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.
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.
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.
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.
The 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.
Trump Administration Releases Drug Pricing Blueprint
The Department of Health and Human Services is seeking public input on a variety of proposals related to drug costs, providing stakeholders with an unprecedented opportunity to shape the administration's drug pricing policies.
Recent Proposals by the Administration Hint at Areas of Focus for Upcoming Drug Pricing Plan
President Trump is expected to announce a drug pricing plan in the coming weeks; signals from the White House indicate potential alignment around several priority policies.
The Seven Types of Drug Pricing Legislation to Watch
Increasingly, states are taking steps to control prescription drug spending and prices.
Payer Trends in Oncology
The shift from volume to value has played a significant role in shaping current payer behavior in the oncology space.
Biosimilars Gain Widespread Adoption by Health Plans
New research from Avalere finds that most health plans are covering at least one of the two biosimilar products currently on the market.