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Health Care Policy and Legislation

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Regulatory Insights
Making Sense of the Federal Budget Process for Managed Care
02/27/2025
The Inflation Reduction Act (IRA) of 2022 was passed as a reconciliation bill. This year, we may have two or more overlapping budget bills. They’re likely to contain some of the most significant legislation of 2025. But how are they...
The Inflation Reduction Act (IRA) of 2022 was passed as a reconciliation bill. This year, we may have two or more overlapping budget bills. They’re likely to contain some of the most significant legislation of 2025. But how are they...
The Inflation Reduction Act...
02/27/2025
First Report Managed Care
Cover Story
What’s Next for Health Care Policy in the US?
11/25/2024
With new faces and shifting power dynamics in Washington, concerns about health care policy in 2025 are rising, including potential reform of PBMs, the 340B program, and the IRA, as well as the push for expanded access to innovative therapies...
With new faces and shifting power dynamics in Washington, concerns about health care policy in 2025 are rising, including potential reform of PBMs, the 340B program, and the IRA, as well as the push for expanded access to innovative therapies...
With new faces and shifting...
11/25/2024
First Report Managed Care
Cover Story
Federal Oversight of Managed Care a Priority
03/01/2024
In 2022, Medicare Advantage plans covered 50% of Medicare enrollees, costing the federal government $403 billion, while 81% of Medicaid enrollees received care through managed care for $254 billion. The Health and Human Services Office of...
In 2022, Medicare Advantage plans covered 50% of Medicare enrollees, costing the federal government $403 billion, while 81% of Medicaid enrollees received care through managed care for $254 billion. The Health and Human Services Office of...
In 2022, Medicare Advantage...
03/01/2024
First Report Managed Care
Cover Story
New Legislation in Washington Focuses on Pharmacy Benefit Managers
11/16/2023
At least 7 bills targeting PBMs have been introduced this year. Our managed care panel assesses the legislation’s ability to reduce health care costs, as well as prospects for passage.
At least 7 bills targeting PBMs have been introduced this year. Our managed care panel assesses the legislation’s ability to reduce health care costs, as well as prospects for passage.
At least 7 bills targeting PBMs...
11/16/2023
First Report Managed Care
Cover Story
Analyzing the Inflation Reduction Act’s Drug Provisions
12/22/2022
Pharmaceutical-related measures of the Inflation Reduction Act will be implemented starting in 2023. Will they deliver as promised by the Biden administration and Congressional Democrats? Or will they serve as an impediment to competition,...
Pharmaceutical-related measures of the Inflation Reduction Act will be implemented starting in 2023. Will they deliver as promised by the Biden administration and Congressional Democrats? Or will they serve as an impediment to competition,...
Pharmaceutical-related measures...
12/22/2022
First Report Managed Care
Cover Story
Threat of Gun Violence Goes Beyond Individual Health
08/02/2022
With the rise of gun violence across the United States, health care professionals and stakeholders across the continuum of care are calling out for recognition of gun violence as a public health issue.
With the rise of gun violence across the United States, health care professionals and stakeholders across the continuum of care are calling out for recognition of gun violence as a public health issue.
With the rise of gun violence...
08/02/2022
First Report Managed Care
Cover Story
ICER's Rare Disease Drug Policy Report Analyzed
05/26/2022
Experts weigh in on 4 proposed reforms and examine each one's impact on payers, patients, providers, and the pharmaceutical industry.
Experts weigh in on 4 proposed reforms and examine each one's impact on payers, patients, providers, and the pharmaceutical industry.
Experts weigh in on 4 proposed...
05/26/2022
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
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
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
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
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
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
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
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
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
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
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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New Respiratory Syncytial Virus Prevention Options on the Horizon for Older Adults
04/21/2023
“It is likely that multiple immunization strategies with complementary value, unique advantages, and use-case scenarios will shape the RSV prevention landscape," researchers said.
“It is likely that multiple immunization strategies with complementary value, unique advantages, and use-case scenarios will shape the RSV prevention landscape," researchers said.
“It is likely that multiple...
04/21/2023
Pharmacy Learning Network
News
Tildrakizumab No Better Than Placebo for Ankylosing Spondylitis
06/09/2023
A 48-week trial of tildrakizumab in patients with ankylosing spondylitis was terminated early after researchers found that the drug had no efficacy in comparison to placebo.
A 48-week trial of tildrakizumab in patients with ankylosing spondylitis was terminated early after researchers found that the drug had no efficacy in comparison to placebo.
A 48-week trial of tildrakizumab...
06/09/2023
First Report Managed Care
News
Dupilumab Reduces COPD Exacerbations in Patients With Type 2 Inflammation
07/07/2023
“In some patients with COPD, type 2 inflammation may increase exacerbation risk and may be indicated by elevated blood eosinophil counts,” said researchers. 
“In some patients with COPD, type 2 inflammation may increase exacerbation risk and may be indicated by elevated blood eosinophil counts,” said researchers. 
“In some patients with COPD,...
07/07/2023
First Report Managed Care
News
Exploring the Cost-Effectiveness of Acalabrutinib Regimens for Treatment-Naive CLL
07/31/2023
Acalabrutinib monotherapy may be a cost-effective treatment option for Medicare patients with treatment-naïve chronic lymphocytic leukemia, according to recent findings.
Acalabrutinib monotherapy may be a cost-effective treatment option for Medicare patients with treatment-naïve chronic lymphocytic leukemia, according to recent findings.
Acalabrutinib monotherapy may be...
07/31/2023
First Report Managed Care

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