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April 2014 - FRMC

Analysis of a Value-Based Insurance Design Program
04/22/2014
Tim Casey
Las Vegas—A retrospective cross-sectional study found that a value-based insurance design program reached the sickest and most costly patients, but it did not attract individuals who were most nonadherent to medications. Only a small...
Las Vegas—A retrospective cross-sectional study found that a value-based insurance design program reached the sickest and most costly patients, but it did not attract individuals who were most nonadherent to medications. Only a small...
Las Vegas—A retrospective...
04/22/2014
First Report Managed Care
Risks of Prescription Drug Abuse
04/22/2014
Tim Casey
Las Vegas—Patients with commercial insurance who are taking prescription drugs are at risk of abusing the medications and burdening the healthcare system with significant costs, according to pharmaceutical and medical claims data. The authors...
Las Vegas—Patients with commercial insurance who are taking prescription drugs are at risk of abusing the medications and burdening the healthcare system with significant costs, according to pharmaceutical and medical claims data. The authors...
Las Vegas—Patients with...
04/22/2014
First Report Managed Care
Costs and Risks Associated with Specialty Medications
04/22/2014
Tim Casey
Las Vegas—According to a retrospective review of a large payer’s specialty drug pharmacy claims from January 1, 2011, to December 31, 2011, 32.3% of patients who received a 90-day supply of an oral oncology drug did not fill the prescription...
Las Vegas—According to a retrospective review of a large payer’s specialty drug pharmacy claims from January 1, 2011, to December 31, 2011, 32.3% of patients who received a 90-day supply of an oral oncology drug did not fill the prescription...
Las Vegas—According to a...
04/22/2014
First Report Managed Care
Medication Adherence Program for Medicare Advantage
04/22/2014
Tim Casey
Las Vegas—A retrospective analysis of claims data from a Medicare Advantage prescription drug plan found that a comprehensive medication adherence program benefitted prescribers and members. From 2012 to 2013, New West Medicare’s adherence...
Las Vegas—A retrospective analysis of claims data from a Medicare Advantage prescription drug plan found that a comprehensive medication adherence program benefitted prescribers and members. From 2012 to 2013, New West Medicare’s adherence...
Las Vegas—A retrospective...
04/22/2014
First Report Managed Care
Conference Insider
Changes in LTC Services and Supports
04/22/2014
Tim Casey
Falls Church—Until recently, long-term services and supports in Medicaid were refined to nursing homes or institutional care. For the past few years, however, there has been a “very dramatic” change in where Medicaid long-term care spending...
Falls Church—Until recently, long-term services and supports in Medicaid were refined to nursing homes or institutional care. For the past few years, however, there has been a “very dramatic” change in where Medicaid long-term care spending...
Falls Church—Until recently,...
04/22/2014
First Report Managed Care
Conference Insider
The ACA is Changing Healthcare
04/22/2014
Tim Casey
Falls Church—The Patient Protection and Affordable Care Act (ACA) has transformed the healthcare industry, leading to delivery and payment reforms. Payers are focusing more on the value of care and attempting to compensate doctors on quality...
Falls Church—The Patient Protection and Affordable Care Act (ACA) has transformed the healthcare industry, leading to delivery and payment reforms. Payers are focusing more on the value of care and attempting to compensate doctors on quality...
Falls Church—The Patient...
04/22/2014
First Report Managed Care
Conference Insider
Poll: Healthcare is Second Most Important Issue Heading into November Elections
04/22/2014
Tim Casey
Washington, DC—A poll released at the AHIP conference found that voters consider healthcare to be the second most important issue heading into the November 2014 midterm elections, trailing only the economy/jobs. Peter Hart and Bill McInturff,...
Washington, DC—A poll released at the AHIP conference found that voters consider healthcare to be the second most important issue heading into the November 2014 midterm elections, trailing only the economy/jobs. Peter Hart and Bill McInturff,...
Washington, DC—A poll released...
04/22/2014
First Report Managed Care
ACE and ARB Treatment among Medicare Beneficiaries with Diabetes and Hypertension
04/22/2014
Melissa D. Cooper
Between 2000 and 2010, the percentage of patients aged ≥65 years with diabetes and hypertension increased from 9% to 15%. Angiotensin-converting enzyme (ACE) inhibitors and angiotensin II receptor blockers (ARBs) have proven to decrease the...
Between 2000 and 2010, the percentage of patients aged ≥65 years with diabetes and hypertension increased from 9% to 15%. Angiotensin-converting enzyme (ACE) inhibitors and angiotensin II receptor blockers (ARBs) have proven to decrease the...
Between 2000 and 2010, the...
04/22/2014
First Report Managed Care
Department
Assessing the Cost Burden of AF and Heart Failure
04/22/2014
Melissa D. Cooper
Common complications of acute coronary syndrome (ACS) are atrial fibrillation (AF) and heart failure.
Common complications of acute coronary syndrome (ACS) are atrial fibrillation (AF) and heart failure.
Common complications of acute...
04/22/2014
First Report Managed Care
Department
Greater Prevalence of Clinically Significant Anxiety and Depression among SSc Cohort
04/22/2014
Eileen Koutnik-Fotopoulos
Systemic sclerosis (SSc) is a connective-tissue disease characterized by excessive collagen deposition in the dermis and internal organs.
Systemic sclerosis (SSc) is a connective-tissue disease characterized by excessive collagen deposition in the dermis and internal organs.
Systemic sclerosis (SSc) is a...
04/22/2014
First Report Managed Care
Self-Guided Intervention Benefits Patients with Depression and Anxiety
04/22/2014
Eileen Koutnik-Fotopoulos
A 2013 study reported the outcomes of a new self-guided Internet-delivered treatment, the Wellbeing Course, for symptoms of anxiety and depression. The study found that the intervention resulted in significant symptom reductions. Furthermore,...
A 2013 study reported the outcomes of a new self-guided Internet-delivered treatment, the Wellbeing Course, for symptoms of anxiety and depression. The study found that the intervention resulted in significant symptom reductions. Furthermore,...
A 2013 study reported the...
04/22/2014
First Report Managed Care
Increased Risk of Cardiac Arrhythmia and Death with Azithromycin and Levofloxacin
04/22/2014
Kerri Fitzgerald
Since the 2012 FDA warning of QT prolongation risks with azithromycin, the drug has been associated with increased risk of death among patients at high baseline risk, but not for younger and middle-aged adults. A recent study examined the...
Since the 2012 FDA warning of QT prolongation risks with azithromycin, the drug has been associated with increased risk of death among patients at high baseline risk, but not for younger and middle-aged adults. A recent study examined the...
Since the 2012 FDA warning of QT...
04/22/2014
First Report Managed Care
Bevacizumab Shows No Improvement in Overall Survival for Patients with Newly Diagnosed Glioblastoma
04/22/2014
Mary Mihalovic
A recent study showed that patients newly diagnosed with glioblastoma and treated with bevacizumab as part of a first-line therapy that also included the current standard of care did not experience an improvement in overall survival [N Engl J...
A recent study showed that patients newly diagnosed with glioblastoma and treated with bevacizumab as part of a first-line therapy that also included the current standard of care did not experience an improvement in overall survival [N Engl J...
A recent study showed that...
04/22/2014
First Report Managed Care
Bevacizumab Improves Overall Survival in Patients with Advanced Cervical Cancer
04/22/2014
Mary Mihalovic
The addition of bevacizumab to the chemotherapeutic regimens of cisplatin-paclitaxel or topotecan-paclitaxel resulted in improved overall survival among patients with advanced cervical cancer, according to results of a recent study [N Engl J...
The addition of bevacizumab to the chemotherapeutic regimens of cisplatin-paclitaxel or topotecan-paclitaxel resulted in improved overall survival among patients with advanced cervical cancer, according to results of a recent study [N Engl J...
The addition of bevacizumab to...
04/22/2014
First Report Managed Care
Ribavirin for Chronic Hepatitis E in Transplant Patients
04/22/2014
Kerri Fitzgerald
While there is no established therapy for hepatitis E virus (HEV), small case series and case reports have shown that a short course of pegylated interferon, or ribavirin, as monotherapy can effectively treat HEV infection. A recent study...
While there is no established therapy for hepatitis E virus (HEV), small case series and case reports have shown that a short course of pegylated interferon, or ribavirin, as monotherapy can effectively treat HEV infection. A recent study...
While there is no established...
04/22/2014
First Report Managed Care
Beta-Carotene and Vitamin E Not Recommended for Cancer and CVD Prevention
04/22/2014
Melissa D. Cooper
Between 2007 and 2010, 49% of adults in the United States reported using at least 1 dietary supplement and 32% reported using a multivitamin-multimineral supplement. In 2011, cancer and cardiovascular disease (CVD) were accountable for 22.8%...
Between 2007 and 2010, 49% of adults in the United States reported using at least 1 dietary supplement and 32% reported using a multivitamin-multimineral supplement. In 2011, cancer and cardiovascular disease (CVD) were accountable for 22.8%...
Between 2007 and 2010, 49% of...
04/22/2014
First Report Managed Care
Obstacles for PCPs Prescribing Buprenorphine for Opioid Addiction
04/22/2014
Melissa D. Cooper
Although buprenorphine is the only available drug for office-based physicians for the treatment of opioid addiction that reports high rates of prolonged success, a recent study found 11 of 17 Oregon primary care physicians (PCPs) trained to...
Although buprenorphine is the only available drug for office-based physicians for the treatment of opioid addiction that reports high rates of prolonged success, a recent study found 11 of 17 Oregon primary care physicians (PCPs) trained to...
Although buprenorphine is the...
04/22/2014
First Report Managed Care
News Connection
Statin Therapy Recipients Increase Under ACC/AHA Guidelines
04/22/2014
Melissa D. Cooper
A recent study showed statin therapy decreased relative cardiovascular risk by 25% [Database Syst Rev. 2013;1:CD004816]. In 2013, the American College of Cardiology and the American Heart Association (ACC/AHA) made recommendations for...
A recent study showed statin therapy decreased relative cardiovascular risk by 25% [Database Syst Rev. 2013;1:CD004816]. In 2013, the American College of Cardiology and the American Heart Association (ACC/AHA) made recommendations for...
A recent study showed statin...
04/22/2014
First Report Managed Care
Conference Insider
Hospital Antibiotic Prescribing Could be Significantly Improved
04/22/2014
Jill Sederstorm
A recent study on antibiotic use in hospitalized patients found that antibiotic prescribing could potentially be improved in more than one-third of the most common prescription scenarios [MMWR. 2014;63(9):194-200]. This study also found that...
A recent study on antibiotic use in hospitalized patients found that antibiotic prescribing could potentially be improved in more than one-third of the most common prescription scenarios [MMWR. 2014;63(9):194-200]. This study also found that...
A recent study on antibiotic use...
04/22/2014
First Report Managed Care
Examining the Relationship Between COPD and Cognitive Impairment
04/22/2014
Melissa D. Cooper
There is a correlation between chronic obstructive pulmonary disease (COPD) and cognitive impairment, but the extent has not previously been accurately determined. Studies have shown anywhere from 12% to 88% incidence of cognitive impairment...
There is a correlation between chronic obstructive pulmonary disease (COPD) and cognitive impairment, but the extent has not previously been accurately determined. Studies have shown anywhere from 12% to 88% incidence of cognitive impairment...
There is a correlation between...
04/22/2014
First Report Managed Care
News Connection
Health Education for Patients with Chronic Conditions
04/22/2014
Kerri Fitzgerald
For chronic conditions, patient health education can reduce mortality and morbidly, in part due to self-managing tasks and understanding of proper medication use. Previous studies have indicated that health professionals sometimes fail to...
For chronic conditions, patient health education can reduce mortality and morbidly, in part due to self-managing tasks and understanding of proper medication use. Previous studies have indicated that health professionals sometimes fail to...
For chronic conditions, patient...
04/22/2014
First Report Managed Care
How Specialty Drugs Will Affect the Future of Healthcare - Q&A with William J. Cardarelli, PharmD, Director of Pharmacy Revenue and Supply, Atrius Health
04/17/2014
First Report Managed Care conducted an interview with William J. Cardarelli, PharmD, one of our Editorial Advisory Board members, to discuss the advances in specialty medicine and how it affects formulary design, health coverage, and economic...
First Report Managed Care conducted an interview with William J. Cardarelli, PharmD, one of our Editorial Advisory Board members, to discuss the advances in specialty medicine and how it affects formulary design, health coverage, and economic...
First Report Managed Care...
04/17/2014
First Report Managed Care
News Connection
Competition in the New Health Exchanges
04/17/2014
Kerri Fitzgerald
Prior to the passing of the Patient Protection and Affordable Care Act (ACA) in 2010, a single insurer owned at least half of the individual market in 30 states and the District of Columbia. While there are upsides to having a dominant...
Prior to the passing of the Patient Protection and Affordable Care Act (ACA) in 2010, a single insurer owned at least half of the individual market in 30 states and the District of Columbia. While there are upsides to having a dominant...
Prior to the passing of the...
04/17/2014
First Report Managed Care
State Medicaid Directors Discuss Expansion
04/17/2014
Tim Casey
Falls Church—When President Barack Obama signed the Patient Protection and Affordable Care Act (ACA) into law in March 2010, the legislation included a provision in which the federal government would stop making payments to states if they did...
Falls Church—When President Barack Obama signed the Patient Protection and Affordable Care Act (ACA) into law in March 2010, the legislation included a provision in which the federal government would stop making payments to states if they did...
Falls Church—When President...
04/17/2014
First Report Managed Care
Conference Insider
More than 7 Million People Sign Up for Coverage on Health Insurance Exchanges
04/17/2014
Tim Casey
Washington, DC—Despite technical glitches that marred the rollout of the health insurance marketplaces last fall, President Barack Obama announced on April 1 that 7.1 million people signed up for insurance coverage in 2014 through the federal...
Washington, DC—Despite technical glitches that marred the rollout of the health insurance marketplaces last fall, President Barack Obama announced on April 1 that 7.1 million people signed up for insurance coverage in 2014 through the federal...
Washington, DC—Despite technical...
04/17/2014
First Report Managed Care

Pipeline Projections

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
Pipeline Projections
How Biosimilars Are Shaping RA Treatment and Reimbursement Strategies
04/29/2025
Roy Moore
In this episode of Pipeline Projections, Roy Moore—Senior Healthcare Research & Data Analyst at Clarivate—discusses the expanding biosimilar pipeline for autoimmune diseases. He highlights recent FDA approvals, formulary and pricing...
In this episode of Pipeline Projections, Roy Moore—Senior Healthcare Research & Data Analyst at Clarivate—discusses the expanding biosimilar pipeline for autoimmune diseases. He highlights recent FDA approvals, formulary and pricing...
In this episode of Pipeline...
04/29/2025
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

April 2014 Volume 11 Issue 4

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