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Commentary

J Collins
Commentary
Time is Therapy: What Managed Care Can Learn from Individuals Navigating Infusion Access
07/14/2026
Jessica Collins, MBA
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...
A patient panel at the 2026...
07/14/2026
First Report Managed Care
Commentary
Through the Payer Lens: Real‑World Evidence That Changes Access
06/25/2026
Chris Terrone; Cynthia Miller; Mitch DeKoven
As regulators and payers place growing emphasis on real-world evidence, new survey findings reveal what managed care decision-makers value most—and how manufacturers can generate and communicate evidence that meaningfully influences coverage...
As regulators and payers place growing emphasis on real-world evidence, new survey findings reveal what managed care decision-makers value most—and how manufacturers can generate and communicate evidence that meaningfully influences coverage...
As regulators and payers place...
06/25/2026
First Report Managed Care
Commentary
Twenty Years of Value-Based Care: Industry Leaders on What's Next
06/25/2026
Patty Hayward; David Lareau; Jeanne Cohen; Alexandria Foley, MSN, RN; Kevin Ritter; Payam Zamani, MD; Eugene Gonsiorek; Mike Camacho; Joseph Kleiman; Bill Kerr, MD
To mark the 20th anniversary of value-based care, health care innovation and value-based care leaders reflect on how the industry has evolved—and why success over the next 20 years will depend on moving from payment reform to the...
To mark the 20th anniversary of value-based care, health care innovation and value-based care leaders reflect on how the industry has evolved—and why success over the next 20 years will depend on moving from payment reform to the...
To mark the 20th anniversary of...
06/25/2026
First Report Managed Care
Commentary
From Risk Scores to Real Outcomes: Why Having More Data Isn’t Solving the Medication Adherence Problem
06/25/2026
Chandra Y. Osborn, PhD, MPH
As managed care shifts toward outcomes-based performance, health plans are discovering that identifying at-risk members is no longer enough—the real competitive advantage lies in driving sustained behavior change to improve medication...
As managed care shifts toward outcomes-based performance, health plans are discovering that identifying at-risk members is no longer enough—the real competitive advantage lies in driving sustained behavior change to improve medication...
As managed care shifts toward...
06/25/2026
First Report Managed Care
Regulatory Insights
Congress Shifts Focus as Health Policy Scrutiny Continues
06/25/2026
Adam Colborn, JD
Although major legislative activity has slowed following pharmacy benefit manager (PBM) reform, ongoing congressional scrutiny of drug patents, price transparency, broker compensation, and the future of Medicare Star Ratings signals that...
Although major legislative activity has slowed following pharmacy benefit manager (PBM) reform, ongoing congressional scrutiny of drug patents, price transparency, broker compensation, and the future of Medicare Star Ratings signals that...
Although major legislative...
06/25/2026
First Report Managed Care
Commentary
Balancing Rigor With Reality: Leveraging Real-World Data and Technology to Enhance Drug Innovation
05/14/2026
Ross Maclean, MD; Kathy Lang, PhD; John Graham, PharmD
Long overlooked for its limitations, real-world data is poised for a transformation as new innovations unlock its potential to drive more meaningful insights and decisions across biopharma.
Long overlooked for its limitations, real-world data is poised for a transformation as new innovations unlock its potential to drive more meaningful insights and decisions across biopharma.
Long overlooked for its...
05/14/2026
First Report Managed Care
Regulatory Insights
A Turning Point in Health Policy: PBM Reform, Integration, and the Rise of DTC Drugs
03/30/2026
Adam Colborn, JD
New federal PBM reforms, heightened scrutiny of health care consolidation, and the expansion of direct-to-consumer drug models are poised to reshape the policy landscape, with uncertain implications for patient costs and market dynamics.
New federal PBM reforms, heightened scrutiny of health care consolidation, and the expansion of direct-to-consumer drug models are poised to reshape the policy landscape, with uncertain implications for patient costs and market dynamics.
New federal PBM reforms,...
03/30/2026
First Report Managed Care
Real-World Data, Artificial Intelligence, Health Care
Commentary
Powering Actionable Insights With Real-Time RWD Dashboards
02/11/2026
Sujay Jadhav
Health care generates massive amounts of real-world data (RWD), and that volume is only continuing to expand. By 2030, the global big data analytics market is expected to reach nearly $350 billion, with health care driving much of that...
Health care generates massive amounts of real-world data (RWD), and that volume is only continuing to expand. By 2030, the global big data analytics market is expected to reach nearly $350 billion, with health care driving much of that...
Health care generates massive...
02/11/2026
First Report Managed Care
Long-Term Care, Post-Acute Care, Lobbying, Politics
Commentary
All Politics Is Local—Why Long-Term and Post-Acute Care Leaders Should Participate in Grassroots Advocacy
01/20/2026
Bill Charnetski
Local long-term and post-acute care leaders can’t afford to sit out politics—by embracing grassroots advocacy, sharing their expertise, and building relationships with lawmakers, they can directly shape the policies that affect their...
Local long-term and post-acute care leaders can’t afford to sit out politics—by embracing grassroots advocacy, sharing their expertise, and building relationships with lawmakers, they can directly shape the policies that affect their...
Local long-term and post-acute...
01/20/2026
Annals of Long-Term Care
Rutzler Headshot
Commentary
Clean-up Your Defenses: Why Health Plans Can't Afford to Wait on Fraud Hygiene
12/08/2025
Erin Rutzler
Health plans must urgently shift from reactive, manual fraud efforts to proactive, technology-driven prepay strategies—supported by unified teams and expert talent—to combat increasingly fast, sophisticated fraud, waste, and abuse schemes and...
Health plans must urgently shift from reactive, manual fraud efforts to proactive, technology-driven prepay strategies—supported by unified teams and expert talent—to combat increasingly fast, sophisticated fraud, waste, and abuse schemes and...
Health plans must urgently shift...
12/08/2025
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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