Drug Pricing
Keep up with our comprehensive coverage of administrative and legislative activity and what it means for industry, plans, providers, and patients.
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).
Webinar: No sPCMA, No Worries … We’ve Got Part D Covered
Just because we can’t meet at sPCMA doesn’t mean we can’t discuss what’s next for Medicare Part D.
With an Influx of Cell and Gene Therapies on the Horizon, New Access, Coverage, and Financing Models Are Needed
With new cell and gene therapies poised to revolutionize treatment for a growing number of disease states, stakeholders are working to reimagine existing value and reimbursement models to meet the special challenges these breakthrough services present.
Podcast: E2 – Avalere Insights on Recent CMS Proposed Payment Rules: MPFS
Tune in to hear the second episode in our 3-part series that focuses on CMS’s most recent proposed payment rules. In episode 2, we’ll be focusing on the Medicare Physician Fee Schedule proposed rule, or MPFS, with a focus on proposed changes to E/M and Opioid Use Disorder (OUD) treatment services.
Podcast: E1 – Avalere Insights on Recent CMS Proposed Payment Rules: OPPS
Tune in to hear the first episode in our 3-part series that focuses on CMS’s most recent proposed payment rules. In episode 1, we’ll be focusing on the outpatient prospective payment system proposed rule, more informally known as the OPPS.
Over Half of Medicare Advantage Beneficiaries Enrolled in Plans that Require Step Therapy for New Starts of Part B RA Biologics in 2019
Avalere analysis of 1,375 Medicare Advantage plans’ 2019 medical benefit drug coverage policies finds that 672—covering approximately 14.3 million lives—apply step therapy to at least 1 of the rheumatoid arthritis biologic drugs covered under Medicare Part B in 2019.
2020 Implementation of Rebate Rule Could Create Uncertainties for Part D Plans
On April 5, CMS issued guidance announcing a voluntary, 2-year demonstration that would modify the Part D risk corridors if the proposed rule to revise the Anti-Kickback Statute safe harbors is effective for 2020.
Understanding the Combined Effects of Drug-Pricing Reforms
The interaction of recently announced drug pricing reforms will have differential implications for stakeholders.
Drug Rebate Proposal Fundamentally Changes Current System, Raises Critical Questions
The swift proposed implementation timeline will require stakeholders to evaluate quickly operational requirements, behavioral responses, cross-program implications, and impact on contractual arrangements.
HHS Proposes to Remove Safe Harbor for Drug Manufacturer Rebates
Yesterday, the Department of Health and Human Services Office of Inspector General released a proposed rule redefining the current safe harbor for pharmaceutical manufacturer discounts and rebates to entities like health plans and pharmacy benefit managers (PBMs).
Drug Importation Proposals Gain Traction but Raise Cost and Operational Questions
The costs of ensuring the safety and efficacy of imported drugs and preventing the entry of counterfeit products are among the many factors that must be weighed against any potential savings from a drug importation program.
International Price Index Model’s Impact on Patients and Providers
New Avalere analysis finds that most seniors in Medicare would not see a reduction in their out-of-pocket costs as a result of the International Price Index Model.
Post-Election, Part B Drug Reform Is Likely to Advance
Avalere analysis finds that most of the payment reductions from the proposed International Pricing Index Model for Part B drugs would affect oncologists, rheumatologists, and ophthalmologists.
Patients Use Generics More Frequently than Brands in Medicare’s Protected Drug Classes
New Avalere research finds high utilization of generic medications in the 6 protected drug classes under Part D.
Summary: What’s on the Horizon for US Drug Pricing Policy in 2019 and Beyond?
On October 25, Avalere experts came together to discuss the latest policy developments related to drugs.