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News
Study Suggests Innovative Value-Based Models for Expanding Cell and Gene Therapy Access
12/17/2024
Juliet Gallagher
Cell and gene therapies (CGTs) offer groundbreaking approaches for treating rare and complex conditions. However, the high costs of CGTs create barriers to equitable access and affordability. A study published in Journal of Medical Economics...
Cell and gene therapies (CGTs) offer groundbreaking approaches for treating rare and complex conditions. However, the high costs of CGTs create barriers to equitable access and affordability. A study published in Journal of Medical Economics...
Cell and gene therapies (CGTs)...
12/17/2024
First Report Managed Care
News
Analysis Shows Proposed CMS ‘Best Price’ Rule May Increase Rebate Liability, Impacting Medicaid
04/26/2024
Dean Celia
A proposed rule from Centers for Medicare & Medicaid Services (CMS), “Misclassification of Drugs, Program Administration and Program Integrity Updates Under the Medicaid Drug Rebate Program,” has been in the spotlight recently. Major health...
A proposed rule from Centers for Medicare & Medicaid Services (CMS), “Misclassification of Drugs, Program Administration and Program Integrity Updates Under the Medicaid Drug Rebate Program,” has been in the spotlight recently. Major health...
A proposed rule from Centers for...
04/26/2024
First Report Managed Care
News
Who Will Benefit Under the Medicare Part D Out-of-Pocket Spending Cap?
02/27/2024
Dean Celia
Starting in 2024, Medicare Part D enrollees could benefit from a cap placed on out-of-pocket drug spending, thanks to a provision in the Inflation Reduction Act of 2022 (IRA).
Starting in 2024, Medicare Part D enrollees could benefit from a cap placed on out-of-pocket drug spending, thanks to a provision in the Inflation Reduction Act of 2022 (IRA).
Starting in 2024, Medicare Part...
02/27/2024
First Report Managed Care
News
Medicare Drug Price Negotiations and Anticipated Ripple Effects
02/15/2024
Paul Nicolaus
The arrival of the Inflation Reduction Act has ushered in a new era of drug price regulation, giving the Centers for Medicare & Medicaid Services (CMS) the ability to negotiate directly with companies that make some of the costliest drugs...
The arrival of the Inflation Reduction Act has ushered in a new era of drug price regulation, giving the Centers for Medicare & Medicaid Services (CMS) the ability to negotiate directly with companies that make some of the costliest drugs...
The arrival of the Inflation...
02/15/2024
First Report Managed Care
News
CMS Announces Increased Participation in ACO Initiatives to Improve Care for Medicare Patients
02/02/2024
Hannah Musick
The Centers for Medicare & Medicaid Services (CMS) has announced increased participation and investment in accountable care organization (ACO) initiatives to improve the quality of care for patients with Medicare and address disparities in...
The Centers for Medicare & Medicaid Services (CMS) has announced increased participation and investment in accountable care organization (ACO) initiatives to improve the quality of care for patients with Medicare and address disparities in...
The Centers for Medicare &...
02/02/2024
First Report Managed Care
News
HCSC Acquires Cigna's Medicare Business in Multi-Billion Dollar Deal
02/01/2024
Hannah Musick
Cigna plans to sell its Medicare business to Health Care Service Corporation for $3.3 billion, leaving the company without a foothold in a sector that has been a major growth engine for the health-insurance industry, as Medicare insurers face...
Cigna plans to sell its Medicare business to Health Care Service Corporation for $3.3 billion, leaving the company without a foothold in a sector that has been a major growth engine for the health-insurance industry, as Medicare insurers face...
Cigna plans to sell its Medicare...
02/01/2024
First Report Managed Care
News
Certain Pharma Company Decisions May Leave Many Americans Unable to Afford Prescription Meds
08/21/2023
Elisabeth Rosenthal
Major pharmaceutical companies are fighting to prevent the US government from negotiating drug prices for Medicare, posing a challenge to the country's first attempt at drug price regulation. 
Major pharmaceutical companies are fighting to prevent the US government from negotiating drug prices for Medicare, posing a challenge to the country's first attempt at drug price regulation. 
Major pharmaceutical companies...
08/21/2023
First Report Managed Care
News
Reduced Postpartum Hospitalizations After Medicaid Expansion
08/18/2023
Hannah Musick
Researchers examining the impact of Medicaid expansions on inpatient hospitalization rates during the first 6 months postpartum found that expansion states experienced significant increases in Medicaid enrollment and insurance coverage.
Researchers examining the impact of Medicaid expansions on inpatient hospitalization rates during the first 6 months postpartum found that expansion states experienced significant increases in Medicaid enrollment and insurance coverage.
Researchers examining the impact...
08/18/2023
First Report Managed Care
News
Feds Say Hospitals That Redistribute Medicaid Money Violate Law
08/17/2023
Samantha Young
Federal regulators say arrangements “appear designed to” redirect Medicaid dollars away from facilities that treat the poorest patients to those that “provide fewer, or even no, Medicaid-covered services,” according to a proposed enforcement...
Federal regulators say arrangements “appear designed to” redirect Medicaid dollars away from facilities that treat the poorest patients to those that “provide fewer, or even no, Medicaid-covered services,” according to a proposed enforcement...
Federal regulators say...
08/17/2023
First Report Managed Care
News
Medicare Could Save $1 Billion by Considering Added Benefit of Expensive Part B Drugs
07/18/2023
Jolynn Tumolo
Researchers find that Medicare could potentially save $1 billion by considering the added therapeutic benefit of expensive Part B drugs and implementing reference pricing.
Researchers find that Medicare could potentially save $1 billion by considering the added therapeutic benefit of expensive Part B drugs and implementing reference pricing.
Researchers find that Medicare...
07/18/2023
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
BTK Inhibitor Regimens: Comparing Outcomes in Real-World Patients With R/R CLL
04/19/2023
Jolynn Tumolo
Researchers studied survival outcomes in patients who were treated with either ibrutinib or idelasib plus rituximab after receiving 2 previous lines of therapy.
Researchers studied survival outcomes in patients who were treated with either ibrutinib or idelasib plus rituximab after receiving 2 previous lines of therapy.
Researchers studied survival...
04/19/2023
First Report Managed Care
News
Global Survey Suggests Patients Have Loose Grasp of Psoriatic Disease
05/16/2023
Jolynn Tumolo
Many patients with moderate to severe psoriasis lack recognition of common manifestations and comorbidities associated with psoriatic disease, according to new research.
Many patients with moderate to severe psoriasis lack recognition of common manifestations and comorbidities associated with psoriatic disease, according to new research.
Many patients with moderate to...
05/16/2023
First Report Managed Care
Conference Coverage
Medicare Telehealth Utilization Rates Lowest in Regions Lacking Access to Specialized Cancer Care
06/02/2023
Maria Asimopoulos
"Advocacy and policy efforts directed towards increasing access to telehealth can ensure equitable and timely access to specialized cancer care in these regions of need," researchers said.
"Advocacy and policy efforts directed towards increasing access to telehealth can ensure equitable and timely access to specialized cancer care in these regions of need," researchers said.
"Advocacy and policy efforts...
06/02/2023
First Report Managed Care
News
Costs, Economic Burden Higher Among Hemophilia A Carriers
06/28/2023
Julie Gould
Study findings show hemophilia A carriers experience more complications and higher health care costs, leading researchers to emphasize early diagnosis and management for preventing long-term complications.
Study findings show hemophilia A carriers experience more complications and higher health care costs, leading researchers to emphasize early diagnosis and management for preventing long-term complications.
Study findings show hemophilia A...
06/28/2023
First Report Managed Care
News
Unfamiliarity With NrAxSpa Can Delay Diagnosis for Years
07/27/2023
Jolynn Tumolo
“Education on cardinal features, epidemiology, burden, and benefits of timely NrAxSpa diagnosis is warranted for health care providers who commonly manage back pain,” researchers advised.
“Education on cardinal features, epidemiology, burden, and benefits of timely NrAxSpa diagnosis is warranted for health care providers who commonly manage back pain,” researchers advised.
“Education on cardinal features,...
07/27/2023
First Report Managed Care

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