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.
In response to the novel coronavirus (COVID-19) pandemic, a majority of state legislatures have either suspended their ongoing legislative sessions or adjourned sine die, which marks the definitive end of a state’s session, earlier than originally scheduled.
In response to the COVID-19 pandemic, FDA has announced actions that may have much broader implications for drug development, lifecycle management, and oversight.
Globally, the need to flatten the epidemic curve of COVID-19 cases has become the top public health priority to save lives and minimize the burden on the health care system. In the absence of treatments and prophylactics for the novel coronavirus, social distancing and quarantine strategies continue to be implemented in the US.
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.
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.
On March 30, Avalere policy experts published a piece in the Health Affairs blog about the existing programs in place to ensure patient access to affordable COVID-19 vaccines.
On March 25, the British Medical Journal Open Quality published an article, “Impact of an Interdisciplinary Malnutrition Quality Improvement Project at a Large Metropolitan Hospital,” co-authored by Kelsey Jones and Kristi Mitchell.
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.
Avalere Health partnered with the Academy of Nutrition and Dietetics and other stakeholders for the Malnutrition Quality Improvement Initiative (MQii) designed to advance evidence-based, high-quality, and patient-driven care for hospitalized older adults who are malnourished or at risk for malnutrition.
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.
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).
Avalere published an abstract in the online Journal of National Comprehensive Cancer Network (JNCCN).
As the Coronavirus Disease 2019 (COVID-19), caused by the novel SARS-CoV-2 virus, rapidly spreads through the US, media and public scrutiny over the current diagnostic testing landscape has increased, given that the US lags behind other countries in the number of tests performed and turnaround time for results reported.
New flexibilities for telehealth services in fee-for-service (FFS) Medicare are designed to support ongoing COVID-19 response efforts.
On March 2, the Supreme Court (SCOTUS) announced that it will review an appeal of the 5th Circuit Court of Appeal’s decision in Texas v. Azar regarding the legality of the Affordable Care Act’s (ACA’s) individual mandate and other provisions.
As the novel coronavirus disease (COVID-19) continues to change daily life, concerns about the impact on global supply chains and possible drug shortages have increased. Additionally, changes to FDA processes may limit its ability to perform essential drug related activities.
Medicare Advantage (MA) plans are using new flexibilities to provide additional supplemental benefits to beneficiaries with chronic illnesses.
As the novel coronavirus (COVID-19) spreads throughout the United States, media and policy focus on the rollout of diagnostic testing for the disease has greatly increased. Understanding the role of testing and screening is key to the control of this outbreak.
Avalere analysis finds that average beneficiary out-of-pocket (OOP) spending for 3 commonly used insulin products remains similar throughout the year, ranging from $95 in December to $136 in June and July.
Avalere analysis finds differences in the demographics of patients with End Stage Renal Disease (ESRD) enrolled in Medicare Advantage (MA) compared to ESRD patients in Fee-for-Service (FFS) Medicare