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News
Optum Rx Eases Access by Dropping Reauthorization for Key Drugs
07/03/2025
Grace Taylor, MS, MA
Optum Rx has eliminated reauthorization requirements for over 140 medications, aiming to reduce care delays and improve access for patients with chronic conditions.
Optum Rx has eliminated reauthorization requirements for over 140 medications, aiming to reduce care delays and improve access for patients with chronic conditions.
Optum Rx has eliminated...
07/03/2025
First Report Managed Care
News
HHS, CMS, and Major Insurers Unite to Announce Voluntary Prior Authorization Reform Pledge
06/23/2025
Hannah Musick
At a landmark press conference, the US Department of Health and Human Services announced that top health officials and major insurers—representing 75% of insured Americans—have signed a voluntary pledge to overhaul the prior authorization...
At a landmark press conference, the US Department of Health and Human Services announced that top health officials and major insurers—representing 75% of insured Americans—have signed a voluntary pledge to overhaul the prior authorization...
At a landmark press conference,...
06/23/2025
First Report Managed Care
News
CVS Health’s Aetna and Blue Cross Blue Shield Among Insurers Pledging to Reform Criticized Prior Authorization Process
06/23/2025
Hannah Musick
Major insurers have pledged to streamline the prior authorization process by 2027, aiming to reduce care delays and administrative burdens while facing ongoing scrutiny from clinicians and patients.
Major insurers have pledged to streamline the prior authorization process by 2027, aiming to reduce care delays and administrative burdens while facing ongoing scrutiny from clinicians and patients.
Major insurers have pledged to...
06/23/2025
First Report Managed Care
News
North Dakota Enacts Prior Authorization Law to Curb Health Coverage Delays
04/28/2025
Grace Taylor, MS, MA
North Dakota has enacted a new law to streamline the prior authorization process and prevent delays in patient care.
North Dakota has enacted a new law to streamline the prior authorization process and prevent delays in patient care.
North Dakota has enacted a new...
04/28/2025
First Report Managed Care
News
Increased Scrutiny of Prior Authorization: Are Payers Fully to Blame, and Can AI Improve the Process?
04/05/2024
Dean Celia
The increased scrutiny of prior authorization, highlighted by media reports and government actions, prompts debate over payer responsibility while exploring the potential for AI to enhance the process.
The increased scrutiny of prior authorization, highlighted by media reports and government actions, prompts debate over payer responsibility while exploring the potential for AI to enhance the process.
The increased scrutiny of prior...
04/05/2024
First Report Managed Care
News
Impact of Patient Cost Sharing on Specialty Drug Utilization, Prior Authorization
05/26/2023
Julie Gould
“Higher levels of patient cost sharing reduce specialty drug use by increasing medication abandonment while generally decreasing initiation and persistence," researchers said.
“Higher levels of patient cost sharing reduce specialty drug use by increasing medication abandonment while generally decreasing initiation and persistence," researchers said.
“Higher levels of patient cost...
05/26/2023
First Report Managed Care
News
ICER Report: Price Transparency, Prior Authorization Process Need Improvements
01/17/2023
Maria Asimopoulos
In addition to illuminating ongoing barriers, the report showed payers’ drug coverage policies largely were aligned with fair access criteria.
In addition to illuminating ongoing barriers, the report showed payers’ drug coverage policies largely were aligned with fair access criteria.
In addition to illuminating...
01/17/2023
First Report Managed Care

Behind the Bill

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
BEHIND THE BILL
When Agencies Lose Power: How 3 Seismic Shifts are Transforming Pharmaceutical Regulation
05/07/2025
Katie Hayes, MJ
In the span of just 9 months, the landscape of administrative law has undergone a transformation so profound that pharmaceutical executives, health care providers, and patients alike are struggling to navigate the new terrain. The Supreme...
In the span of just 9 months, the landscape of administrative law has undergone a transformation so profound that pharmaceutical executives, health care providers, and patients alike are struggling to navigate the new terrain. The Supreme...
In the span of just 9 months,...
05/07/2025
First Report Managed Care
Behind the Bill
The Medicare Paradox, Part 3: Strategic Trade Doesn’t Have to be a Zero-Sum Game
05/07/2025
Katie Hayes, MJ
Over the past 2 weeks, I’ve examined the growing friction between the Section 232 pharmaceutical tariff investigations and the Medicare drug pricing reforms authorized by the Inflation Reduction Act (IRA). These 2 policy agendas—industrial...
Over the past 2 weeks, I’ve examined the growing friction between the Section 232 pharmaceutical tariff investigations and the Medicare drug pricing reforms authorized by the Inflation Reduction Act (IRA). These 2 policy agendas—industrial...
Over the past 2 weeks, I’ve...
05/07/2025
First Report Managed Care

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Trending Articles

News
Achieving Disease Control in PsA, AS Associated with Lower Medical Costs
09/15/2023
Jolynn Tumolo
A study published in Rheumatology and Therapy found that individuals diagnosed with psoriatic arthritis (PsA) or ankylosing spondylitis (AS) and exhibiting lower levels of disease activity incurred reduced healthcare resource utilization and...
A study published in Rheumatology and Therapy found that individuals diagnosed with psoriatic arthritis (PsA) or ankylosing spondylitis (AS) and exhibiting lower levels of disease activity incurred reduced healthcare resource utilization and...
A study published in...
09/15/2023
First Report Managed Care
News
Growth of Digital Therapeutics Requires Collaboration Among Key Players
10/06/2023
Jolynn Tumolo
The rapidly expanding field of digital therapeutics would likely benefit from international collaboration among manufacturers, government regulatory agencies, and researchers, according to a study published in NPJ Digital Medicine.
The rapidly expanding field of digital therapeutics would likely benefit from international collaboration among manufacturers, government regulatory agencies, and researchers, according to a study published in NPJ Digital Medicine.
The rapidly expanding field of...
10/06/2023
First Report Managed Care
News
Aflibercept May Improve Anatomic Progression in Nonproliferative Diabetic Retinopathy, But Not Visual Acuity
10/26/2023
Hannah Musick
“Aflibercept as a preventive strategy, as used in this trial, may not be generally warranted for patients with NPDR without CI-DME,” said researchers.
“Aflibercept as a preventive strategy, as used in this trial, may not be generally warranted for patients with NPDR without CI-DME,” said researchers.
“Aflibercept as a preventive...
10/26/2023
First Report Managed Care
Commentary
Why Better Lab Management Is Key to Value-Based Care
11/16/2023
Benion S. Horton, MD, MHA; Michael G. Lemieux, PhD
The health care community needs another tool to support its efforts to improve care while still managing testing use and costs. Lab benefit managers (LBMs) can provide the expertise to ensure the right tests are ordered at the right times to...
The health care community needs another tool to support its efforts to improve care while still managing testing use and costs. Lab benefit managers (LBMs) can provide the expertise to ensure the right tests are ordered at the right times to...
The health care community needs...
11/16/2023
First Report Managed Care
News
Targeted Medicine and Biological Therapies Fighting Type 2 Inflammation in Patients With Asthma
12/20/2023
Emry Lloyd
In a recent review, Imran Howell, University of Oxford, UK, and colleagues sought to understand the impact of biological therapies and targeted medicines for type 2 inflammation in patients with asthma.
In a recent review, Imran Howell, University of Oxford, UK, and colleagues sought to understand the impact of biological therapies and targeted medicines for type 2 inflammation in patients with asthma.
In a recent review, Imran...
12/20/2023
First Report Managed Care

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