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Latest Formulary Exclusions from Top PBMs Demonstrate Issues in the Drug Pricing Landscape
02/21/2024
Experts highlight the impact of the "warped incentives" in drug pricing's gross-to-net bubble, revealing that despite significant discounts, certain biosimilars are excluded from the formularies of major pharmacy benefit managers, leading to...
Experts highlight the impact of the "warped incentives" in drug pricing's gross-to-net bubble, revealing that despite significant discounts, certain biosimilars are excluded from the formularies of major pharmacy benefit managers, leading to...
Experts highlight the impact of...
02/21/2024
First Report Managed Care
News
Assessing the 2024 Medicare Fee Changes: Impact on Physicians, Payers, and Value-Based Care
02/20/2024
The 2024 Medicare physician fee schedule final rule, after evaluation using the fee schedule look-up tool and input from 2 experts, presents a mixed picture for primary care physicians (PCPs) and potential improvements for specialists, though...
The 2024 Medicare physician fee schedule final rule, after evaluation using the fee schedule look-up tool and input from 2 experts, presents a mixed picture for primary care physicians (PCPs) and potential improvements for specialists, though...
The 2024 Medicare physician fee...
02/20/2024
First Report Managed Care
News
FTC and HHS Launch Joint Inquiry into Generic Drug Shortages: Seeking Public Input on GPOs and Wholesalers
02/16/2024
In a news release published on February 14, 2024, the US Department of Health and Human Services (HHS) issued a "Request for Information" in collaboration with the Federal Trade Commission (FTC). This request aims to gain insight into how...
In a news release published on February 14, 2024, the US Department of Health and Human Services (HHS) issued a "Request for Information" in collaboration with the Federal Trade Commission (FTC). This request aims to gain insight into how...
In a news release published on...
02/16/2024
First Report Managed Care
News
Medicare Drug Price Negotiations and Anticipated Ripple Effects
02/15/2024
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
Dairy, Gluten Show No Major Effect on MS Activity and Quality of Life
02/15/2024
Dairy and gluten intake had no substantial effects on disease activity and quality of life in a retrospective study of 186 patients with multiple sclerosis (MS). Researchers published their findings online in Multiple Sclerosis Journal –...
Dairy and gluten intake had no substantial effects on disease activity and quality of life in a retrospective study of 186 patients with multiple sclerosis (MS). Researchers published their findings online in Multiple Sclerosis Journal –...
Dairy and gluten intake had no...
02/15/2024
First Report Managed Care
News
What Do the Drug Price Changes Announced in January Tell Us?
02/14/2024
The initial findings regarding the changes in prescription drug prices for 2024 have arrived. In this summary, we’ll outline shifts and seek insights from Edmund J Pezalla, MD, founder and CEO, Enlightenment Bioconsult, examine underlying...
The initial findings regarding the changes in prescription drug prices for 2024 have arrived. In this summary, we’ll outline shifts and seek insights from Edmund J Pezalla, MD, founder and CEO, Enlightenment Bioconsult, examine underlying...
The initial findings regarding...
02/14/2024
First Report Managed Care
News
Comparative Effectiveness for Bronchodilator Responsiveness Testing
02/09/2024
A new study compares the efficacy of salbutamol administration via a nebulizer vs a metered-dose inhaler with a spacer for bronchodilator responsiveness testing.
A new study compares the efficacy of salbutamol administration via a nebulizer vs a metered-dose inhaler with a spacer for bronchodilator responsiveness testing.
A new study compares the...
02/09/2024
First Report Managed Care
News
Impact of Brolucizumab on Choroidal Morphology in Neovascular AMD: Insights From a Comparative Study
02/07/2024
Brolucizumab significantly impacts choroidal morphology in eyes affected by type 1 neovascular AMD, according to a study published in Scientific Reports.
Brolucizumab significantly impacts choroidal morphology in eyes affected by type 1 neovascular AMD, according to a study published in Scientific Reports.
Brolucizumab significantly...
02/07/2024
First Report Managed Care
News
CMS Announces Increased Participation in ACO Initiatives to Improve Care for Medicare Patients
02/02/2024
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
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

Behind the Bill

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
Behind the Bill
Medicare Drug Negotiations 2.0: New Administration, Same Mission?
01/22/2025
Last week brought 2 major developments in health care policy: President Trump's inauguration and the Centers for Medicare and Medicaid Services’ (CMS) announcement of 15 additional drugs selected for Medicare price negotiations. While these...
Last week brought 2 major developments in health care policy: President Trump's inauguration and the Centers for Medicare and Medicaid Services’ (CMS) announcement of 15 additional drugs selected for Medicare price negotiations. While these...
Last week brought 2 major...
01/22/2025
First Report Managed Care
Behind the Bill
The First 100 Days: Health Care's Critical Deadlines in 2025
01/15/2025
The 119th Congress faces immediate health care deadlines amid significant leadership transitions. While much attention focuses on high-profile nominations like Dr Oz for Centers for Medicare and Medicaid Services (CMS) Administrator and...
The 119th Congress faces immediate health care deadlines amid significant leadership transitions. While much attention focuses on high-profile nominations like Dr Oz for Centers for Medicare and Medicaid Services (CMS) Administrator and...
The 119th Congress faces...
01/15/2025
First Report Managed Care
Behind the Bill
Trump's Executive Orders in a Post-Chevron World: Implications for Health Care Policy
01/08/2025
Happy New Year! As we dive into 2025, it’s clear that this year promises to bring significant changes to health care. With President-elect Donald Trump's inauguration just weeks away, the spotlight is already shifting to how his...
Happy New Year! As we dive into 2025, it’s clear that this year promises to bring significant changes to health care. With President-elect Donald Trump's inauguration just weeks away, the spotlight is already shifting to how his...
Happy New Year! As we dive into...
01/08/2025
First Report Managed Care
Behind the Bill
A Tale of Two Congresses—Health Care Policy in the 117th vs 118th
12/18/2024
The 118th Congress is wrapping up with a whimper rather than a bang when it comes to health care legislation, particularly compared to its predecessor's transformative impact on pharmaceutical policy. As we reflect on these past 4 years, the...
The 118th Congress is wrapping up with a whimper rather than a bang when it comes to health care legislation, particularly compared to its predecessor's transformative impact on pharmaceutical policy. As we reflect on these past 4 years, the...
The 118th Congress is wrapping...
12/18/2024
First Report Managed Care
Behind the Bill
Medicare Privatization Under New CMS Leadership: What's Really at Stake
12/11/2024
After writing about Dr Oz's potential impact on Medicare drug negotiations last week, I found myself diving deeper into an aspect of his nomination that deserves closer attention: his vision for Medicare's future. A letter from Senate...
After writing about Dr Oz's potential impact on Medicare drug negotiations last week, I found myself diving deeper into an aspect of his nomination that deserves closer attention: his vision for Medicare's future. A letter from Senate...
After writing about Dr Oz's...
12/11/2024
First Report Managed Care
Behind the Bill
Medicare Drug Negotiations Under New CMS Leadership
12/04/2024
President-elect Donald Trump nominated Dr Mehmet Oz to lead the Centers for Medicare & Medicaid Services (CMS). With this potential change in leadership, are there any implications for Medicare’s drug price negotiation program,...
President-elect Donald Trump nominated Dr Mehmet Oz to lead the Centers for Medicare & Medicaid Services (CMS). With this potential change in leadership, are there any implications for Medicare’s drug price negotiation program,...
President-elect Donald Trump...
12/04/2024
First Report Managed Care
Behind the Bill

When Recess Isn’t a Break: What NLRB v Canning Means for HHS
11/20/2024
As Robert F. Kennedy Jr’s nomination for Secretary of Health and Human Services (HHS) moves through the Senate, there’s growing discussion about whether a recess appointment could be used to bypass confirmation challenges. The Supreme Court’s...
As Robert F. Kennedy Jr’s nomination for Secretary of Health and Human Services (HHS) moves through the Senate, there’s growing discussion about whether a recess appointment could be used to bypass confirmation challenges. The Supreme Court’s...
As Robert F. Kennedy Jr’s...
11/20/2024
First Report Managed Care

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