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Behind the Bill
CMS Expands Site-Neutral Medicare Payments for Outpatient Care
08/07/2026
Hannah Musick
CMS’ proposed expansion of site-neutral Medicare payments aims to lower spending and beneficiary costs for certain outpatient services, while hospitals warn that equalizing payments across care settings could overlook the higher costs of...
CMS’ proposed expansion of site-neutral Medicare payments aims to lower spending and beneficiary costs for certain outpatient services, while hospitals warn that equalizing payments across care settings could overlook the higher costs of...
CMS’ proposed expansion of...
08/07/2026
First Report Managed Care
News
US Patients With NSCLC Demonstrate Higher Rates of Health Care Utilization and Costs
08/07/2026
Rebecca Amrick
Researchers found that among patients with advanced non-small cell lung cancer (NSCLC), those living in the US had higher rates of health care utilization and higher care costs, illustrating the substantial economic burden associated with...
Researchers found that among patients with advanced non-small cell lung cancer (NSCLC), those living in the US had higher rates of health care utilization and higher care costs, illustrating the substantial economic burden associated with...
Researchers found that among...
08/07/2026
First Report Managed Care
News
Discontinued Coverage for Obesity Medications Associated With Lower Employee Satisfaction
08/05/2026
Rebecca Amrick
Researchers found that removing coverage for obesity medications was associated with worse employee morale, higher rates of burnout, and decreased job satisfaction and productivity.
Researchers found that removing coverage for obesity medications was associated with worse employee morale, higher rates of burnout, and decreased job satisfaction and productivity.
Researchers found that removing...
08/05/2026
First Report Managed Care
News
Medicaid Coverage Remains Suboptimal After Medicare Enrollment
08/03/2026
Rebecca Amrick
A study found that waiving the Medicare Savings Program (MSP) asset test could help newly enrolled Medicare beneficiaries retain Medicaid coverage, but variations in state-level coverage and suboptimal rates of enrollment raise concerns about...
A study found that waiving the Medicare Savings Program (MSP) asset test could help newly enrolled Medicare beneficiaries retain Medicaid coverage, but variations in state-level coverage and suboptimal rates of enrollment raise concerns about...
A study found that waiving the...
08/03/2026
First Report Managed Care
Behind the Bill
Court Challenge Tests CMS' New Medicaid Work Requirement Rule
07/31/2026
Hannah Musick
A federal court has allowed CMS' new Medicaid work requirement rule to move forward while a multistate legal challenge continues, setting the stage for a broader debate over how the landmark eligibility changes will be implemented nationwide.
A federal court has allowed CMS' new Medicaid work requirement rule to move forward while a multistate legal challenge continues, setting the stage for a broader debate over how the landmark eligibility changes will be implemented nationwide.
A federal court has allowed CMS'...
07/31/2026
First Report Managed Care
News
GLP-1 RAs Have Higher Utilization Among Patients With Obesity Than Bariatric Surgery
07/28/2026
Rebecca Amrick
A study found that glucagon-like peptide-1 receptor agonists (GLP-1 RAs) are the more common treatment option for obesity among adolescents and young adults compared to bariatric surgery.
A study found that glucagon-like peptide-1 receptor agonists (GLP-1 RAs) are the more common treatment option for obesity among adolescents and young adults compared to bariatric surgery.
A study found that glucagon-like...
07/28/2026
First Report Managed Care
News
Kidney Transplant Referrals Show Significant Attrition Before Waitlisting
07/28/2026
Grace Taylor, MS, MA
A large US electronic health record analysis found that only 1 in 10 patients referred for kidney transplantation ultimately received a transplant, highlighting substantial attrition before waitlisting and identifying key patient- and...
A large US electronic health record analysis found that only 1 in 10 patients referred for kidney transplantation ultimately received a transplant, highlighting substantial attrition before waitlisting and identifying key patient- and...
A large US electronic health...
07/28/2026
First Report Managed Care
News
Insurance Coverage Impacts Episode of Care for Spinal Fusions
07/27/2026
Rebecca Amrick
A study found that among patients who underwent lumbar fusions, those covered by Medicare Advantage had longer lengths of stay and higher rates of home discharges than those covered by Medicare Fee-For-Service, illustrating gaps in episode of...
A study found that among patients who underwent lumbar fusions, those covered by Medicare Advantage had longer lengths of stay and higher rates of home discharges than those covered by Medicare Fee-For-Service, illustrating gaps in episode of...
A study found that among...
07/27/2026
First Report Managed Care
News
US Study Identifies Factors Linked to Low Metabolic Bariatric Surgery Uptake
07/24/2026
Grace Taylor, MS, MA
A large US cohort study found that only 3% of adults newly diagnosed with obesity underwent metabolic bariatric surgery within one year, with provider type, body mass index, sex, and other clinical factors strongly influencing access to...
A large US cohort study found that only 3% of adults newly diagnosed with obesity underwent metabolic bariatric surgery within one year, with provider type, body mass index, sex, and other clinical factors strongly influencing access to...
A large US cohort study found...
07/24/2026
First Report Managed Care
Behind the Bill
Federal Court Pauses Key ACA Marketplace Rule Changes
07/23/2026
Hannah Musick
A federal court has temporarily blocked several key provisions of Centers for Medicare & Medicaid Services' (CMS') 2027 Affordable Care Act (ACA) Marketplace rule, setting up a high-stakes legal battle over federal authority, Marketplace...
A federal court has temporarily blocked several key provisions of Centers for Medicare & Medicaid Services' (CMS') 2027 Affordable Care Act (ACA) Marketplace rule, setting up a high-stakes legal battle over federal authority, Marketplace...
A federal court has temporarily...
07/23/2026
First Report Managed Care

Pipeline Projections

PIPELINE PROJECTIONS
The Evolving Alzheimer Disease Treatment Landscape: Anti-Amyloid Therapies and Beyond
07/21/2026
Roy Moore
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 explores the evolving...
07/21/2026
First Report Managed Care
PIPELINE PROJECTIONS
Emerging Therapies Reshaping Atopic Dermatitis Care
03/26/2026
Roy Moore
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 outlines how a rapidly...
03/26/2026
First Report Managed Care
Pipe
Pipeline Projections
Emerging Migraine Treatments Challenge a Mature Market
11/20/2025
Roy Moore
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 of Clarivate’s market...
11/20/2025
First Report Managed Care
Pipeline Projections
Pipeline Projections
Redefining Asthma Management With Emerging Anti-Inflammatories
10/01/2025
Roy Moore
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...
Roy Moore, a market access...
10/01/2025
First Report Managed Care
Pipeline Projections
The Shift in MS Care as Biologics and BTK Inhibitors Advance
07/25/2025
Roy Moore
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...
In this edition of Pipeline...
07/25/2025
First Report Managed Care

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Behind the Bill

Behind the Bill
HHS Hits Reset on 340B Rebate Model After Court Setbacks
02/11/2026
Juliet Gallagher
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...
The US Department of Health and...
02/11/2026
First Report Managed Care
Behind the Bill
Funding Package Extends Medicare Telehealth, Enacts PBM Reforms, and Updates Hospital Oversight
02/05/2026
Juliet Gallagher
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...
On February 3, 2026, President...
02/05/2026
First Report Managed Care
Behind the Bill
The Senate’s $3 Trillion Deal. Tax Relief Now, Medicaid Coverage Loss Later?
07/02/2025
Katie Hayes, MJ
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...
The Senate has done it. After...
07/02/2025
First Report Managed Care
Behind the Bill
When a Cap Isn’t Just a Cap: How a Provider Tax Proposal Could Reshape Medicaid Financing
06/25/2025
Katie Hayes, MJ
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...
In Washington, the most...
06/25/2025
First Report Managed Care
Behind the Bill
Rewriting the Safety Net? Inside the Senate’s Changes to Medicaid and the ACA
06/18/2025
Katie Hayes, MJ
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...
Over the past few weeks, I’ve...
06/18/2025
First Report Managed Care
Behind the Bill
How States Might Respond to the One Big Beautiful Bill Act
06/11/2025
Katie Hayes, MJ
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,...
With the One Big Beautiful Bill...
06/11/2025
First Report Managed Care
Behind the Bill
Is the Affordable Care Act on the Chopping Block? What the One Big Beautiful Bill Act Tells Us.
06/04/2025
Katie Hayes, MJ
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...
It’s been weeks of...
06/04/2025
First Report Managed Care
Behind the Bill
From House to Senate: The Journey of Cutting Medicaid
05/28/2025
Katie Hayes, MJ
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...
Last week, the House of...
05/28/2025
First Report Managed Care
Behind the Bill
Eligibility, Paperwork, and Penalties: The Not-So-Hidden Costs of Medicaid ‘Reform’
05/21/2025
Katie Hayes, MJ
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 another eventful week...
05/21/2025
First Report Managed Care
Behind the Bill
A Busy Week in Drug Pricing Policy: Aligning US Drug Prices With Global Standards?
05/14/2025
Katie Hayes, MJ
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...
It’s been a busy few days for...
05/14/2025
First Report Managed Care

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