First Report Managed Care

Behind the Bill

The Medicare Paradox: How Tariffs Could Undermine IRA Drug Pricing Reforms

In this week’s Behind the Bill, the Trump administration’s Section 232 investigation into pharmaceutical imports risks inflating drug costs and destabilizing Medicare reforms, setting the stage for a high-stakes clash between trade policy and prescription drug affordability.

Formulary Frontlines

Comparative Review of Anticoagulant Coverage Across 3 Major Health Plans

In this report, First Report Managed Care provides a comparative assessment of coverage considerations for anticoagulant therapies across health plans, offering insights to help payers and health care decision makers stay informed and maintain a competitive edge.

Pipeline Projections

Examining Newly FDA-Approved Anticoagulants and Upcoming Drugs in the Approval Pipeline

News

Urban Residents With Arthritis Access More In-Person Care Than Rural Counterparts

04/24/2025

Lisa Kuhns, PhD, MD

Individuals with rheumatoid arthritis (RA) and osteoarthritis (OA) living in rural areas access significantly less in-person health care than those in urban settings, according to a study published in Arthritis Care & Research.

Individuals with rheumatoid...

04/24/2025

First Report Managed Care

News

Continued Immunotherapy Beyond Progression May Extend Survival in Metastatic NSCLC

04/23/2025

Grace Taylor, MS, MA

Study finds extended survival with immunotherapy beyond disease progression for patients with non–small cell lung cancer.

Study finds extended survival...

04/23/2025

First Report Managed Care

News

New siRNA Shows Long-Term Efficacy and Enhanced Safety in Hemophilia A and B

04/21/2025

Grace Taylor, MS, MA

A long-term study reveals that fitusiran effectively rebalances hemostasis while reducing bleeding episodes in patients with hemophilia.

A long-term study reveals that...

04/21/2025

First Report Managed Care

News

Bone Health Screenings Underused in US Hemophilia Centers Despite High Risk

04/17/2025

Grace Taylor, MS, MA

Low screening rates for osteoporosis in people with hemophilia highlight a critical gap in preventative care at US federally funded hemophilia centers.

Low screening rates for...

04/17/2025

First Report Managed Care

News

New Treatment for Vitiligo Offers Long-Term Cost Savings and High Repigmentation Success

04/14/2025

Lisa Kuhns, PhD, MD

A novel treatment for stable vitiligo combining autologous skin cell suspension (ASCS) with phototherapy has demonstrated both clinical success and long-term cost savings when compared to phototherapy alone, according to study results...

A novel treatment for stable...

04/14/2025

First Report Managed Care

News

Fitusiran Shows Sustained Bleed Control and Safety With AT-Guided Dosing in Hemophilia

04/14/2025

Juliet Gallagher

Findings from a phase 2 open-label extension study suggest that fitusiran, a small interfering RNA (siRNA) therapy targeting antithrombin (AT), offers sustained bleeding control and quality of life improvements in people with moderate or...

Findings from a phase 2...

04/14/2025

First Report Managed Care

News

Fixed-Duration Mosunetuzumab Offers Effective and Budget-Friendly Option for Relapsed Follicular Lymphoma

04/14/2025

Lisa Kuhns, PhD, MD

Mosunetuzumab adds a highly effective, fixed-duration treatment option for patients with relapsed or refractory (R/R) follicular lymphoma (FL), with minimal financial impact to payers.

Mosunetuzumab adds a highly...

04/14/2025

First Report Managed Care

News

Expert Panel Calls for Improved Utilization of Biosimilar Anti-TNF-α Therapies in IBD to Enable Earlier, More Effective Treatment

04/11/2025

Hannah Musick

Researchers urge for the broader use of biosimilar anti-TNF-α therapies in irritable bowel disease (IBD) to support earlier, more effective treatment and improve long-term outcomes, emphasizing the need for targeted clinician and patient...

Researchers urge for the broader...

04/11/2025

First Report Managed Care

News

Study Quantifies How Social and Structural Factors Drive Racial Inequities in NSCLC Care

04/11/2025

Lisa Kuhns, PhD, MD

Black patients with non-small cell lung cancer (NSCLC) in the US experience significantly worse care and outcomes compared with White patients, and these disparities are largely explained by exposure to structural racism across the health...

Black patients with non-small...

04/11/2025

First Report Managed Care

News

MUSETTE Trial Confirms Optimal Dosing of Ocrelizumab for Relapsing MS

04/10/2025

Danielle Sposato

In a recent press release, Genentech has announced results from the phase 3 MUSETTE trial (NCT04544436), which evaluated higher doses of intravenous (IV) ocrelizumab (Ocrevus) in patients with relapsing multiple sclerosis (RMS).

In a recent press release,...

04/10/2025

First Report Managed Care

KOL Insights

Interview

Bridging the Gap: Policy, Equity, and Access in Urological Health

04/16/2025

Mica Phillips

Mica Phillips, executive vice president at Aeroflow Urology, discusses how economic, cultural, and systemic barriers limit access to incontinence care for minority populations, emphasizing the need for broader insurance coverage—including...

Mica Phillips, executive vice...

04/16/2025

First Report Managed Care

Commentary

Want to Engage Health Plan Members? First, Build Trust

03/27/2025

Chandra Y. Osborn, PhD, MPH

Trust in health plans is critically low—especially among those in poor health—but by leading with empathy, removing barriers to care, and using data-driven, personalized strategies rooted in behavioral science, plans can rebuild trust,...

Trust in health plans is...

03/27/2025

First Report Managed Care

Commentary

Improving Value-Based Care With Contract Lifecycle Management

03/20/2025

Tom Cowen

Effective value-based contracts require clear definitions, structured data, and automation through contract lifecycle management (CLM) solutions to streamline negotiation, ensure transparency, and adapt to evolving health care policies and...

Effective value-based contracts...

03/20/2025

First Report Managed Care

Commentary

Equitable Health Care in 2025: Experts Share a Vision for Inclusive and Accessible Care

01/23/2025

Experts weigh in on how advancements in AI, smart technology, and innovative care models will drive equitable health care in 2025 by improving access, reducing disparities, and enhancing patient outcomes across underserved populations.

Experts weigh in on how...

01/23/2025

First Report Managed Care

Commentary

How to Maximize the Value of GLP-1 Drugs While Improving Health Equity

01/14/2025

Julie Schulz, MD, MPH; Michael Dovidio, PharmD

GLP-1 drugs present significant financial and health equity challenges, offering transformative benefits for obesity and cardiometabolic disorders while requiring data-driven strategies for cost-effective and equitable access.

GLP-1 drugs present significant...

01/14/2025

First Report Managed Care

Commentary

How Health Systems Can Meet the Expanding Needs of Specialty Pharmacies

01/03/2025

Health systems must adapt to the growing demand for specialty pharmacies by scaling services, embracing technology, and collaborating with experts to improve patient outcomes, reduce administrative burdens, and navigate regulatory challenges.

Health systems must adapt to the...

01/03/2025

First Report Managed Care

Interview

Transforming Drug Development Through Real-World Evidence and Artificial Intelligence

01/03/2025

Jo Varshney, DVM, PhD

In this interview, Dr Jo Varshney, founder and CEO of VeriSIM Life, discusses the complexities of drug development, the role of AI in accelerating discovery, the integration of real-world evidence, and strategies to reduce costs while...

In this interview, Dr Jo...

01/03/2025

First Report Managed Care

Commentary

2024 Trends and 2025 Predictions: Insights From Health Care Leaders on Advancing Medicare, AI Solutions, and Clinical Data Utilization

12/27/2024

In this exclusive commentary for First Report Managed Care, health experts and business leaders explore how advancements in Medicare Advantage, ambient intelligence, generative AI, cybersecurity, risk adjustment, precision oncology, and AI...

In this exclusive commentary for...

12/27/2024

First Report Managed Care

Interview

Nontraditional Players in Health Care Highlight the Need to Balance Quality and Cost-Effectiveness With Convenience and Accessibility

12/03/2024

Lucienne Ide, MD, PhD

In this interview, Dr Lucienne Ide discusses the challenges nontraditional players face in health care, the critical role of trust, and the need for innovative, collaborative solutions to improve access, outcomes, and cost-effectiveness.

In this interview, Dr Lucienne...

12/03/2024

First Report Managed Care

Commentary

Navigating the Decline of Medicare Advantage Star Ratings in 2025: Six Need-to-Knows

11/25/2024

Cindy Henry

The 2025 Medicare Advantage Star Ratings present a new landscape for MA plans, with fewer achieving high ratings due to changes in methodology, utilization patterns, ongoing litigation, and potential impacts of recent election outcomes. Learn...

The 2025 Medicare Advantage Star...

11/25/2024

First Report Managed Care

Issue Features

Interactive Features

Poll

Adapting Medicare Advantage Plans to Star Ratings in 2025

01/10/2025

With Medicare Advantage under increased scrutiny and Star Ratings impacting payments, how do you think plans will adapt in 2025?

With Medicare Advantage under...

01/10/2025

First Report Managed Care

Poll

Lumbar Disc Herniation Treatment Potential

01/07/2025

Do you believe that condoliase has the potential to fill a crucial treatment gap between conservative care and surgical options for patients with lumbar disc herniation?

Do you believe that condoliase...

01/07/2025

First Report Managed Care

Poll

Treatment Timing for HIV Antiretroviral Therapy

12/09/2024

Do you believe that immediate initiation of antiretroviral therapy (ART) following an HIV diagnosis, as opposed to delaying treatment, significantly benefits individuals and communities?

Do you believe that immediate...

12/09/2024

First Report Managed Care

Poll

Opinions on RSV Mutations

07/29/2024

Are you concerned about the impact of RSV mutations on the effectiveness of current therapeutics in preventing the virus from spreading?

Are you concerned about the...

07/29/2024

First Report Managed Care

Quiz

COPD and RSV Infection Incidences

07/23/2024

Hannah Musick

True or False: Patients with chronic obstructive pulmonary disease (COPD) have a lower incidence of RSV infection compared to the general population because treatments for COPD also alleviate the symptoms of RSV.

True or False: Patients with...

07/23/2024

First Report Managed Care

Behind the Bill

The Medicare Paradox: How Tariffs Could Undermine IRA Drug Pricing Reforms

04/23/2025

Katie Hayes, MJ

The Trump administration's recent announcement of national security investigations into pharmaceutical imports has set up a potential collision course with one of the most significant health care reforms in recent years. While the White...

The Trump administration's...

04/23/2025

First Report Managed Care

Behind the Bill

The Bitter Pill, Now in Motion: Pharma Tariffs Move from Rhetoric to Reality

04/16/2025

Katie Hayes, MJ

Last week, I flagged the growing risk that tariffs could upend affordability in the generics market. This week, the Trump administration made it official: it’s launching national security investigations under Section 232 of the Trade...

Last week, I flagged the growing...

04/16/2025

First Report Managed Care

Behind the Bill

The Bitter Pill: How Tariffs Could Make Generics Less Affordable

04/09/2025

Katie Hayes, MJ

As President Donald Trump’s administration introduces a series of tariffs aimed at rebalancing trade and boosting US manufacturing, one sector in particular is watching closely: pharmaceuticals. While drugs themselves may not be directly...

As President Donald Trump’s...

04/09/2025

First Report Managed Care

Behind the Bill

SCOTUS Takes on the Nondelegation Doctrine: Surprising Reactions and What They Mean for Agency Power

04/02/2025

Katie Hayes, MJ

The Supreme Court recently heard arguments in Federal Communication Commission (FCC) v Consumers’ Research, a case that I covered in February and one that could dramatically reshape federal agency authority through the nondelegation...

The Supreme Court recently heard...

04/02/2025

First Report Managed Care

Behind the Bill

Dr Oz’s Prescription for Making Medicaid “Viable at Every Level”

03/26/2025

Katie Hayes, MJ

On Tuesday, March 25, 2025, the Senate Finance Committee voted to advance Dr Mehmet Oz in his confirmation as the next head of the Centers for Medicare and Medicaid Services (CMS).1 The full Senate vote is expected “soon” (whatever that...

On Tuesday, March 25, 2025, the...

03/26/2025

First Report Managed Care

Behind the Bill

The $880 Billion Question Continues: Dr Oz's Confirmation and the Future of Medicaid

03/19/2025

Katie Hayes, MJ

Last week, I explored the $880 billion question facing Congress—whether lawmakers could achieve their budget goals without cutting Medicaid. This week, that question took center stage as Dr Mehmet Oz, President Trump's nominee to lead the...

Last week, I explored the $880...

03/19/2025

First Report Managed Care

Behind the Bill

The $880 Billion Question: Can Congress Cut Spending Without Touching Medicaid?

03/12/2025

Katie Hayes, MJ

I’d like to step away from administrative law for a moment to provide a quick update on Medicaid. With news coming from all sides, what does the future of Medicaid actually look like? The House of Representatives narrowly passed a budget...

I’d like to step away from...

03/12/2025

First Report Managed Care

Behind the Bill

RFK Jr’s Public Comment Ban: The Silent Shift in Health Care Rulemaking

03/05/2025

Katie Hayes, MJ

The erosion of administrative law continues, and with it, the dismantling of decades-long precedent. In June, the Supreme Court overturned a 40-year-old doctrine that allowed federal agencies to interpret their own ambiguous statutes. Later...

The erosion of administrative...

03/05/2025

First Report Managed Care

Behind the Bill

Prevention Over Pills? The First 2 Weeks of Health Care’s New Direction

02/26/2025

Katie Hayes, MJ

The dust has barely settled from Robert F Kennedy Jr’s confirmation as Secretary of Health and Human Services (HHS), but the changes are already coming fast and furious—a key theme of the Trump Administration’s actions within the last several...

The dust has barely settled from...

02/26/2025

First Report Managed Care

Behind the Bill

The Nondelegation Doctrine: The Next Constitutional Showdown (Part 2)

02/19/2025

Katie Hayes, MJ

Last week, I explored the potential revival of the nondelegation doctrine through Federal Communication Commission v Consumers’ Research. Today, I want to examine what this could mean for health care regulation by considering the parallels...

Last week, I explored the...

02/19/2025

First Report Managed Care