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Insights & Analysis

There’s one constant in healthcare: change. Count on us to break down the trends so you can stay up to date. Follow our take on each piece of this deep, intertwined, and often perplexing industry to find opportunities and practical approaches to move healthcare forward.

Abby Moorman

New Federal Rule Could Affect Infusion Site of Care Amid COVID-19 Pandemic

The Centers for Medicare & Medicaid Services (CMS) issued a new Interim Final Rule (IFR) that is intended to allow additional beneficiaries, especially those who are at high-risk, to receive home infusions amid COVID-19 transmission concerns. Specifically, the CMS clarified the definition of “homebound” under the Medicare Home Health Benefit and temporarily suspended enforcement of the National and Local Coverage Determinations (NCD and LCD) related to home infusion services. Uncertainties remain as to how these new flexibilities will be utilized, as well as how these flexibilities could impact treatment outcomes.

Ekemeni Isaiah

Select Part D Plans Have Higher PMPM Spending for LIS in Most Protected Classes

As plans continue to assess the proposed changes to their liability in the Medicare Part D benefit, understanding variations in spending by enrollee can help elucidate how policy changes might affect their spending. This Avalere analysis examines a subset of MA-PD and PDP plans with at least 75% of their enrollment comprising those with LIS. This analysis aims to quantify spending on drugs within the 6 protected classes for low-income subsidy (LIS) and non-LIS beneficiaries in this subset of PDP and MA-PD plans.

Christina Badaracco

Payer Issues, Part 2: Health Plans’ Interventions to Address Food Insecurity

The growing prevalence and disparities in chronic diseases necessitate that health plans address food insecurity to improve patient outcomes. The combination of increasing need for access to healthy food and changes in the health policy and insurance landscape create opportunities to address food insecurity through a variety of payers.

Hillary Stires

What the Rollover from Drugs to Biologics Means

On Monday, March 23, over 90 products that had historically been regulated as drugs were deemed to be licensed as a biologic. This includes insulin products. During the past several years, the Food & Drug Administration (FDA) has released guidance about their interpretation of the provision to guide sponsors and provide information about what to expect for the transition.

Katie Patton

States Act to Ensure Coverage Protections in Advance of ACA Decision

The majority of 2020 state legislative sessions are either approaching crossover deadlines or adjournment. In 2019 and 2020, at least 15 states (CT, DE, FL, HI, IN, LA, MD, ME, NH, NJ, NM, NV, OR, VT, and WA) have enacted laws to create or study coverage protections against pre-existing condition exclusions or coverage of all essential health benefits (EHB) provided for in the Affordable Care Act (ACA).

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