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News
Increased Scrutiny of Prior Authorization: Are Payers Fully to Blame, and Can AI Improve the Process?
04/05/2024
Dean Celia
The increased scrutiny of prior authorization, highlighted by media reports and government actions, prompts debate over payer responsibility while exploring the potential for AI to enhance the process.
The increased scrutiny of prior authorization, highlighted by media reports and government actions, prompts debate over payer responsibility while exploring the potential for AI to enhance the process.
The increased scrutiny of prior...
04/05/2024
First Report Managed Care
News
Impact of Patient Cost Sharing on Specialty Drug Utilization, Prior Authorization
05/26/2023
Julie Gould
“Higher levels of patient cost sharing reduce specialty drug use by increasing medication abandonment while generally decreasing initiation and persistence," researchers said.
“Higher levels of patient cost sharing reduce specialty drug use by increasing medication abandonment while generally decreasing initiation and persistence," researchers said.
“Higher levels of patient cost...
05/26/2023
First Report Managed Care
News
ICER Report: Price Transparency, Prior Authorization Process Need Improvements
01/17/2023
Maria Asimopoulos
In addition to illuminating ongoing barriers, the report showed payers’ drug coverage policies largely were aligned with fair access criteria.
In addition to illuminating ongoing barriers, the report showed payers’ drug coverage policies largely were aligned with fair access criteria.
In addition to illuminating...
01/17/2023
First Report Managed Care

Behind the Bill

Behind the Bill
The Bitter Pill: How Tariffs Could Make Generics Less Affordable
04/09/2025
Katie Hayes, MJ
As President Donald Trump’s administration introduces a series of tariffs aimed at rebalancing trade and boosting US manufacturing, one sector in particular is watching closely: pharmaceuticals. While drugs themselves may not be directly...
As President Donald Trump’s administration introduces a series of tariffs aimed at rebalancing trade and boosting US manufacturing, one sector in particular is watching closely: pharmaceuticals. While drugs themselves may not be directly...
As President Donald Trump’s...
04/09/2025
First Report Managed Care
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

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News
Real-World Study Confirms Effectiveness, Safety of Therapy for CRSwNP
05/12/2023
Jolynn Tumolo
Researchers studied clinical outcomes and adverse events in patients with chronic rhinosinusitis with nasal polyps who received biweekly dupilumab.
Researchers studied clinical outcomes and adverse events in patients with chronic rhinosinusitis with nasal polyps who received biweekly dupilumab.
Researchers studied clinical...
05/12/2023
First Report Managed Care
Conference Coverage
Peripheral Myeloid Cells as Effective Prognostic Markers in Patients With NSCLC Treated With Cemiplimab
06/01/2023
Grace Taylor, MS, MA
Researchers evaluated the use of myeloid cells, including monocytes and eosinophilis, as prognostic biomarkers for patients with non-small cell lung cancer (NSCLC) who have been treated with cemiplimab.
Researchers evaluated the use of myeloid cells, including monocytes and eosinophilis, as prognostic biomarkers for patients with non-small cell lung cancer (NSCLC) who have been treated with cemiplimab.
Researchers evaluated the use of...
06/01/2023
First Report Managed Care
News
Obesity Drug Comparison Ranks Semaglutide Tops for Weight Loss, Waist Reduction
06/27/2023
Jolynn Tumolo
Semaglutide and phentermine/topiramate were associated with more weight loss and waist circumference reduction at 12 months compared with other obesity drugs, according to results from a systematic review and network meta-analysis. 
Semaglutide and phentermine/topiramate were associated with more weight loss and waist circumference reduction at 12 months compared with other obesity drugs, according to results from a systematic review and network meta-analysis. 
Semaglutide and...
06/27/2023
First Report Managed Care
News
Study Finds Low Rate of CAR T-cell Therapy in Older Adults With DLBCL
07/27/2023
Jolynn Tumolo
"CAR T-cell therapy was associated with favorable effectiveness, but the CAR T-cell therapy use in older patients was very low," particularly among patients aged at least 75 years, according to researchers.
"CAR T-cell therapy was associated with favorable effectiveness, but the CAR T-cell therapy use in older patients was very low," particularly among patients aged at least 75 years, according to researchers.
"CAR T-cell therapy was...
07/27/2023
First Report Managed Care
News
Higher Ocrelizumab Exposure Linked to Greater Reduction in MS Disability Progression
08/17/2023
Jolynn Tumolo
“A consistent trend of higher ocrelizumab exposure leading to greater reduction in risk of confirmed disability progression was observed, particularly in the relapsing MS trials, and was not associated with a higher rate of adverse events,”...
“A consistent trend of higher ocrelizumab exposure leading to greater reduction in risk of confirmed disability progression was observed, particularly in the relapsing MS trials, and was not associated with a higher rate of adverse events,”...
“A consistent trend of higher...
08/17/2023
First Report Managed Care

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