Keep up with our comprehensive coverage of administrative and legislative activity and what it means for industry, plans, providers, and patients.
Pending ASP Changes Impact Payments & May Shape Future FDA Filings
Beginning July 1, 2021, average sales price (ASP) calculations for Part B drugs with an additional non-covered self-administered formulation could alter Medicare reimbursement.
2021 State Drug Pricing Legislation: The Evolution Beyond Transparency
The majority of state legislatures are currently in session, and many states are taking steps to address prescription drug spending and prices through a range of legislative proposals. While states have historically focused on price transparency, state policymakers are now moving beyond those measures to more directly control prescription drug prices through reference pricing, affordability review boards setting upper payment limits, and other price control mechanisms.
Majority of Part D Spending Is on Brand Drugs in Classes with Generics
With Congress likely to consider a second reconciliation bill in the near future that may include various drug-pricing and Medicare Part D reform policies as spending offsets, an updated Avalere analysis examines spending across classes with various availability of brand and generic drugs.
Three Considerations for 2021 Drug Pricing Reform Outlook
A second reconciliation package could include significant drug pricing reforms as a means to pay for permanent coverage expansion and other top priorities.
Generic Drug Placement on Part D Generic Tiers Declines Again in 2021
A new analysis from Avalere finds that in 2021, Medicare Part D plans place generic prescription drugs on generic tiers 45% of the time, a decrease from 64% in 2016.
MFN Model Would Have Had a Major Impact on Certain Providers
New Avalere analysis finds that the the Most Favored Nation (MFN) Model would have a significant negative impact on Medicare providers that furnish Part B drugs—especially in oncology and rheumatology—and those in rural areas.
Podcast: Most Favored Nation Model Stakeholder Considerations
Tune into another episode of Start Your Day with Avalere. In this segment, experts from Avalere’s Policy practice discuss the Most Favored Nation (MFN) drug pricing model, how it works, and the implications for stakeholders.
Most Favored Nation Rule’s Impact on Medicare Beneficiaries OOP Costs
New Avalere analysis finds that most Medicare fee-for-service (FFS) beneficiaries would not see a substantial reduction in their out-of-pocket (OOP) costs as a result of the Most Favored Nation (MFN) model.
Avalere Statement on Trump Administration Drug Pricing Reforms
Earlier today, the Trump Administration released long-anticipated drug pricing reforms, including rules related to a Most Favored Nation (MFN) approach for drugs administered by providers in Medicare and rebate reform for the Medicare Part D program. Both rules represent fundamental shifts in our current system and have significant implications for manufacturers, health plans, pharmacies, providers, and patients.
Video: 2020 Election with Avalere: What Are the Drug Pricing Policies?
Tune into our third episode of the Avalere Health Essential Voice: 2020 Election series. In this segment, our experts discuss candidates’ respective approaches to drug pricing policies, and where there is unexpected overlap.
Podcast: 2020 Election with Avalere: What Are the Drug Pricing Policies?
Tune into our third episode of the Avalere Health Essential Voice: 2020 Election series. In this segment, our experts discuss candidates’ respective approaches to drug pricing policies and where there is unexpected overlap.
“Most Favored Nation” EO Creates New Questions on International Prices
On September 13, the Trump Administration released the much-anticipated “Most Favored Nation” (MFN) Executive Order (EO), calling for models that would cap the price Medicare pays for select Part B and D drugs. The President’s EO underscores the administration’s continued focus on reducing prescription drug price disparities between the US and other developed countries.
EOs Direct Drug Pricing Action, Raise Additional Questions
The administration’s 4 drug pricing EOs direct agency action across a host of policy areas, including Part D rebates, Part B reimbursement and pricing, 340B drug discounts, and drug importation. Next steps and a timeline for agency action will vary by EO dependent on the specific policies to be advanced or finalized. In the interim, stakeholders should explore outstanding questions and contemplate near- and longer-term policy scenarios.
Avalere Statement on Prescription Drug Pricing Executive Orders
On July 24, the administration released 3 executive orders (EO) and announced the planned publication of a fourth EO, all focused on prescription drug pricing. The EOs reflect a combination of familiar policy goals (e.g., rebate reform, importation, international pricing) and a new 340B initiative, and in combination could have substantial implications for healthcare stakeholders and pharmaceutical markets if implemented.
Podcast: E4 – Specialty Pharmacy Stakeholder Perspectives: COVID-19 Business Impacts
In the fourth episode of the Specialty Pharmacy Stakeholder Perspectives podcast series, Avalere is joined by Adam Hanauer, Associate Vice President at Humana Specialty Pharmacy, and Mark Sasala, Principal Business Analyst of Products at Creehan & Company, to discuss the outlook of specialty pharmacy with a focus on the environmental considerations and potential impacts of COVID-19.
Follow the Pill: Understanding the Prescription Drug Supply Chain
Prescription drugs are dispensed to patients through a complex supply chain that involves a broad array of entities, contract arrangements, and payments. The following diagram outlines how a typical prescription drug may flow through the drug supply chain.
Podcast: E3 – Specialty Pharmacy Stakeholder Perspectives: Provider Outlook & Market Access
In the third episode of the Specialty Pharmacy Stakeholder Perspectives podcast series, Avalere is joined by Dr. Colin Edgerton to discuss the specialty pharmacy dynamics with a focus on the provider outlook.
Podcast: E2 – Specialty Pharmacy Stakeholder Perspectives: Patient Outlook
In the second episode of the Specialty Pharmacy Stakeholder Perspectives series, Avalere is joined by Marc Boutin, CEO of the National Health Council, discussing the specialty pharmacy dynamics with a focus on the patient perspective.
Podcast: E1 – Specialty Pharmacy Stakeholder Perspectives: Specialty Pharmacy Outlook
In the first episode of the Specialty Pharmacy Stakeholder Perspectives series, Avalere is joined by Joel Wright, CEO at AllianceRx and Ernie Shopes, SVP Products and Client Delivery at Creehan and Company, discussing the outlook for specialty pharmacy, including a focus on trends in the pipeline and overall landscape.
What’s Next for Medicaid Drug Pricing?
On February 27, Avalere experts discussed the latest policy, pricing, and reimbursement challenges for prescription drugs in Medicaid in the “What’s Next for Medicaid Drug Pricing?” webinar. They reviewed the ways prescription drugs are managed in Medicaid, what innovative medicines may mean for the program, and potential implications of CMS’ Healthy Adult Opportunity (HAO).