As health policy debates resurface in Washington, unresolved battles over Affordable Care Act (ACA) subsidies, health savings accounts, and pharmacy benefit manager (PBM) reform are shaping a high-stakes landscape for payers heading into the new year.
In this exclusive Formulary Frontlines report, First Report Managed Care compares formulary coverage across Blue Cross Blue Shield FEP Blue Standard, Cigna Healthcare Standard 3-Tier, and UnitedHealthcare to identify differences in tier placement, prior authorization requirements, step therapy, specialty pharmacy management, dispensing limits, and quantity limits for therapies used to treat depression and anxiety.
From explosive demand for GLP-1s and new policy pressures to emerging technologies and affordability challenges, the industry is at a crossroads.
In this exclusive First Report Managed Care webinar, our expert panel unpacks the complex forces reshaping the market—and what stakeholders must do to adapt.
Researchers found that Medicare Advantage beneficiaries had lower utilization of discretionary procedures compared to traditional Medicare, with the greatest difference being observed among White beneficiaries.
Researchers found that Medicare Advantage beneficiaries had lower utilization of discretionary procedures compared to traditional Medicare, with the greatest difference being observed among White beneficiaries.
In a cost-effective analysis of pharmacotherapies, semaglutide and tirzepatide demonstrated better cost-effectiveness than standard of care among patients with metabolic dysfunction‐associated steatohepatitis (MASH).
In a cost-effective analysis of pharmacotherapies, semaglutide and tirzepatide demonstrated better cost-effectiveness than standard of care among patients with metabolic dysfunction‐associated steatohepatitis (MASH).
In an analysis of patients with relapsed or refractory follicular lymphoma receiving chimeric antigen receptor (CAR) T-cell therapy, axicabtagene ciloleucel (axi-cel) was associated with improved effectiveness and higher toxicity compared to...
In an analysis of patients with relapsed or refractory follicular lymphoma receiving chimeric antigen receptor (CAR) T-cell therapy, axicabtagene ciloleucel (axi-cel) was associated with improved effectiveness and higher toxicity compared to...
Researchers found that asciminib 200 mg twice daily demonstrated significant efficacy and manageable toxicity among patients with T315I-mutated chronic myeloid leukemia in chronic phase (CML-CP).
Researchers found that asciminib 200 mg twice daily demonstrated significant efficacy and manageable toxicity among patients with T315I-mutated chronic myeloid leukemia in chronic phase (CML-CP).
Federal regulators have finalized new health insurance price transparency requirements aimed at improving pricing disclosures, strengthening consumer access to cost information, and streamlining reporting obligations for health plans and...
Federal regulators have finalized new health insurance price transparency requirements aimed at improving pricing disclosures, strengthening consumer access to cost information, and streamlining reporting obligations for health plans and...
A US population-based study of more than 63 000 patients with myeloproliferative neoplasms identified improved survival in primary myelofibrosis alongside persistent differences in incidence and survival across disease subtypes, age groups,...
A US population-based study of more than 63 000 patients with myeloproliferative neoplasms identified improved survival in primary myelofibrosis alongside persistent differences in incidence and survival across disease subtypes, age groups,...
Researchers found that mosunetuzumab was associated with high response rates and manageable safety among patients with relapsed or refractory follicular lymphoma (FL), even those who do not qualify for clinical trials.
Researchers found that mosunetuzumab was associated with high response rates and manageable safety among patients with relapsed or refractory follicular lymphoma (FL), even those who do not qualify for clinical trials.
In the phase 3 TRuE-AD4 trial, ruxolitinib cream significantly improved disease severity, itch, and quality of life among adults with moderate atopic dermatitis who had not responded adequately to conventional topical therapies, potentially...
In the phase 3 TRuE-AD4 trial, ruxolitinib cream significantly improved disease severity, itch, and quality of life among adults with moderate atopic dermatitis who had not responded adequately to conventional topical therapies, potentially...
Researchers found that full-risk contracts were associated with variations in service utilization patterns, providing potential benchmarks which could help inform physician fee schedule reforms.
Researchers found that full-risk contracts were associated with variations in service utilization patterns, providing potential benchmarks which could help inform physician fee schedule reforms.
The Centers for Medicare & Medicaid Services (CMS) has finalized the Global Benchmark for Efficient Drug Pricing (GLOBE) Model, linking certain Medicare Part B drug rebates to international prices in an effort to lower federal spending and...
The Centers for Medicare & Medicaid Services (CMS) has finalized the Global Benchmark for Efficient Drug Pricing (GLOBE) Model, linking certain Medicare Part B drug rebates to international prices in an effort to lower federal spending and...
Hamad Husainy, DO, FACEP, discusses opportunities to strengthen care transitions, improve data sharing, and reduce avoidable emergency department visits and hospital readmissions.
Hamad Husainy, DO, FACEP, discusses opportunities to strengthen care transitions, improve data sharing, and reduce avoidable emergency department visits and hospital readmissions.
In this interview, Travis Morgan, CPA, MBA, discusses how a pharmacist-led medication optimization program targeting polypharmacy among Medicare accountable care organization beneficiaries was associated with increasing reductions in total...
In this interview, Travis Morgan, CPA, MBA, discusses how a pharmacist-led medication optimization program targeting polypharmacy among Medicare accountable care organization beneficiaries was associated with increasing reductions in total...
In this interview, Rakshith Yashvanth discusses how health plans can move SDOH programs beyond referrals by strengthening community partnerships, reducing administrative burden, and using linked data to measure service delivery and long-term...
In this interview, Rakshith Yashvanth discusses how health plans can move SDOH programs beyond referrals by strengthening community partnerships, reducing administrative burden, and using linked data to measure service delivery and long-term...
As the 2026 midterm elections approach, Senate Finance Committee proposals, competing 340B reform bills, and bipartisan Medicare legislation offer insight into the health care priorities that could shape the next Congress.
As the 2026 midterm elections approach, Senate Finance Committee proposals, competing 340B reform bills, and bipartisan Medicare legislation offer insight into the health care priorities that could shape the next Congress.
Hass Saad, MD; Fawad Butt; Tomas Bednar; Eugene Gonsiorek; David Feldman, MD; Bob Watson; Ronald F. Dixon, MD
Health care leaders discuss how the FY 2027 CMS inpatient payment rule may shape hospital finances, digital infrastructure, care coordination, and readiness for nationwide joint replacement bundles.
Health care leaders discuss how the FY 2027 CMS inpatient payment rule may shape hospital finances, digital infrastructure, care coordination, and readiness for nationwide joint replacement bundles.
In this interview, a guest expert shares insights discussed at the 2026 American Society of Clinical Oncology (ASCO) Annual Meeting about the updated ASCO Living Guideline for multiple myeloma, including broader use of quadruplet regimens,...
In this interview, a guest expert shares insights discussed at the 2026 American Society of Clinical Oncology (ASCO) Annual Meeting about the updated ASCO Living Guideline for multiple myeloma, including broader use of quadruplet regimens,...
Roy Moore explores the evolving Alzheimer's disease pipeline, highlighting the promise of anti-amyloid therapies, emerging competitors, and the challenges ahead.
Roy Moore explores the evolving Alzheimer's disease pipeline, highlighting the promise of anti-amyloid therapies, emerging competitors, and the challenges ahead.
In this interview, a guest expert discusses how health plans are evaluating innovative therapies through the lens of value-based care and explains why real-world evidence, interoperable data, and scalable contract infrastructure are essential...
In this interview, a guest expert discusses how health plans are evaluating innovative therapies through the lens of value-based care and explains why real-world evidence, interoperable data, and scalable contract infrastructure are essential...
A patient panel at the 2026 National Infusion Center Association (NICA) Annual Conference underscored how delays driven by prior authorization, benefit design, and administrative barriers can profoundly affect the lives of individuals with...
A patient panel at the 2026 National Infusion Center Association (NICA) Annual Conference underscored how delays driven by prior authorization, benefit design, and administrative barriers can profoundly affect the lives of individuals with...
In this expert commentary, Dr Toby Maher discusses the evolving treatment landscape in progressive pulmonary fibrosis (PPF) and the potential implications of the longer-term FIBRONEER-ILD trial findings. He explores how nerandomilast may...
In this expert commentary, Dr Toby Maher discusses the evolving treatment landscape in progressive pulmonary fibrosis (PPF) and the potential implications of the longer-term FIBRONEER-ILD trial findings. He explores how nerandomilast may...
A new white paper explores how continuous ketone monitoring (CKM) may help address gaps in reactive testing and support earlier intervention for diabetic ketoacidosis (DKA) risk.
Early access decisions in rare oncology require more than promising data. In advanced squamous cell carcinoma of the anal canal (SCAC), managed care professionals must weigh benefit, safety, and statistical context when determining coverage. Featuring insights from Al Benson, MD, this video examines immunotherapy advances and outlines frameworks to guide policy decisions.
A newly released white paper reviews extended 76-week data from a phase 3 study of nerandomilast in idiopathic pulmonary fibrosis (IPF), highlighting durability of findings and safety observations. Explore how maturing evidence may support informed, evidence-based coverage and formulary considerations in a progressive disease setting.
New extended follow-up results from FIBRONEER-IPF provide insight beyond 52 weeks, offering a clearer view of sustained lung function trends, disease progression and mortality risk, and treatment persistence. Explore key outcomes through week 76 with nerandomilast and what longer-term evidence may mean for payer confidence in chronic IPF management.
This article reviews the extended follow-up findings from the Phase III FIBRONEER-ILD trial and examines the potential implications of nerandomilast for the management of PPF. It highlights the durability of lung function benefits, clinically...
This article reviews the extended follow-up findings from the Phase III FIBRONEER-ILD trial and examines the potential implications of nerandomilast for the management of PPF. It highlights the durability of lung function benefits, clinically...
The infographic summarizes 76-week study data from the phase 3 FIBRONEER-IPF trial to provide additional insights on lung function trends, disease progression, mortality risk, and safety outcomes over time with nerandomilast.
The infographic summarizes 76-week study data from the phase 3 FIBRONEER-IPF trial to provide additional insights on lung function trends, disease progression, mortality risk, and safety outcomes over time with nerandomilast.
JOURNAVX is an oral nonopioid indicated for the treatment of moderate-to-severe acute pain in adults—the first and only oral pain signal inhibitor highly selective for NaV1.81
JOURNAVX is an oral nonopioid indicated for the treatment of moderate-to-severe acute pain in adults—the first and only oral pain signal inhibitor highly selective for NaV1.81
The infographic summarizes the FIBRONEER-IPF Phase 3 trial results, demonstrating nerandomilast significantly reduced the decline in forced vital capacity (FVC) over 52 weeks compared to placebo. Nerandomilast exhibited a favorable safety...
The infographic summarizes the FIBRONEER-IPF Phase 3 trial results, demonstrating nerandomilast significantly reduced the decline in forced vital capacity (FVC) over 52 weeks compared to placebo. Nerandomilast exhibited a favorable safety...
Health care organizations will be under increasing financial pressure in 2025 and beyond as they struggle to reduce costs while improving care quality—particularly as actions at the federal level threaten to severely disrupt the industry. Not...
Health care organizations will be under increasing financial pressure in 2025 and beyond as they struggle to reduce costs while improving care quality—particularly as actions at the federal level threaten to severely disrupt the industry. Not...
Do you think retifanlimab plus carboplatin/paclitaxel should be adopted as the new frontline standard of care for patients with advanced squamous cell carcinoma of the anal canal?
Do you think retifanlimab plus carboplatin/paclitaxel should be adopted as the new frontline standard of care for patients with advanced squamous cell carcinoma of the anal canal?
Roy Moore outlines how a rapidly expanding atopic dermatitis pipeline is intensifying competition, reshaping payer strategies, and raising the bar for new therapies.
Roy Moore outlines how a rapidly expanding atopic dermatitis pipeline is intensifying competition, reshaping payer strategies, and raising the bar for new therapies.
True or False: The transformation of traditional health care call centers into “smart access hubs” relies entirely on artificial intelligence (AI) to manage all patient interactions and scheduling.
True or False: The transformation of traditional health care call centers into “smart access hubs” relies entirely on artificial intelligence (AI) to manage all patient interactions and scheduling.
Roy Moore explores the evolving Alzheimer's disease pipeline, highlighting the promise of anti-amyloid therapies, emerging competitors, and the challenges ahead.
Roy Moore explores the evolving Alzheimer's disease pipeline, highlighting the promise of anti-amyloid therapies, emerging competitors, and the challenges ahead.
Roy Moore outlines how a rapidly expanding atopic dermatitis pipeline is intensifying competition, reshaping payer strategies, and raising the bar for new therapies.
Roy Moore outlines how a rapidly expanding atopic dermatitis pipeline is intensifying competition, reshaping payer strategies, and raising the bar for new therapies.
Roy Moore of Clarivate’s market access team discussed the evolving migraine treatment landscape, highlighting the maturation of the acute and prophylactic markets, the emergence of new therapies such as triptan-COX-2 combinations, gepants,...
Roy Moore of Clarivate’s market access team discussed the evolving migraine treatment landscape, highlighting the maturation of the acute and prophylactic markets, the emergence of new therapies such as triptan-COX-2 combinations, gepants,...
Roy Moore, a market access expert, discusses the evolving asthma drug pipeline, highlighting upcoming therapies—including Breztri, depemokimab, and masitinib—their potential to improve adherence and outcomes, payer considerations around cost...
Roy Moore, a market access expert, discusses the evolving asthma drug pipeline, highlighting upcoming therapies—including Breztri, depemokimab, and masitinib—their potential to improve adherence and outcomes, payer considerations around cost...
In this edition of Pipeline Projections, Roy Moore breaks down the rapidly evolving landscape of multiple sclerosis treatments—highlighting the shift from injectables to orals, the rise of monoclonal antibodies, and the promise of innovative...
In this edition of Pipeline Projections, Roy Moore breaks down the rapidly evolving landscape of multiple sclerosis treatments—highlighting the shift from injectables to orals, the rise of monoclonal antibodies, and the promise of innovative...
The US Department of Health and Human Services (HHS) has formally scrapped its 340B Rebate Model Pilot Program following a series of court rulings that blocked its implementation—signaling a significant pause in one of the most closely...
The US Department of Health and Human Services (HHS) has formally scrapped its 340B Rebate Model Pilot Program following a series of court rulings that blocked its implementation—signaling a significant pause in one of the most closely...
On February 3, 2026, President Donald Trump signed a broad government funding package that includes multi-year extensions for Medicare teleath and hospital-at-home programs, new oversight requirements for pharmacy benefit managers (PBMs), and...
On February 3, 2026, President Donald Trump signed a broad government funding package that includes multi-year extensions for Medicare teleath and hospital-at-home programs, new oversight requirements for pharmacy benefit managers (PBMs), and...
The Senate has done it. After weeks of behind-the-scenes wrangling and last-minute amendments, lawmakers have passed a sprawling tax-and-spending megabill that makes good on a long-standing Republican goal: making the 2017 Trump tax cuts...
The Senate has done it. After weeks of behind-the-scenes wrangling and last-minute amendments, lawmakers have passed a sprawling tax-and-spending megabill that makes good on a long-standing Republican goal: making the 2017 Trump tax cuts...
In Washington, the most consequential policies are often buried in the fine print. One such detail in the Senate Finance Committee’s latest tax and spending proposal would gradually cap provider taxes—a core funding tool states use to pull in...
In Washington, the most consequential policies are often buried in the fine print. One such detail in the Senate Finance Committee’s latest tax and spending proposal would gradually cap provider taxes—a core funding tool states use to pull in...
Over the past few weeks, I’ve been following the progress of the One Big Beautiful Bill Act (OBBBA), which started in the House with sweeping tax reforms and some eye-catching health care proposals. Now, the Senate has released its (highly...
Over the past few weeks, I’ve been following the progress of the One Big Beautiful Bill Act (OBBBA), which started in the House with sweeping tax reforms and some eye-catching health care proposals. Now, the Senate has released its (highly...
With the One Big Beautiful Bill Act (OBBBA) still in the hands of the Senate, much of the national conversation has centered on what this legislation would do to federal coverage programs. But regardless of how the federal process unfolds,...
With the One Big Beautiful Bill Act (OBBBA) still in the hands of the Senate, much of the national conversation has centered on what this legislation would do to federal coverage programs. But regardless of how the federal process unfolds,...
It’s been weeks of headline-grabbing debate over Medicaid work requirements, and the “One Big Beautiful Bill Act” remains in the Senate as they deliberate over several health care provisions. While the Medicaid provisions sparked most of the...
It’s been weeks of headline-grabbing debate over Medicaid work requirements, and the “One Big Beautiful Bill Act” remains in the Senate as they deliberate over several health care provisions. While the Medicaid provisions sparked most of the...
Last week, the House of Representatives narrowly passed the One Big Beautiful Bill Act (HR 1, 119th Congress) by a single vote, sending the sweeping tax and spending reconciliation package, backed by President Trump, to the Senate. With its...
Last week, the House of Representatives narrowly passed the One Big Beautiful Bill Act (HR 1, 119th Congress) by a single vote, sending the sweeping tax and spending reconciliation package, backed by President Trump, to the Senate. With its...
It’s been another eventful week in health policy—a phrase that’s quickly becoming routine. This time, House Republicans advanced a sweeping budget reconciliation bill, designed to implement elements of the March budget resolution, with a...
It’s been another eventful week in health policy—a phrase that’s quickly becoming routine. This time, House Republicans advanced a sweeping budget reconciliation bill, designed to implement elements of the March budget resolution, with a...
It’s been a busy few days for drug pricing policy. While I’d love to dig into the details of both President Trump’s latest executive order and the newest Republican bill that would cut Medicaid spending, we don’t have the time—and this isn’t...
It’s been a busy few days for drug pricing policy. While I’d love to dig into the details of both President Trump’s latest executive order and the newest Republican bill that would cut Medicaid spending, we don’t have the time—and this isn’t...