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December 2016 - FRMC

News
Insulin Prices: Are PBMs and Insurers Doing Their Part?
01/02/2017
Dave Muoio
As public outcry over high drug prices has reached a fever pitch, drugmakers, PBMs, and payers have become caught up in a blame game over who is really responsible for the high prices of insulin products.
As public outcry over high drug prices has reached a fever pitch, drugmakers, PBMs, and payers have become caught up in a blame game over who is really responsible for the high prices of insulin products.
As public outcry over high drug...
01/02/2017
First Report Managed Care
News
TAVR: A Potential Lifesaver That Comes at a Cost
12/31/2016
Dean Celia
The nonsurgical option for candidates for surgical aortic valve replacement (SAVR) is transcatheter aortic valve replacement (TAVR) – but it comes at a cost.
The nonsurgical option for candidates for surgical aortic valve replacement (SAVR) is transcatheter aortic valve replacement (TAVR) – but it comes at a cost.
The nonsurgical option for...
12/31/2016
First Report Managed Care
News
TrumpCare: The Uncertain Path to Repeal Part 2
12/30/2016
Dean Celia
First Report Managed Care spoke to government insiders and managed care experts to tease out the complexities of the path to repeal, replace, or restructure the ACA.
First Report Managed Care spoke to government insiders and managed care experts to tease out the complexities of the path to repeal, replace, or restructure the ACA.
First Report Managed Care spoke...
12/30/2016
First Report Managed Care
News Connection
Simponi Aria Effective for Treating Ankylosing Spondylitis
12/19/2016
Study showed that Simponi Aria (golimumab; Janssen), an anti-tumor necrosis factor (TNF)-alpha therapy, was effective in treating active ankylosing spondylitis.
Study showed that Simponi Aria (golimumab; Janssen), an anti-tumor necrosis factor (TNF)-alpha therapy, was effective in treating active ankylosing spondylitis.
Study showed that Simponi Aria...
12/19/2016
First Report Managed Care
News Connection
Bosulif Superior to Imatinib for First-line Chronic Phase Ph+ CML Therapy
12/19/2016
New data suggests Bosulif (bosutinib; Pfizer Inc) is superior to imatinib as a treatment for Philadelphia chromosome positive (Ph+) chronic myeloid leukemia (CML).
New data suggests Bosulif (bosutinib; Pfizer Inc) is superior to imatinib as a treatment for Philadelphia chromosome positive (Ph+) chronic myeloid leukemia (CML).
New data suggests Bosulif...
12/19/2016
First Report Managed Care
News Connection
FDA Approves Opdivo for Head and Neck Cancer Patients
12/19/2016
Opdivo (nivolumab; Bristol-Myers Squibb) was found to increase survival of patients with metastatic or recurrent squamous cell carcinoma of the head and neck.
Opdivo (nivolumab; Bristol-Myers Squibb) was found to increase survival of patients with metastatic or recurrent squamous cell carcinoma of the head and neck.
Opdivo (nivolumab; Bristol-Myers...
12/19/2016
First Report Managed Care
News Connection
Access to Multiple Health Systems May Put Patients at Risk
12/19/2016
The safety of patients with dementia who received prescriptions through both the Veterans Affairs system and through Medicare Part D was compromised. 
The safety of patients with dementia who received prescriptions through both the Veterans Affairs system and through Medicare Part D was compromised. 
The safety of patients with...
12/19/2016
First Report Managed Care
News Connection
ASCO Releases Criteria for Clinical Pathways in Oncology
12/19/2016
The American Society of Clinical Oncology (ASCO) recently published criteria for the development of high-quality clinical pathways in oncology to ensure that all clinical pathways used in oncology promote high-quality patient care. 
The American Society of Clinical Oncology (ASCO) recently published criteria for the development of high-quality clinical pathways in oncology to ensure that all clinical pathways used in oncology promote high-quality patient care. 
The American Society of Clinical...
12/19/2016
First Report Managed Care
News Connection
Court Delays ACA Case Proceedings Until Trump Takes Office
12/19/2016
A federal appeals court has granted a request by House Republicans to delay the Obama administration’s appeal of a key Affordable Care Act (ACA) ruling until after President-elect Donald Trump has taken office.
A federal appeals court has granted a request by House Republicans to delay the Obama administration’s appeal of a key Affordable Care Act (ACA) ruling until after President-elect Donald Trump has taken office.
A federal appeals court has...
12/19/2016
First Report Managed Care
News Connection
Tom Price Nominated to Head HHS
12/19/2016
According to a recent announcement, President-elect Donald Trump has nominated Rep Tom Price, MD (R-GA)—a staunch opponent of the ACA—for secretary of the Department of Health and Human Services (HHS). Trump has also nominated Seema Verma—a...
According to a recent announcement, President-elect Donald Trump has nominated Rep Tom Price, MD (R-GA)—a staunch opponent of the ACA—for secretary of the Department of Health and Human Services (HHS). Trump has also nominated Seema Verma—a...
According to a recent...
12/19/2016
First Report Managed Care
News Connection
$6.3 Billion 21st Century Cures Act Passes
12/19/2016
After easily passing the US House of Representatives and a subsequent vote to end debate on the proposal in the US Senate, the 21st Century Cures Act seemed poised to pass the Senate at press time and move forward to President Obama to sign...
After easily passing the US House of Representatives and a subsequent vote to end debate on the proposal in the US Senate, the 21st Century Cures Act seemed poised to pass the Senate at press time and move forward to President Obama to sign...
After easily passing the US...
12/19/2016
First Report Managed Care
News Connection
Enrollment in Managed Medicaid Plans Increases Significantly
12/19/2016
According to a recent analysis, enrollment in Medicaid programs provided through managed care organizations increased significantly between June 2015 and June 2016.
According to a recent analysis, enrollment in Medicaid programs provided through managed care organizations increased significantly between June 2015 and June 2016.
According to a recent analysis,...
12/19/2016
First Report Managed Care
News Connection
Global Drug Spending Expected to Reach $1.5 Trillion by 2021
12/19/2016
A recent report revealed global drug spending on medicines is expected to surpass $1 trillion by the year 2021, however, over the next five years, spending is expected to slow from previous records. 
A recent report revealed global drug spending on medicines is expected to surpass $1 trillion by the year 2021, however, over the next five years, spending is expected to slow from previous records. 
A recent report revealed global...
12/19/2016
First Report Managed Care
News Connection
Novo Nordisk Pledges to Limit Drug Price Increases, Critics Respond
12/19/2016
In an effort to combat controversy over climbing prices, and hoping to simplify a complex system, Novo Nordisk has detailed a series of steps to ensure a “positive impact on affordability for patients,” according to a recent press release.
In an effort to combat controversy over climbing prices, and hoping to simplify a complex system, Novo Nordisk has detailed a series of steps to ensure a “positive impact on affordability for patients,” according to a recent press release.
In an effort to combat...
12/19/2016
First Report Managed Care
The Rise of Value-Based Drug Pricing: Is It Effective?
12/19/2016
Jill Sederstorm
With stakeholders clamoring for a way to quell rising drug prices, more pharmacy benefit managers are exploring value-based drug pricing models.
With stakeholders clamoring for a way to quell rising drug prices, more pharmacy benefit managers are exploring value-based drug pricing models.
With stakeholders clamoring for...
12/19/2016
First Report Managed Care
TrumpCare: The Uncertain Path to Repeal Part 1
12/19/2016
Dean Celia
President-elect Donald J Trump has declared that the Trump Administration will be asking Congress to either amend Obamacare or repeal and replace it. 
President-elect Donald J Trump has declared that the Trump Administration will be asking Congress to either amend Obamacare or repeal and replace it. 
President-elect Donald J Trump...
12/19/2016
First Report Managed Care
Formulary Frontlines®
COPD: Challenges and Consequences for Stakeholders
12/19/2016
Eileen Koutnik-Fotopoulos
The clinical and economic burden of chronic obstructive pulmonary disease is compounded by underdiagnosis and undertreatment.
The clinical and economic burden of chronic obstructive pulmonary disease is compounded by underdiagnosis and undertreatment.
The clinical and economic burden...
12/19/2016
First Report Managed Care
Department
Antibiotic Prophylaxis Cost-Effective to Prevent Infective Endocarditis
12/19/2016
Using antibiotic prophylaxis to prevent ineffective endocarditis is cost-effective for patients at risk and especially cost-effective among patients with a high risk, according to a presentation at the American Heart Association 2016...
Using antibiotic prophylaxis to prevent ineffective endocarditis is cost-effective for patients at risk and especially cost-effective among patients with a high risk, according to a presentation at the American Heart Association 2016...
Using antibiotic prophylaxis to...
12/19/2016
First Report Managed Care
Department
Eliquis More Cost-Effective Than Warfarin Among Elderly With NVAFf
12/19/2016
According to a study, use of Eliquis was associated with lower costs and use of health care resources among elderly patients with nonvalvular atrial fibrillation.
According to a study, use of Eliquis was associated with lower costs and use of health care resources among elderly patients with nonvalvular atrial fibrillation.
According to a study, use of...
12/19/2016
First Report Managed Care
Department
Sarilumab Superior to Humira as Monotherapy for Active RA
12/19/2016
Results showed that sarilumab was superior to Humira (adalimumab) as monotherapy in patients with active rheumatoid arthritis.
Results showed that sarilumab was superior to Humira (adalimumab) as monotherapy in patients with active rheumatoid arthritis.
Results showed that sarilumab...
12/19/2016
First Report Managed Care
Department
Patient Preference Varies Between Biosimilars or Biologics
12/19/2016
For patients, satisfaction with biosimilar medications is generally no different than satisfaction with bio-originator medications. 
For patients, satisfaction with biosimilar medications is generally no different than satisfaction with bio-originator medications. 
For patients, satisfaction with...
12/19/2016
First Report Managed Care
Department
Collaborative Relationships Between Payers, Providers Needed to Improve Care
12/19/2016
Kimberly White opened the NAMCP 2016 Fall Managed Care Forum with how physicians and payers can collaborate to improve care and lower costs. 
Kimberly White opened the NAMCP 2016 Fall Managed Care Forum with how physicians and payers can collaborate to improve care and lower costs. 
Kimberly White opened the NAMCP...
12/19/2016
First Report Managed Care
Department
Developments in Asthma Treatment
12/19/2016
David Lang, MD presented on the newest developments in asthma treatment during the NAMCP 2016 Fall Managed Care Forum.
David Lang, MD presented on the newest developments in asthma treatment during the NAMCP 2016 Fall Managed Care Forum.
David Lang, MD presented on the...
12/19/2016
First Report Managed Care
Department
Integrating Novel Personalized Therapy Into NSCLC Treatment
12/19/2016
During an NAMCP 2016 Fall Managed Care Forum presentation, Joel W Neal, MD, PhD, discussed how to integrate novel personalized therapies, such as immunotherapy, into non-small cell lung cancer (NSCLC) treatment plans to optimize outcomes. 
During an NAMCP 2016 Fall Managed Care Forum presentation, Joel W Neal, MD, PhD, discussed how to integrate novel personalized therapies, such as immunotherapy, into non-small cell lung cancer (NSCLC) treatment plans to optimize outcomes. 
During an NAMCP 2016 Fall...
12/19/2016
First Report Managed Care
Department
Psychosocial Risk Linked to Increased Readmissions, Length of Stay
12/19/2016
Patients undergoing hematopoietic stem cell transplantation with psychosocial vulnerability are at risk for hospital readmission and increased length of stay.
Patients undergoing hematopoietic stem cell transplantation with psychosocial vulnerability are at risk for hospital readmission and increased length of stay.
Patients undergoing...
12/19/2016
First Report Managed Care
Managed Care Q&A
Improving Outcomes and Reducing Costs With Minimally Invasive Surgery
12/15/2016
David Costill
In this interview with Deborah S Keller, MD, Department of Surgery,  Baylor University Medical Center, Dr Keller discusses cost-effective invasive surgery.
In this interview with Deborah S Keller, MD, Department of Surgery,  Baylor University Medical Center, Dr Keller discusses cost-effective invasive surgery.
In this interview with Deborah S...
12/15/2016
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

December 2016 Volume 13 Issue 12

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