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First Report Managed Care

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Featured

Jennifer L. Mathieu Senior Vice President, Professional and Government Affairs at AMCP
Interview
05/15/2024
Jennifer L. Mathieu Senior Vice President, Professional and Government Affairs, AMCP
Learn about developments in federal legislation and regulations within the pharmacy landscape shaping the future of managed care in an interview with a session presenter from AMCP 2024.
Learn about developments in federal legislation and regulations within the pharmacy landscape shaping the future of managed care in an interview with a session presenter from AMCP 2024.
Learn about developments in...
05/15/2024
First Report Managed Care
Conference Coverage
05/01/2024
Danielle Sposato
The specialty pharmacy pipeline was the subject of one of many informative sessions at the annual Asembia Summit this year. Key insights were shared about current drugs in the pipeline according to their drug designations, the phase of each...
The specialty pharmacy pipeline was the subject of one of many informative sessions at the annual Asembia Summit this year. Key insights were shared about current drugs in the pipeline according to their drug designations, the phase of each...
The specialty pharmacy pipeline...
05/01/2024
First Report Managed Care
News
04/25/2024

Grace Taylor

Grace Taylor
A study published in Molecular Therapy Nucleic Acids highlights a treatment strategy for treating hemophilia B by combining rebalancing coagulation pathways and human factor 9 (hF9) gene knock-in (KI) using a lipid nanoparticle and...
A study published in Molecular Therapy Nucleic Acids highlights a treatment strategy for treating hemophilia B by combining rebalancing coagulation pathways and human factor 9 (hF9) gene knock-in (KI) using a lipid nanoparticle and...
A study published in Molecular...
04/25/2024
First Report Managed Care
News
04/24/2024
Hannah Musick
Dr Rhonda Voskuhl received the 2024 John Dystel prize for her groundbreaking research on sex differences in multiple sclerosis (MS), advancing women's health.
Dr Rhonda Voskuhl received the 2024 John Dystel prize for her groundbreaking research on sex differences in multiple sclerosis (MS), advancing women's health.
Dr Rhonda Voskuhl received the...
04/24/2024
First Report Managed Care
News
03/28/2024

Emry Lloyd

Emry Lloyd
Different target-to-treat strategies for polymyalgia rheumatica and giant cell arthritis and how physicians can understand these strategies to suitably treat patients were revealed in a literature review.
Different target-to-treat strategies for polymyalgia rheumatica and giant cell arthritis and how physicians can understand these strategies to suitably treat patients were revealed in a literature review.
Different target-to-treat...
03/28/2024
First Report Managed Care
News
03/28/2024

Emry Lloyd

Emry Lloyd
Patients with recurrent Clostridioides difficile infection have shown significant results when administered a fecal microbiota transplant. This study evaluated the safety and efficacy of using a fecal microbiota transplant for patients with...
Patients with recurrent Clostridioides difficile infection have shown significant results when administered a fecal microbiota transplant. This study evaluated the safety and efficacy of using a fecal microbiota transplant for patients with...
Patients with recurrent...
03/28/2024
First Report Managed Care
News
03/26/2024

By Emry Lloyd

By Emry Lloyd
Clostridioides difficile is a bacterium that causes gastrointestinal issues in patients. This article describes how physicians can understand Clostridioides difficile and its makeup to determine how to treat or manage infection.
Clostridioides difficile is a bacterium that causes gastrointestinal issues in patients. This article describes how physicians can understand Clostridioides difficile and its makeup to determine how to treat or manage infection.
Clostridioides difficile is a...
03/26/2024
First Report Managed Care
News
03/05/2024
Hannah Musick
The Justice Department is investigating UnitedHealth’s ownership of the largest US health care insurer and its relationship with doctor groups and drug benefits amid concerns of potential antitrust violations.
The Justice Department is investigating UnitedHealth’s ownership of the largest US health care insurer and its relationship with doctor groups and drug benefits amid concerns of potential antitrust violations.
The Justice Department is...
03/05/2024
First Report Managed Care
News
03/04/2024

Emry Lloyd

Emry Lloyd
Every year, millions of necessary medical service claims are denied by health care providers; policymakers want to balance these denials for those who need care and how this affects patients with diabetic macular edema.
Every year, millions of necessary medical service claims are denied by health care providers; policymakers want to balance these denials for those who need care and how this affects patients with diabetic macular edema.
Every year, millions of...
03/04/2024
First Report Managed Care
Shomali Podcast
Podcasts
02/27/2024

Featuring Mansur Shomali, MD, chief medical officer at Welldoc, endocrinologist at MedStar Health 

Featuring Mansur Shomali, MD, chief m...
Discover how digital therapeutics are revolutionizing disease management, patient care, reducing health care costs, and more with Dr Mansur Shomali, CMO at Welldoc.
Discover how digital therapeutics are revolutionizing disease management, patient care, reducing health care costs, and more with Dr Mansur Shomali, CMO at Welldoc.
Discover how digital...
02/27/2024
First Report Managed Care
News
02/09/2024

Emry Lloyd

Emry Lloyd
A new study compares the efficacy of salbutamol administration via a nebulizer vs a metered-dose inhaler with a spacer for bronchodilator responsiveness testing.
A new study compares the efficacy of salbutamol administration via a nebulizer vs a metered-dose inhaler with a spacer for bronchodilator responsiveness testing.
A new study compares the...
02/09/2024
First Report Managed Care

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Commentary

Anne Headshot
Commentary
05/06/2024
Anne Dabrow Woods, DNP, RN, CRNP, ANP-BC, AGACNP-BC, FAAN
It's no secret that nursing is in a state of crisis. From the onset of the COVID-19 pandemic to now, nurses nationwide have increasingly battled rising burnout and stress–all while caring for higher-acuity patients, with less support. Anne...
It's no secret that nursing is in a state of crisis. From the onset of the COVID-19 pandemic to now, nurses nationwide have increasingly battled rising burnout and stress–all while caring for higher-acuity patients, with less support. Anne...
It's no secret that nursing is...
05/06/2024
First Report Managed Care
Headshots
Commentary
04/09/2024

Britteny Matero, partner and senior vice president, Market Access, Innsena, and Jaime Bland, DNP, RN, president and chief executive officer, CyncHealth

Britteny Matero, partner and senior v...
The US faces a critical maternal health crisis, with high maternal mortality rates exacerbated by COVID-19 and racial disparities. Institutional changes are needed to prevent these largely preventable deaths, and two experts highlight...
The US faces a critical maternal health crisis, with high maternal mortality rates exacerbated by COVID-19 and racial disparities. Institutional changes are needed to prevent these largely preventable deaths, and two experts highlight...
The US faces a critical maternal...
04/09/2024
First Report Managed Care
Shannon Smith Headshot
Commentary
04/02/2024

Shannon Smith, RN, BSN

Shannon Smith, RN, BSN
As the health care industry prepares for the Centers for Medicare & Medicaid Services (CMS) to implement new guidelines to streamline prior authorization procedures, significant operational changes are on the horizon for health care payers....
As the health care industry prepares for the Centers for Medicare & Medicaid Services (CMS) to implement new guidelines to streamline prior authorization procedures, significant operational changes are on the horizon for health care payers....
As the health care industry...
04/02/2024
First Report Managed Care
Julie Schulz headshot
Commentary
03/27/2024

By Julie Schulz, MD, MPH

By Julie Schulz, MD, MPH
Chronic kidney disease (CKD) is an insidious condition with devastating consequences when detected and treated too late. While primary care physicians usually make the initial diagnosis, regular screening is not routine for the general...
Chronic kidney disease (CKD) is an insidious condition with devastating consequences when detected and treated too late. While primary care physicians usually make the initial diagnosis, regular screening is not routine for the general...
Chronic kidney disease (CKD) is...
03/27/2024
First Report Managed Care
Kevin/Avikar Hedshots
Commentary
03/20/2024

Kevin Riley, CEO, President, Zyter|TruCare; Avikar Govil, Insights Health Product Manager, Zyter|TruCare

Kevin Riley, CEO, President, Zyter|Tr...
The rapid evolution of Generative Artificial Intelligence (Gen AI) is fundamentally transforming the health care industry, ushering in an era of increased personalization, efficiency, and improved patient outcomes. In this commentary, experts...
The rapid evolution of Generative Artificial Intelligence (Gen AI) is fundamentally transforming the health care industry, ushering in an era of increased personalization, efficiency, and improved patient outcomes. In this commentary, experts...
The rapid evolution of...
03/20/2024
First Report Managed Care
James Wallace Headshot
Commentary
03/08/2024

James Wallace, CEO of DecisionRx

James Wallace, CEO of DecisionRx ...
Medication adherence poses a significant challenge in health care, with far-reaching consequences for patients and the health care system. It is a complex issue influenced by various factors, including undesirable side effects, lack of...
Medication adherence poses a significant challenge in health care, with far-reaching consequences for patients and the health care system. It is a complex issue influenced by various factors, including undesirable side effects, lack of...
Medication adherence poses a...
03/08/2024
First Report Managed Care
Commentary
03/01/2024

Amit Gupta, MD, Medical Director, Clinical Strategy at Sagility

Amit Gupta, MD, Medical Director, Cli...
Utilization management is evolving from a cost-centric process to a focus on quality of care, with trends including exception-based authorization handling and value-based arrangements to reduce administrative burden and provider abrasion.
Utilization management is evolving from a cost-centric process to a focus on quality of care, with trends including exception-based authorization handling and value-based arrangements to reduce administrative burden and provider abrasion.
Utilization management is...
03/01/2024
First Report Managed Care
Commentary
03/01/2024

Michael Gould, AVP, Interoperability Strategy at ZeOmega

Michael Gould, AVP, Interoperability ...
CMS has published the Interoperability and Prior Authorization final rule to drive transformative outcomes in the health care ecosystem, requiring payers and providers to adopt new standards and FHIR APIs to reduce inefficiencies and improve...
CMS has published the Interoperability and Prior Authorization final rule to drive transformative outcomes in the health care ecosystem, requiring payers and providers to adopt new standards and FHIR APIs to reduce inefficiencies and improve...
CMS has published the...
03/01/2024
First Report Managed Care
Alex Sommer
Commentary
02/14/2024

Alex Sommer, vice president, State Government Affairs, Avalon Healthcare Solutions

Alex Sommer, vice president, State Go...
Biomarker bills are merely the latest in what is likely to be a wave of legislation mandating coverage of new tests and therapies that are part of the growth in precision medicine. This will make it increasingly difficult for plans to control...
Biomarker bills are merely the latest in what is likely to be a wave of legislation mandating coverage of new tests and therapies that are part of the growth in precision medicine. This will make it increasingly difficult for plans to control...
Biomarker bills are merely the...
02/14/2024
First Report Managed Care
Christie Headshot
Commentary
02/13/2024

Christie Teigland, PhD, VP of Research Science and Advanced Analytics, Inovalon

Christie Teigland, PhD, VP of Researc...
As part of the 2024 Medicare Advantage (MA) and Part D Final Rule, CMS is enhancing the Star Ratings program by implementing a Health Equity Index (HEI) reward to incentivize MA and Part D contracts with 500 or more members to address...
As part of the 2024 Medicare Advantage (MA) and Part D Final Rule, CMS is enhancing the Star Ratings program by implementing a Health Equity Index (HEI) reward to incentivize MA and Part D contracts with 500 or more members to address...
As part of the 2024 Medicare...
02/13/2024
First Report Managed Care

Interviews

Jennifer L. Mathieu Senior Vice President, Professional and Government Affairs at AMCP
Interview
05/15/2024
Jennifer L. Mathieu Senior Vice President, Professional and Government Affairs, AMCP
Learn about developments in federal legislation and regulations within the pharmacy landscape shaping the future of managed care in an interview with a session presenter from AMCP 2024.
Learn about developments in federal legislation and regulations within the pharmacy landscape shaping the future of managed care in an interview with a session presenter from AMCP 2024.
Learn about developments in...
05/15/2024
First Report Managed Care
Jay Ackerman Headshot
Interview
05/07/2024
Jay Ackerman, President & CEO, Reveleer
Artificial intelligence (AI)-powered workflows and prospective analytics are advancing value-based care by improving patient outcomes and reducing costs. In a recent interview, an expert emphasizes that leveraging AI technologies enables...
Artificial intelligence (AI)-powered workflows and prospective analytics are advancing value-based care by improving patient outcomes and reducing costs. In a recent interview, an expert emphasizes that leveraging AI technologies enables...
Artificial intelligence...
05/07/2024
First Report Managed Care
Gary Jessee
Interview
04/04/2024

Featuring Gary Jessee, senior vice president at Sellers Dorsey  

Featuring Gary Jessee, senior vice pr...
Learn about how states are grappling with finding the balance between expanding and optimizing MLTSS programs while navigating recent health care reforms and tightening budget constraints in this recent interview with guest expert Gary...
Learn about how states are grappling with finding the balance between expanding and optimizing MLTSS programs while navigating recent health care reforms and tightening budget constraints in this recent interview with guest expert Gary...
Learn about how states are...
04/04/2024
First Report Managed Care
Dr Brian Covino
Interview
03/05/2024

Featuring Brian Covino, MD, CMO, Cohere Health

Featuring Brian Covino, MD, CMO, Cohe...
There are several barriers to adopting electronic prior authorization in health care. With financial incentives and standardized processes, there is still room for improvement. An expert introduces the concept of green lighting, a data-driven...
There are several barriers to adopting electronic prior authorization in health care. With financial incentives and standardized processes, there is still room for improvement. An expert introduces the concept of green lighting, a data-driven...
There are several barriers to...
03/05/2024
First Report Managed Care
John Fryer
Interview
03/04/2024

Featuring John Fryer, chief revenue officer at Lumeris 

Featuring John Fryer, chief revenue o...
Learn about the benefits, challenges, and measurement of effective value-based care programs, emphasizing the role of artificial intelligence in driving improved patient outcomes and cost reduction in this interview with John Fryer, CRO at...
Learn about the benefits, challenges, and measurement of effective value-based care programs, emphasizing the role of artificial intelligence in driving improved patient outcomes and cost reduction in this interview with John Fryer, CRO at...
Learn about the benefits,...
03/04/2024
First Report Managed Care
Steve Vacarro
Interview
02/29/2024

Featuring Stephen Vaccaro, president, HHAeXchange

Featuring Stephen Vaccaro, president,...
In this interview, an expert discusses the importance of Electronic Visit Verification (EVV) in homecare services. EVV ensures accurate documentation of homecare visits, leading to improved patient outcomes and quality of care. Medicaid has a...
In this interview, an expert discusses the importance of Electronic Visit Verification (EVV) in homecare services. EVV ensures accurate documentation of homecare visits, leading to improved patient outcomes and quality of care. Medicaid has a...
In this interview, an expert...
02/29/2024
First Report Managed Care
Interview
01/24/2024

Featuring Faris Ghawi, co-founder and CEO, Vytalize Health

Featuring Faris Ghawi, co-founder and...
Vytalize Health, as an ACO REACH entity, assumes full risk for the cost and quality of care, sharing upside incentives with primary and nonprimary care providers based on predefined metrics. Faris Ghawi offers insights into how ACOs like...
Vytalize Health, as an ACO REACH entity, assumes full risk for the cost and quality of care, sharing upside incentives with primary and nonprimary care providers based on predefined metrics. Faris Ghawi offers insights into how ACOs like...
Vytalize Health, as an ACO REACH...
01/24/2024
First Report Managed Care
Lucienne Ide
Interview
01/24/2024

Featuring Lucienne Ide, MD, PhD, founder and CEO of Rimidi  

Featuring Lucienne Ide, MD, PhD, foun...
Rimidi has partnered with the Brighter Day Health Foundation to bring chronic disease management to underserved populations through church-based wellness clinics, providing remote patient monitoring supported by Medicare reimbursement and...
Rimidi has partnered with the Brighter Day Health Foundation to bring chronic disease management to underserved populations through church-based wellness clinics, providing remote patient monitoring supported by Medicare reimbursement and...
Rimidi has partnered with the...
01/24/2024
First Report Managed Care
Jason Bush
Interview
01/19/2024

Featuring Jason Bush, PhD, executive vice president of product at Avalon Healthcare Solutions 

Featuring Jason Bush, PhD, executive ...
The rapid growth of genetic testing, the challenges it presents for the rare disease community, clinicians, and payers, and the impact on coding practices are explored with Jason Bush, executive vice president of product at Avalon Healthcare...
The rapid growth of genetic testing, the challenges it presents for the rare disease community, clinicians, and payers, and the impact on coding practices are explored with Jason Bush, executive vice president of product at Avalon Healthcare...
The rapid growth of genetic...
01/19/2024
First Report Managed Care
Cindy Gaines Headshot
Interview
01/19/2024

Featuring Cindy Gaines, MSN, RN, chief clinical transformation officer at Lumeon

Featuring Cindy Gaines, MSN, RN, chie...
The health care industry increasingly focuses on hospital-at-home and alternative care models due to bed shortages and staffing issues. Hospital-at-home care, existing since 1995, gained recent attention as organizations struggle with patient...
The health care industry increasingly focuses on hospital-at-home and alternative care models due to bed shortages and staffing issues. Hospital-at-home care, existing since 1995, gained recent attention as organizations struggle with patient...
The health care industry...
01/19/2024
First Report Managed Care

Podcasts

Owens
Podcasts
03/28/2024

Featuring Gary Owens, MD, president of Gary Owens Associates

Featuring Gary Owens, MD, president o...
Join us as guest expert Gary Owens discusses how formulary exclusions can impact patient medication adherence and lead to adverse economic outcomes, making the need for non-medical switching and formulary exception requests an important issue...
Join us as guest expert Gary Owens discusses how formulary exclusions can impact patient medication adherence and lead to adverse economic outcomes, making the need for non-medical switching and formulary exception requests an important issue...
Join us as guest expert Gary...
03/28/2024
First Report Managed Care
Prajapati Podcast
Podcasts
02/27/2024

Featuring Yash Prajapati, consultant at ZS Associates 

Featuring Yash Prajapati, consultant ...
Join us in exploring the challenges and opportunities in the development, approval, and integration of digital therapeutic solutions with ZS Associates Consultant Yash Prajapati.
Join us in exploring the challenges and opportunities in the development, approval, and integration of digital therapeutic solutions with ZS Associates Consultant Yash Prajapati.
Join us in exploring the...
02/27/2024
First Report Managed Care
Shomali Podcast
Podcasts
02/27/2024

Featuring Mansur Shomali, MD, chief medical officer at Welldoc, endocrinologist at MedStar Health 

Featuring Mansur Shomali, MD, chief m...
Discover how digital therapeutics are revolutionizing disease management, patient care, reducing health care costs, and more with Dr Mansur Shomali, CMO at Welldoc.
Discover how digital therapeutics are revolutionizing disease management, patient care, reducing health care costs, and more with Dr Mansur Shomali, CMO at Welldoc.
Discover how digital...
02/27/2024
First Report Managed Care
Larry Hsu Headshot
Podcasts
01/11/2024

Featuring Larry Hsu, MD, medical director at HMSA

Featuring Larry Hsu, MD, medical dire...
A doctor and expert in value-based care offers insights into treatment costs and treatment regimens for patients with polymyalgia rheumatica.
A doctor and expert in value-based care offers insights into treatment costs and treatment regimens for patients with polymyalgia rheumatica.
A doctor and expert in...
01/11/2024
First Report Managed Care
alpesh amin
Podcasts
10/23/2023

Featuring Alpesh Amin, MD, MBA 

Featuring Alpesh Amin, MD, MBA  ...
Alpesh Amin, MD, MBA , professor and chair, University of California, discusses the results of a recent study, and explains why better treatments to reduce primary C difficile infection and recurrences in older adults can lower the mortality...
Alpesh Amin, MD, MBA , professor and chair, University of California, discusses the results of a recent study, and explains why better treatments to reduce primary C difficile infection and recurrences in older adults can lower the mortality...
Alpesh Amin, MD, MBA , professor...
10/23/2023
First Report Managed Care

Department

IPF letters
Formulary Frontlines®
05/13/2024

Reviewed by Elizabeth Volkmann, MD, MS

Reviewed by Elizabeth Volkmann, MD, M...
IPF is a chronic, progressive interstitial lung disease that presents a significant burden to ~3 million patients worldwide. Despite ongoing challenges with IPF diagnosis and management, new therapies in development are showing promise.
IPF is a chronic, progressive interstitial lung disease that presents a significant burden to ~3 million patients worldwide. Despite ongoing challenges with IPF diagnosis and management, new therapies in development are showing promise.
IPF is a chronic, progressive...
05/13/2024
First Report Managed Care
Managed Care Q&A
03/01/2024

Featuring John Stahl, Senior Director, Consulting at Clarivate and Matthew Arnold, Principal Analyst at Clarivate

Featuring John Stahl, Senior Director...
Experts from Clarivate discuss the evolving pharmaceutical landscape in 2024, emphasizing the need for payers to balance supporting innovative breakthrough medicines with containing health care costs.
Experts from Clarivate discuss the evolving pharmaceutical landscape in 2024, emphasizing the need for payers to balance supporting innovative breakthrough medicines with containing health care costs.
Experts from Clarivate discuss...
03/01/2024
First Report Managed Care
Conference Insider
12/07/2023
A roundup of news and research presented at AMCP Nexus in Orlando, FL, October 16-19, 2023.
A roundup of news and research presented at AMCP Nexus in Orlando, FL, October 16-19, 2023.
A roundup of news and research...
12/07/2023
First Report Managed Care
Formulary Frontlines®
06/20/2023
Julie Gould
Bladder cancer was the sixth most common cancer type in the United States in 2020, behind breast, lung, prostate, colon, and skin cancers.
Bladder cancer was the sixth most common cancer type in the United States in 2020, behind breast, lung, prostate, colon, and skin cancers.
Bladder cancer was the sixth...
06/20/2023
First Report Managed Care
Conference Insider
06/20/2023
The Academy of Managed Care Pharmacy occurred March 21-24, 2023 in San Antonio, Texas.
The Academy of Managed Care Pharmacy occurred March 21-24, 2023 in San Antonio, Texas.
The Academy of Managed Care...
06/20/2023
First Report Managed Care

Columns

Surgical Pearls
10/18/2022
Riya Gandhi, MA, Associate Editor
In this interview, Loren D. Krueger, MD, met with The Dermatologist to discuss the benefits and risks of surgical treatments for patients with vitiligo based on a recent systematic review and meta-analysis.
In this interview, Loren D. Krueger, MD, met with The Dermatologist to discuss the benefits and risks of surgical treatments for patients with vitiligo based on a recent systematic review and meta-analysis.
In this interview, Loren D....
10/18/2022
The Dermatologist
Viewpoint
06/06/2022
Edmund J Pezalla, MD
Edmund J Pezalla, MD, founder and CEO of Enlightenment Bioconsult, Hartford, CT provides insight on rare disease drug policy noting volume and indication-based contracts as potential solutions for managing costs of therapies.
Edmund J Pezalla, MD, founder and CEO of Enlightenment Bioconsult, Hartford, CT provides insight on rare disease drug policy noting volume and indication-based contracts as potential solutions for managing costs of therapies.
Edmund J Pezalla, MD, founder...
06/06/2022
First Report Managed Care
Viewpoint
05/28/2021

Chris Hobson, MD, Chief Medical Officer at Orion Health

Chris Hobson, MD, Chief Medical Offic...
"COVID-19 and political uncertainty placed immense pressure across the entirety of the health care industry as organizations were tasked with balancing an already overloaded system with limited resources and shifting priorities to respond...
"COVID-19 and political uncertainty placed immense pressure across the entirety of the health care industry as organizations were tasked with balancing an already overloaded system with limited resources and shifting priorities to respond...
"COVID-19 and political...
05/28/2021
First Report Managed Care
Viewpoint
04/12/2021

Vasilios Nassiopoulos, Vice President of Platform Strategy and Innovation, Hayes

Vasilios Nassiopoulos, Vice President...
Holistic approaches to revenue integrity ensure that all billing and compliance functions are working collaboratively to address all sides of a claim.
Holistic approaches to revenue integrity ensure that all billing and compliance functions are working collaboratively to address all sides of a claim.
Holistic approaches to revenue...
04/12/2021
First Report Managed Care
Viewpoint
08/31/2020

Jessica Schiller, RN, BSN, MAS, Director of Clinical Programs at Wellframe

Jessica Schiller, RN, BSN, MAS, Direc...
Social determinants of health (SDoH) reflect a wide variety of factors, including where people live, their education level, their occupation, and their ability to access support networks.
Social determinants of health (SDoH) reflect a wide variety of factors, including where people live, their education level, their occupation, and their ability to access support networks.
Social determinants of health...
08/31/2020
First Report Managed Care

Features

Cover Story
03/01/2024
Mary Beth Nierengarten
In 2022, Medicare Advantage plans covered 50% of Medicare enrollees, costing the federal government $403 billion, while 81% of Medicaid enrollees received care through managed care for $254 billion. The Health and Human Services Office of...
In 2022, Medicare Advantage plans covered 50% of Medicare enrollees, costing the federal government $403 billion, while 81% of Medicaid enrollees received care through managed care for $254 billion. The Health and Human Services Office of...
In 2022, Medicare Advantage...
03/01/2024
First Report Managed Care
Feature Story
03/01/2024
Paul Nicolaus
PwC's Health Research Institute surveyed health plan actuaries covering nearly 100 million employer-sponsored and 10 million Affordable Care Act marketplace members to project medical cost trends for 2023-2024, highlighting factors like...
PwC's Health Research Institute surveyed health plan actuaries covering nearly 100 million employer-sponsored and 10 million Affordable Care Act marketplace members to project medical cost trends for 2023-2024, highlighting factors like...
PwC's Health Research Institute...
03/01/2024
First Report Managed Care
Sponsored
02/28/2024
On behalf of Teva Pharmaceuticals, we are pleased to present The Teva Biosimilars Trend Report, Vol. I. This report examines current developments in the rapidly evolving biosimilars market from the perspective of managed care professionals,...
On behalf of Teva Pharmaceuticals, we are pleased to present The Teva Biosimilars Trend Report, Vol. I. This report examines current developments in the rapidly evolving biosimilars market from the perspective of managed care professionals,...
On behalf of Teva...
02/28/2024
First Report Managed Care
Cover Story
12/07/2023
Mary Beth Nierengarten
Ignoring the appropriate use of drugs is equally harmful when negotiating with PBMs, as it can and does result in the wrong drugs getting on a formulary with the obvious downstream effect on patient care, costs, and outcomes.
Ignoring the appropriate use of drugs is equally harmful when negotiating with PBMs, as it can and does result in the wrong drugs getting on a formulary with the obvious downstream effect on patient care, costs, and outcomes.
Ignoring the appropriate use of...
12/07/2023
First Report Managed Care
Feature Story
12/07/2023
Paul Nicolaus
The COVID-19 pandemic and policies initiated in response to it have altered the landscape of health insurance coverage, and recent projections indicate that there could be another significant shift taking place as these temporary policies...
The COVID-19 pandemic and policies initiated in response to it have altered the landscape of health insurance coverage, and recent projections indicate that there could be another significant shift taking place as these temporary policies...
The COVID-19 pandemic and...
12/07/2023
First Report Managed Care

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