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.

Interview: 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.

Interview: 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.

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).

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.

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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.

Alternative Financing Models for Durable Cures

Transformative medicines, like gene and cell therapies, are beginning to be approved in the US, and more are expected to come.

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.

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