First Report Managed Care
Conference Coverage
Inside the New Era of PBM Contracting: Lessons from AMCP Nexus 2025
10/29/2025
Juliet Gallagher
At AMCP Nexus 2025, Jennifer Cruz, PharmD, and Nguyen-Khang Tran-Tan, PharmD, RPh, MBA, ALM, presented a pragmatic view of how pharmacy benefit manager (PBM) contracting is evolving. Their message was clear: PBM contracts must be treated as...
At AMCP Nexus 2025, Jennifer Cruz, PharmD, and Nguyen-Khang Tran-Tan, PharmD, RPh, MBA, ALM, presented a pragmatic view of how pharmacy benefit manager (PBM) contracting is evolving. Their message was clear: PBM contracts must be treated as...
At AMCP Nexus 2025, Jennifer...
10/29/2025
First Report Managed Care
Conference Coverage
Understanding Payer Perspectives on Precision Medicine: Key Takeaways from AMCP Nexus 2025
10/28/2025
Juliet Gallagher
In a session at AMCP Nexus 2025, Steven Kheloussi, PharmD, MBA, FAMCP, and Jennifer Billings, PharmD, BCGP, provided a comprehensive overview of the rapidly evolving precision medicine landscape and the payer considerations that accompany it....
In a session at AMCP Nexus 2025, Steven Kheloussi, PharmD, MBA, FAMCP, and Jennifer Billings, PharmD, BCGP, provided a comprehensive overview of the rapidly evolving precision medicine landscape and the payer considerations that accompany it....
In a session at AMCP Nexus 2025,...
10/28/2025
First Report Managed Care
News
Cemiplimab in Metastatic Basal Cell Carcinoma: Durable Outcomes With Real-World Relevance for Payers
10/22/2025
Juliet Gallagher
A study recently published in Future Oncology highlights the emerging role of cemiplimab, an immune checkpoint inhibitor, in the management of metastatic basal cell carcinoma (mBCC).
A study recently published in Future Oncology highlights the emerging role of cemiplimab, an immune checkpoint inhibitor, in the management of metastatic basal cell carcinoma (mBCC).
A study recently published in...
10/22/2025
First Report Managed Care
News
Study Finds Nurse Practitioners Use Low-Value Care at Comparable or Lower Rates, With Key Implications for Coverage Oversight
06/30/2025
Juliet Gallagher
A cross-sectional analysis of 2021 outpatient claims in Arizona, Nevada, and New Mexico suggests that primary care nurse practitioners (NPs) deliver some of the most common low-value care (LVC) services at rates comparable to or lower than...
A cross-sectional analysis of 2021 outpatient claims in Arizona, Nevada, and New Mexico suggests that primary care nurse practitioners (NPs) deliver some of the most common low-value care (LVC) services at rates comparable to or lower than...
A cross-sectional analysis of...
06/30/2025
First Report Managed Care
News
Private Shared Savings Model Lowers Colon Cancer Costs Without Reducing Utilization
06/19/2025
Juliet Gallagher
A recent quasi-experimental study provides new insight into how private payer–based shared savings programs (SSPs) can help reduce oncology treatment costs without compromising adherence to evidence-based care.
A recent quasi-experimental study provides new insight into how private payer–based shared savings programs (SSPs) can help reduce oncology treatment costs without compromising adherence to evidence-based care.
A recent quasi-experimental...
06/19/2025
First Report Managed Care
News
Unpacking Demographic Data Behind Health Care Costs in the US
02/18/2025
Hannah Musick
A Value in Health study sheds light on the demographic and medical factors driving health care costs in the US, emphasizing the need for targeted interventions to curb escalating expenses.
A Value in Health study sheds light on the demographic and medical factors driving health care costs in the US, emphasizing the need for targeted interventions to curb escalating expenses.
A Value in Health study sheds...
02/18/2025
First Report Managed Care
News
Cigna Introduces Performance-Based Reform to Improve Transparency and Access to Care
02/05/2025
Juliet Gallagher
Cigna has announced a performance-based initiative that ties executive compensation to customer satisfaction metrics, invests $150 million to improve care delivery and digital tools, and enhances transparency with an annual report on prior...
Cigna has announced a performance-based initiative that ties executive compensation to customer satisfaction metrics, invests $150 million to improve care delivery and digital tools, and enhances transparency with an annual report on prior...
Cigna has announced a...
02/05/2025
Integrated Healthcare Executive
News
SDOH Disparities Among Black and Hispanic Patients With Ovarian Cancer
07/18/2024
Hannah Musick
Research published in Gynecologic Oncology reveals how social determinants of health (SDOH) impact the well-being of Black and Hispanic patients who survived ovarian cancer compared to White survivors, emphasizing the need for targeted...
Research published in Gynecologic Oncology reveals how social determinants of health (SDOH) impact the well-being of Black and Hispanic patients who survived ovarian cancer compared to White survivors, emphasizing the need for targeted...
Research published in...
07/18/2024
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

Steve Vacarro
Interview
The Role of Electronic Visit Verification in Enhancing Quality, Efficiency, and Medicaid Integrity
02/29/2024

Featuring Stephen Vaccaro, president, HHAeXchange

Featuring Stephen Vaccaro, president,...
In this interview, an expert discusses the importance of Electronic Visit Verification (EVV) in homecare services. EVV ensures accurate documentation of homecare visits, leading to improved patient outcomes and quality of care. Medicaid has a...
In this interview, an expert discusses the importance of Electronic Visit Verification (EVV) in homecare services. EVV ensures accurate documentation of homecare visits, leading to improved patient outcomes and quality of care. Medicaid has a...
In this interview, an expert...
02/29/2024
First Report Managed Care
News
From Indolent to Aggressive: Understanding Lymphoma Transformation
04/09/2024
Hannah Musick
“Histologic transformation of indolent lymphoma to aggressive lymphoma, most commonly DLBCL, represents a well-recognized event,” said researchers. “While work in the past decade has shed light on many of the genetic and biological changes of...
“Histologic transformation of indolent lymphoma to aggressive lymphoma, most commonly DLBCL, represents a well-recognized event,” said researchers. “While work in the past decade has shed light on many of the genetic and biological changes of...
“Histologic transformation of...
04/09/2024
First Report Managed Care
News
Hospital Costs May Be Higher for Patients With Private Insurance
05/14/2024
Hannah Musick
A recent research report reveals that individuals with private health insurance pay 254% more for hospital procedures than Medicare rates, leading to potentially increased costs for millions of Americans.
A recent research report reveals that individuals with private health insurance pay 254% more for hospital procedures than Medicare rates, leading to potentially increased costs for millions of Americans.
A recent research report reveals...
05/14/2024
First Report Managed Care
News
Fitusiran Prophylaxis Shows Promise for Protection Against Bleeding for Patients With Hemophilia A or B
06/05/2024
Grace Taylor, MS, MA
A phase 3 study evaluated the efficacy and safety of fitusiran in males with hemophilia A or B who were receiving bypassing agent (BPA)/clotting factor concentrate (CFC) prophylaxis.
A phase 3 study evaluated the efficacy and safety of fitusiran in males with hemophilia A or B who were receiving bypassing agent (BPA)/clotting factor concentrate (CFC) prophylaxis.
A phase 3 study evaluated the...
06/05/2024
First Report Managed Care
Infographic
The Efficacy and Safety of an Oral Phosphodiesterase 4B (PDE4B) Inhibitor, BI 1015550, in Patients With Idiopathic Pulmonary Fibrosis (IPF): A Phase 2 Clinical Trial
07/24/2024
This infographic summarizes a recent Phase 2 clinical trial evaluating the efficacy and safety of an oral phosphodiesterase inhibitor in patients with idiopathic pulmonary fibrosis (IPF).
This infographic summarizes a recent Phase 2 clinical trial evaluating the efficacy and safety of an oral phosphodiesterase inhibitor in patients with idiopathic pulmonary fibrosis (IPF).
This infographic summarizes a...
07/24/2024
First Report Managed Care

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