Drug Pricing
Keep up with our comprehensive coverage of administrative and legislative activity and what it means for industry, plans, providers, and patients.
Featured Content
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.
Webinar: Drug Pricing Policy: What’s on the Horizon?
Avalere experts examine the current drug pricing policy landscape and what potential changes stakeholders should prepare for.
Key Considerations for Medicare Advantage Plans Evaluating New Part B Step Therapy Flexibility
Following its recent announcement to grant Medicare Advantage (MA) plans the flexibility to use step therapy techniques for Part B drugs beginning in January 2019, the Centers for Medicare & Medicaid Services (CMS) released an FAQ with additional guidance on its implementation.
CMS Announces New Flexibilities in Medicare Part D
Under an indication-based formulary design approach, Part D plans will be able to tailor the drugs that are on their formulary by indication.
Eliminating Drug Rebates Requires Complex Solutions
Reforms to “eliminate rebates” could have varying impacts based on features of their design.
CMS Grants Medicare Advantage Plans Flexibility to Use Step Therapy for Part B Drugs
Beginning in January 2019, Medicare Advantage (MA) plans will have the flexibility to use step-therapy techniques for Part B drugs, according to a CMS memo released on August 7.
Avalere Analysis Highlights Complexities of Transitioning Medicare Part B Drugs into Part D
Moving certain Part B drugs to Part D, a proposal being evaluated by the Trump administration, would have disparate financial impacts on patients.