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September 2018 - First Report Managed Care

Featured Article

Hospitals Brace for Impact of 340B Drug Pricing Program Changes
09/14/2018
Mary Beth Nierengarten
Since the implementation of changes to the 340B Drug Pricing program in January 2018, a long, growing debate over the merits and problems with the program has only strengthened. 
Since the implementation of changes to the 340B Drug Pricing program in January 2018, a long, growing debate over the merits and problems with the program has only strengthened. 
Since the implementation of...
09/14/2018
First Report Managed Care
Managed Care Q&A
Improving Access Through Walgreens New Digital Platform
09/18/2018
David Costill
Giovanni Monti, MBA, MIA, Walgreens Boots Alliance vice president, and director of Healthcare Innovation, discusses the new platform created by Walgreens—Find Care Now—and explains how it will expand access to care for patients and also...
Giovanni Monti, MBA, MIA, Walgreens Boots Alliance vice president, and director of Healthcare Innovation, discusses the new platform created by Walgreens—Find Care Now—and explains how it will expand access to care for patients and also...
Giovanni Monti, MBA, MIA,...
09/18/2018
First Report Managed Care
News Connection
CVS Shifts to ICER Value-Based Drug Pricing Strategy
09/18/2018
CVS Caremark will shift to using the Institute for Clinical and Economic Review’s (ICER) value-based drug pricing system, which excludes some high-cost drugs from health plans, a white paper from CVS explained.
CVS Caremark will shift to using the Institute for Clinical and Economic Review’s (ICER) value-based drug pricing system, which excludes some high-cost drugs from health plans, a white paper from CVS explained.
CVS Caremark will shift to using...
09/18/2018
First Report Managed Care
News Connection
Prescription Drug Costs Account for 15% of Total Health Care Spending
09/18/2018
Despite the frequent claim by the industry that 10% of spending goes toward pharmaceuticals, a new report published online in Health Affairs suggests that prescription drugs may actually account for roughly 15% of all money spent on total...
Despite the frequent claim by the industry that 10% of spending goes toward pharmaceuticals, a new report published online in Health Affairs suggests that prescription drugs may actually account for roughly 15% of all money spent on total...
Despite the frequent claim by...
09/18/2018
First Report Managed Care
News Connection
CMS Increases Pricing Transparency, Requires Hospitals to Post Prices Online
09/18/2018
The Centers for Medicare and Medicaid Services (CMS) has issued a final rule on the Inpatient Prospective Payment System (IPPS) that increases pricing transparency by pushing hospitals to post standard charges online in a machine-readable...
The Centers for Medicare and Medicaid Services (CMS) has issued a final rule on the Inpatient Prospective Payment System (IPPS) that increases pricing transparency by pushing hospitals to post standard charges online in a machine-readable...
The Centers for Medicare and...
09/18/2018
First Report Managed Care
News Connection
Express Scripts Announces Formulary Exclusions for 2019, Drops Nearly 50 Drugs
09/18/2018
The nation’s largest pharmacy benefit manager, Express Scripts, has announced they will drop approximately 48 drugs in 2019 from its current lineup of covered drugs, according to a company press release.
The nation’s largest pharmacy benefit manager, Express Scripts, has announced they will drop approximately 48 drugs in 2019 from its current lineup of covered drugs, according to a company press release.
The nation’s largest pharmacy...
09/18/2018
First Report Managed Care
News Connection
CMS Announces Strategy to Lower Medicare Advantage Costs
09/18/2018
In an effort to negotiate better deals for Medicare patients and create competition between drugs used to treat the same conditions, the Centers for Medicare and Medicaid Services (CMS) has announced they will shift more than half of the...
In an effort to negotiate better deals for Medicare patients and create competition between drugs used to treat the same conditions, the Centers for Medicare and Medicaid Services (CMS) has announced they will shift more than half of the...
In an effort to negotiate better...
09/18/2018
First Report Managed Care
News Connection
VA Secretary Clarifies Collective Bargaining Authority Relating to Patient Care
09/18/2018
Robert Wilkie, department of Veteran Affairs (VA) secretary, recently clarified that unions can no longer use collective bargaining rights when it comes to professional conduct and patient care by VA providers.
Robert Wilkie, department of Veteran Affairs (VA) secretary, recently clarified that unions can no longer use collective bargaining rights when it comes to professional conduct and patient care by VA providers.
Robert Wilkie, department of...
09/18/2018
First Report Managed Care
News Connection
VA, Walgreens Announce Collaboration
09/18/2018
In an effort to improve care coordination for veterans, the Department of Veteran Affairs (VA) has announced it will work with Walgreens to coordinate patient and pharmaceutical care for VA-enrolled patients. 
In an effort to improve care coordination for veterans, the Department of Veteran Affairs (VA) has announced it will work with Walgreens to coordinate patient and pharmaceutical care for VA-enrolled patients. 
In an effort to improve care...
09/18/2018
First Report Managed Care
News Connection
Ahead of VA MISSION Act Expansion, Caregiver Program Requires Attention
09/18/2018
According to a recent analysis from the Department of Veteran Affairs (VA) Office of Inspector General (OIG), the VA has not adequately monitored its Caregiver Assistance Program, which has resulted in patient care access limitations and...
According to a recent analysis from the Department of Veteran Affairs (VA) Office of Inspector General (OIG), the VA has not adequately monitored its Caregiver Assistance Program, which has resulted in patient care access limitations and...
According to a recent analysis...
09/18/2018
First Report Managed Care
Conference Insider
Meeting Preview: What to Expect at HQC 2018
09/18/2018
The 2018 Health Care Quality Congress (HQC) is a new national meeting by the National Committee for Quality Assurance (NCQA) that will take place October 5–7 at the Hyatt Regency in Dallas, TX. 
The 2018 Health Care Quality Congress (HQC) is a new national meeting by the National Committee for Quality Assurance (NCQA) that will take place October 5–7 at the Hyatt Regency in Dallas, TX. 
The 2018 Health Care Quality...
09/18/2018
First Report Managed Care
Conference Insider
AMA Adopts New Policy Leading to More Affordable ACA Marketplace Plans
09/18/2018
The AMA House of Delegates announced at the 2018 AMA Annual meeting the adoption of a new policy that will help make ACA marketplace plans more affordable in order to increase the number of members covered.
The AMA House of Delegates announced at the 2018 AMA Annual meeting the adoption of a new policy that will help make ACA marketplace plans more affordable in order to increase the number of members covered.
The AMA House of Delegates...
09/18/2018
First Report Managed Care
Conference Insider
Integrating Precision Medicine Into Alternative Payment Models
09/18/2018
According to a panel at the 2018 AMA Annual Meeting, the AMA is committed to working toward integrating precision medicine into alternative payment models (APMs). This is part of the AMA’s effort to move to a health care system that is rooted...
According to a panel at the 2018 AMA Annual Meeting, the AMA is committed to working toward integrating precision medicine into alternative payment models (APMs). This is part of the AMA’s effort to move to a health care system that is rooted...
According to a panel at the 2018...
09/18/2018
First Report Managed Care
Conference Insider
Improving Patient Care, Outcomes Through Augmented Intelligence
09/18/2018
According to experts cited in an AMA Board of Trustees report, whose recommendations were adopted at the 2018 AMA Annual Meeting, computational methods, techniques, and systems for data analysis can also be used in health care. 
According to experts cited in an AMA Board of Trustees report, whose recommendations were adopted at the 2018 AMA Annual Meeting, computational methods, techniques, and systems for data analysis can also be used in health care. 
According to experts cited in an...
09/18/2018
First Report Managed Care
Conference Insider
On-Demand PrEP Use is Highly Effective for Preventing HIV in High-Risk MSM
09/18/2018
Results from Prevenir, an ongoing observational study, presented at AIDS 2018, provided further evidence that on-demand PrEP is an effective strategy for preventing HIV acquisition in at-risk men who have sex with men (MSM).
Results from Prevenir, an ongoing observational study, presented at AIDS 2018, provided further evidence that on-demand PrEP is an effective strategy for preventing HIV acquisition in at-risk men who have sex with men (MSM).
Results from Prevenir, an...
09/18/2018
First Report Managed Care
Conference Insider
“Kick and Kill” HIV Cure Study Fails to Reduce Viral Load
09/18/2018
In the first randomized controlled trial to evaluate a ‘’kick-and-kill’’ approach in patients with primary HIV infection, presented at AIDS 2018, there was no impact on measures of the HIV reservoir.
In the first randomized controlled trial to evaluate a ‘’kick-and-kill’’ approach in patients with primary HIV infection, presented at AIDS 2018, there was no impact on measures of the HIV reservoir.
In the first randomized...
09/18/2018
First Report Managed Care
Conference Insider
New Long-Term Data From APPROACH HIV Vaccine Study Shows Promise
09/18/2018
Researchers presented at AIDS 2018 encouraging new long-term data from APPROACH, a phase 1/2a study evaluating the safety and immunogenicity of several different HIV vaccine regimens.
Researchers presented at AIDS 2018 encouraging new long-term data from APPROACH, a phase 1/2a study evaluating the safety and immunogenicity of several different HIV vaccine regimens.
Researchers presented at AIDS...
09/18/2018
First Report Managed Care
A Novel—And Cost-Effective—Approach to End-Stage Renal Disease
09/18/2018
Jeff Craven
Studies have shown success with hepatitis C-positive kidney transplantation in patients with end-stage renal disease followed by treatment with direct-acting antivirals to cure the infection. Experts discuss why this approach is not only...
Studies have shown success with hepatitis C-positive kidney transplantation in patients with end-stage renal disease followed by treatment with direct-acting antivirals to cure the infection. Experts discuss why this approach is not only...
Studies have shown success with...
09/18/2018
First Report Managed Care
Trump Administration Issues Final Rule Expanding Short-term Insurance
09/18/2018
Paul Nicolaus
Consumers will now have the ability to purchase short-term, limited-duration insurance policies for more extended periods of time. Experts weigh in on the potential impact of increased access to less comprehensive plans.
Consumers will now have the ability to purchase short-term, limited-duration insurance policies for more extended periods of time. Experts weigh in on the potential impact of increased access to less comprehensive plans.
Consumers will now have the...
09/18/2018
First Report Managed Care
Payer Roundtable: ICER`s Increasing Influence—And Future Implications
09/18/2018
Dean Celia
A report is coming on drug price increases that are unsupported by evidence. How should stakeholders prepare, and when does it make sense for drugmakers to push back?
A report is coming on drug price increases that are unsupported by evidence. How should stakeholders prepare, and when does it make sense for drugmakers to push back?
A report is coming on drug price...
09/18/2018
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

September 2018 Volume 15 Issue 9

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