Drug Pricing and Affordability
Keep up with our comprehensive coverage of administrative and legislative activity and what it means for industry, plans, providers, and patients.
Can Comprehensive 340B Reform Generate Federal Savings?
Stakeholders are debating potential reforms to the 340B program, with specific policies directly or indirectly impacting federal spending.
Trends in Generic Tiering in Medicare Part D, 2011–2021
From 2011 to 2021, there was an increase in higher formulary tiering, patient out-of-pocket spending, and negotiated price for a cohort of generics.
Upper Payment Limits on Drugs Could Alter Patient Access
State approaches to PDABs and UPLs vary, but all approaches could impact patient access and affordability.
Over Half of Generic Drugs Are Not on Part D Generic Tiers
In recent years, Medicare Part D plan tier placement of generic prescription drugs has declined, from 64.5% in 2016 to 43.8% in 2024.
States Will Prioritize Drug Affordability and Access in 2024
States will commence legislative sessions at the beginning of January. Drug pricing, including payment limits and reference pricing, as well as improved access will be key priorities.
IRA Negotiation Creates Ripple Effects Across Drug Markets
Medicare negotiation has ripple effects across therapeutic markets, requiring manufacturers to reassess strategies to stay ahead of the changing drug landscape.
IRA Drug Price Negotiation Impact on Cardiovascular Drugs
A new Avalere white paper raises important considerations on potential added lifecycle pressures for sponsors of cardiovascular disease products.
How Will 340B Discounts Interact with Negotiated Drugs’ MFP?
The IRA requires covered entities to pay the lesser of a drug’s 340B ceiling price and MFP, presenting operational complications for manufacturers and providers.
Court Ruling Will Limit Accumulators
A district court’s decision to strike down the 2021 NBPP is the latest policy update on the use of copay adjustment programs, but questions persist.
How Can Manufacturers Help Shape Medicare Negotiations?
Manufacturers should reevaluate CMS engagement strategies as soon as possible to maximize the opportunity to influence the IPAY 2026 Medicare negotiations.
Manufacturers Should Assess Wastage to Inform Mitigation Strategy
Manufacturers impacted by the Part B discarded drug refund policy should assess claims billing and adjudication patterns to inform mitigation strategy.
Will Part D Redesign Lower OOP Costs for HIV Care?
The IRA’s Part D redesign could lower out-of-pocket costs for people with HIV; providers can help make sure their patients are aware of these changes.
What is the Role of 340B Grantees?
Some federal grant recipients use 340B program eligibility to expand their reach and services provided to a wide range of patient populations.
Video: Unpacking the Implications of the Negotiated Drug List, Part 1
Delve into the far-reaching implications of the recently announced negotiated drug list as Avalere experts provide insights and answers to pressing questions surrounding CMS's landmark decision on Part D drug pricing and its impact on manufacturers, patients, and the future healthcare landscape.
CMS Selects First 10 Drugs for Medicare Negotiation
CMS selected 10 Part D drugs for the first year of negotiation. Stakeholders should consider engagement opportunities and evaluate broader therapeutic dynamics.
How Will the IRA Impact the Future of Biosimilars?
Multiple Inflation Reduction Act provisions impact biologics and biosimilars, but the net impact and potential consequences will vary across products.
States Turn to Drug Price Boards to Reduce Spending
State legislatures are increasingly considering prescription drug affordability boards and upper payment limits to lower state expenditures and patient costs.
Proposed Operational Updates to the Discarded Drug Refund Policy
In CY 2024 rulemaking, CMS proposes operational clarification to the discarded drug refund policy finalized last year.
How Do IRA Policies and the Enhancing Oncology Model Interact?
Manufacturers should adjust commercial and evidence generation strategies in response to the shifted incentives under the IRA and Enhancing Oncology Model.
CMS Best Price Discount Stacking Proposal May Trigger AMP Cap
Requiring manufacturers to stack all discounts provided through the supply chain could increase Medicaid rebate liability and complicate rebate dynamics.