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Volume 16, Issue 8, August 2019 - First Report Managed Care

Featured Article

Will New Guidance Improve Outcomes in Patients With Chronic Conditions?
08/26/2019
Dean Celia
The IRS, with input from HHS, expands list of preventive care options for HSA participants with high deductible health plans; our experts offer insights, predict the level of adoption, and address potential downsides.
The IRS, with input from HHS, expands list of preventive care options for HSA participants with high deductible health plans; our experts offer insights, predict the level of adoption, and address potential downsides.
The IRS, with input from HHS,...
08/26/2019
First Report Managed Care
Ensuring Access to Primary Care for Medicare Beneficiaries
08/26/2019
Mary Beth Nierengarten
The June MEDPAC report outlines areas where improvement is needed, emphasizing the importance of Medicare beneficiaries’ access to primary care and increasing incentive for medical students to choose primary care as a career choice.
The June MEDPAC report outlines areas where improvement is needed, emphasizing the importance of Medicare beneficiaries’ access to primary care and increasing incentive for medical students to choose primary care as a career choice.
The June MEDPAC report outlines...
08/26/2019
First Report Managed Care
Formulary Frontlines®
Innovations in Managing Hemophilia
08/26/2019
Eileen Koutnik-Fotopoulos
Although hemophilia is designated an orphan disease by the FDA because it affects fewer than 200,000 people in the United States, it imposes a significant financial and burden on patients, caregivers, and society.
Although hemophilia is designated an orphan disease by the FDA because it affects fewer than 200,000 people in the United States, it imposes a significant financial and burden on patients, caregivers, and society.
Although hemophilia is...
08/26/2019
First Report Managed Care

Department

Formulary Frontlines®
Innovations in Managing Hemophilia
08/26/2019
Eileen Koutnik-Fotopoulos
Although hemophilia is designated an orphan disease by the FDA because it affects fewer than 200,000 people in the United States, it imposes a significant financial and burden on patients, caregivers, and society.
Although hemophilia is designated an orphan disease by the FDA because it affects fewer than 200,000 people in the United States, it imposes a significant financial and burden on patients, caregivers, and society.
Although hemophilia is...
08/26/2019
First Report Managed Care
Managed Care Q&A
Discussing Biosimilars: Barriers and Cost Effectiveness, Part 1
08/26/2019
Edan Stanley
Scott Vogel, partner and PBM executive, Confidio, recently spoke about the many challenges biosimilars face coming to market and where the market might be heading.
Scott Vogel, partner and PBM executive, Confidio, recently spoke about the many challenges biosimilars face coming to market and where the market might be heading.
Scott Vogel, partner and PBM...
08/26/2019
First Report Managed Care
Managed Care Q&A
Discussing Biosimilars: Barriers and Cost Effectiveness, Part 2
08/26/2019
Edan Stanley
Sonja Quale, PharmD, chief clinical officer and vice president of informatics, Confidio, recently spoke about the many challenges biosimilars face coming to market and where the market might be heading
Sonja Quale, PharmD, chief clinical officer and vice president of informatics, Confidio, recently spoke about the many challenges biosimilars face coming to market and where the market might be heading
Sonja Quale, PharmD, chief...
08/26/2019
First Report Managed Care
Conference Insider
PBMI Specialty Rx Forum: Getting the Most from Your Specialty Contract
08/26/2019
Edan Stanley
Gregory O Callahan, MBA, consultant, and Brian N Anderson, MBA, principal, both from Milliman, a consulting and actuarial firm, offer expertise on how to maximize the effectiveness of specialty contracts.
Gregory O Callahan, MBA, consultant, and Brian N Anderson, MBA, principal, both from Milliman, a consulting and actuarial firm, offer expertise on how to maximize the effectiveness of specialty contracts.
Gregory O Callahan, MBA,...
08/26/2019
First Report Managed Care
Conference Insider
Preparing Payers for the New Therapies in the Pipeline
08/26/2019
Edan Stanley
Susan Trieu, PharmD, director of enterprise specialty clinical solutions at MedImpact Health Systems, discusses new therapies in the pipeline and what payers should focus on.
Susan Trieu, PharmD, director of enterprise specialty clinical solutions at MedImpact Health Systems, discusses new therapies in the pipeline and what payers should focus on.
Susan Trieu, PharmD, director of...
08/26/2019
First Report Managed Care
News Connection
CMS to Expand Coverage for Ambulatory Blood Pressure Monitoring
08/26/2019
The Centers for Medicare & Medicaid Services announced a plan to expand coverage for ambulatory blood pressure monitoring (ABPM) in response to a request from stakeholders.
The Centers for Medicare & Medicaid Services announced a plan to expand coverage for ambulatory blood pressure monitoring (ABPM) in response to a request from stakeholders.
The Centers for Medicare &...
08/26/2019
First Report Managed Care
News Connection
Public Charge Rule Change Threatens Coverage for Millions of Children
08/26/2019
In October 2018, the Trump administration proposed rule changes to the criteria immigration officials use to determine whether an immigrant becomes a public charge and a recent study shows that these changes could result in over 8 million...
In October 2018, the Trump administration proposed rule changes to the criteria immigration officials use to determine whether an immigrant becomes a public charge and a recent study shows that these changes could result in over 8 million...
In October 2018, the Trump...
08/26/2019
First Report Managed Care

Insights

Commentary
ACOs Matter More Than Ever Despite Uneven Growth
08/26/2019
Robin Lloyd
Robin Lloyd, chief commercial officer, Health Fidelity, discusses the latest trends and policy changes impacting ACOs and reflects on new federal policies, highlighting future opportunities in value-based care.
Robin Lloyd, chief commercial officer, Health Fidelity, discusses the latest trends and policy changes impacting ACOs and reflects on new federal policies, highlighting future opportunities in value-based care.
Robin Lloyd, chief commercial...
08/26/2019
First Report Managed Care

Behind the Bill

Behind the Bill
SCOTUS Takes on the Nondelegation Doctrine: Surprising Reactions and What They Mean for Agency Power
04/02/2025
Katie Hayes, MJ
The Supreme Court recently heard arguments in Federal Communication Commission (FCC) v Consumers’ Research, a case that I covered in February and one that could dramatically reshape federal agency authority through the nondelegation...
The Supreme Court recently heard arguments in Federal Communication Commission (FCC) v Consumers’ Research, a case that I covered in February and one that could dramatically reshape federal agency authority through the nondelegation...
The Supreme Court recently heard...
04/02/2025
First Report Managed Care
Behind the Bill
Dr Oz’s Prescription for Making Medicaid “Viable at Every Level”
03/26/2025
Katie Hayes, MJ
On Tuesday, March 25, 2025, the Senate Finance Committee voted to advance Dr Mehmet Oz in his confirmation as the next head of the Centers for Medicare and Medicaid Services (CMS).1 The full Senate vote is expected “soon” (whatever that...
On Tuesday, March 25, 2025, the Senate Finance Committee voted to advance Dr Mehmet Oz in his confirmation as the next head of the Centers for Medicare and Medicaid Services (CMS).1 The full Senate vote is expected “soon” (whatever that...
On Tuesday, March 25, 2025, the...
03/26/2025
First Report Managed Care
Behind the Bill
The $880 Billion Question Continues: Dr Oz's Confirmation and the Future of Medicaid
03/19/2025
Katie Hayes, MJ
Last week, I explored the $880 billion question facing Congress—whether lawmakers could achieve their budget goals without cutting Medicaid. This week, that question took center stage as Dr Mehmet Oz, President Trump's nominee to lead the...
Last week, I explored the $880 billion question facing Congress—whether lawmakers could achieve their budget goals without cutting Medicaid. This week, that question took center stage as Dr Mehmet Oz, President Trump's nominee to lead the...
Last week, I explored the $880...
03/19/2025
First Report Managed Care
Behind the Bill
The $880 Billion Question: Can Congress Cut Spending Without Touching Medicaid?
03/12/2025
Katie Hayes, MJ
I’d like to step away from administrative law for a moment to provide a quick update on Medicaid. With news coming from all sides, what does the future of Medicaid actually look like? The House of Representatives narrowly passed a budget...
I’d like to step away from administrative law for a moment to provide a quick update on Medicaid. With news coming from all sides, what does the future of Medicaid actually look like? The House of Representatives narrowly passed a budget...
I’d like to step away from...
03/12/2025
First Report Managed Care
Behind the Bill
RFK Jr’s Public Comment Ban: The Silent Shift in Health Care Rulemaking
03/05/2025
Katie Hayes, MJ
The erosion of administrative law continues, and with it, the dismantling of decades-long precedent. In June, the Supreme Court overturned a 40-year-old doctrine that allowed federal agencies to interpret their own ambiguous statutes. Later...
The erosion of administrative law continues, and with it, the dismantling of decades-long precedent. In June, the Supreme Court overturned a 40-year-old doctrine that allowed federal agencies to interpret their own ambiguous statutes. Later...
The erosion of administrative...
03/05/2025
First Report Managed Care
Behind the Bill
Prevention Over Pills? The First 2 Weeks of Health Care’s New Direction
02/26/2025
Katie Hayes, MJ
The dust has barely settled from Robert F Kennedy Jr’s confirmation as Secretary of Health and Human Services (HHS), but the changes are already coming fast and furious—a key theme of the Trump Administration’s actions within the last several...
The dust has barely settled from Robert F Kennedy Jr’s confirmation as Secretary of Health and Human Services (HHS), but the changes are already coming fast and furious—a key theme of the Trump Administration’s actions within the last several...
The dust has barely settled from...
02/26/2025
First Report Managed Care
Behind the Bill
The Nondelegation Doctrine: The Next Constitutional Showdown (Part 2)
02/19/2025
Katie Hayes, MJ
Last week, I explored the potential revival of the nondelegation doctrine through Federal Communication Commission v Consumers’ Research. Today, I want to examine what this could mean for health care regulation by considering the parallels...
Last week, I explored the potential revival of the nondelegation doctrine through Federal Communication Commission v Consumers’ Research. Today, I want to examine what this could mean for health care regulation by considering the parallels...
Last week, I explored the...
02/19/2025
First Report Managed Care
Behind the Bill
The Nondelegation Doctrine: The Next Constitutional Showdown (Part 1)
02/12/2025
Katie Hayes, MJ
Just when you thought the dust had settled from the Chevron decision, the Supreme Court is gearing up to hear arguments in Federal Communications Commission v Consumers' Research next month, potentially reviving the long-dormant nondelegation...
Just when you thought the dust had settled from the Chevron decision, the Supreme Court is gearing up to hear arguments in Federal Communications Commission v Consumers' Research next month, potentially reviving the long-dormant nondelegation...
Just when you thought the dust...
02/12/2025
First Report Managed Care
Behind the Bill
No, President Trump Did Not Actually Sign an Executive Order That Would Increase Drug Costs for Beneficiaries
02/05/2025
Katie Hayes, MJ
On inauguration day, President Trump issued an executive order rescinding several Biden-era health care initiatives, including 3 experimental drug pricing models developed by the Center for Medicare and Medicaid Innovation (CMMI). Oh boy did...
On inauguration day, President Trump issued an executive order rescinding several Biden-era health care initiatives, including 3 experimental drug pricing models developed by the Center for Medicare and Medicaid Innovation (CMMI). Oh boy did...
On inauguration day, President...
02/05/2025
First Report Managed Care
Behind the Bill
Robert F. Kennedy Jr’s Confirmation and the Unexpected Turn in the Drug Pricing Debate
01/29/2025
Katie Hayes, MJ
The Plot Thickens in Drug Pricing Drama Just when you thought the drug pricing debate couldn't get more interesting, Robert F. Kennedy Jr adds an unexpected twist. During closed-door Senate meetings, President Trump’s US Department of...
The Plot Thickens in Drug Pricing Drama Just when you thought the drug pricing debate couldn't get more interesting, Robert F. Kennedy Jr adds an unexpected twist. During closed-door Senate meetings, President Trump’s US Department of...
The Plot Thickens in Drug...
01/29/2025
First Report Managed Care

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Trending Articles

News
Improving Health Outcomes Through Early COPD and Asthma Intervention
10/04/2024
Hannah Musick
Research published in the New England Journal of Medicine shows that early diagnosis and treatment of undiagnosed COPD or asthma can reduce health care utilization for respiratory illness and improve overall health outcomes.
Research published in the New England Journal of Medicine shows that early diagnosis and treatment of undiagnosed COPD or asthma can reduce health care utilization for respiratory illness and improve overall health outcomes.
Research published in the New...
10/04/2024
First Report Managed Care
News
Advances in Factor IX Therapy Offer New Hope for Hemophilia B Treatment
10/23/2024
Lisa Kuhns, PhD, MD
New factor IX therapies promise improved treatment for hemophilia B.
New factor IX therapies promise improved treatment for hemophilia B.
New factor IX therapies promise...
10/23/2024
First Report Managed Care
News
JAK Inhibitor Improves Symptoms in Patients With Psoriatic Arthritis and Axial Involvement
04/21/2023
Jolynn Tumolo
In two phase 3 studies comparing upadacitinib to placebo and adalimumab, upadacitinib improved symptoms in patients with psoriatic arthritis and axial involvement.
In two phase 3 studies comparing upadacitinib to placebo and adalimumab, upadacitinib improved symptoms in patients with psoriatic arthritis and axial involvement.
In two phase 3 studies comparing...
04/21/2023
First Report Managed Care
News
Risk of Psychiatric Comorbidity Higher in Patients With Ankylosing Spondylitis
05/19/2023
Jolynn Tumolo
Findings from a population-based, cross-sectional study suggest that patients with ankylosing spondylitis are at a higher risk of developing psychiatric disorders.
Findings from a population-based, cross-sectional study suggest that patients with ankylosing spondylitis are at a higher risk of developing psychiatric disorders.
Findings from a...
05/19/2023
First Report Managed Care
Conference Coverage
Significant Number of Solid Tumor Drug Approvals Added Complexity to Existing Regimens
06/08/2023
Maria Asimopoulos
A significant portion of drug approvals for nonhematologic solid cancers in the last 12 years were for indications which added to existing regimens, which could increase costs and exposure to side effects, researchers said.
A significant portion of drug approvals for nonhematologic solid cancers in the last 12 years were for indications which added to existing regimens, which could increase costs and exposure to side effects, researchers said.
A significant portion of drug...
06/08/2023
First Report Managed Care

August 2019 Volume 16 Issue 8

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