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.
Third Party to Assess Value of Digital Health Technology
As the US value assessment landscape evolves, a new third-party framework may standardize requirements and open reimbursement pathways for digital health.
Guide to Vaccine Coverage Policies
The IRA expanded vaccine access, but variations in federal policies governing vaccine coverage requirements and implementation remain
SNF 3-Day Waiver Use During the COVID-19 Pandemic
Use of the 3-day waiver was stable over the course of the pandemic, though shifts in admission sources were observed.
How Can Manufacturers Help Shape Medicare Negotiations?
Manufacturers should reevaluate CMS engagement strategies as soon as possible to maximize the opportunity to influence the IPAY 2026 Medicare negotiations.
Manufacturers Should Assess Wastage to Inform Mitigation Strategy
Manufacturers impacted by the Part B discarded drug refund policy should assess claims billing and adjudication patterns to inform mitigation strategy.
Physician Payment for Some Services Lags Behind Inflation
Physician reimbursement for some services under Medicare FFS has declined, while payment increased for the same services in the hospital outpatient setting.
Will Part D Redesign Lower OOP Costs for HIV Care?
The IRA’s Part D redesign could lower out-of-pocket costs for people with HIV; providers can help make sure their patients are aware of these changes.
What is the Role of 340B Grantees?
Some federal grant recipients use 340B program eligibility to expand their reach and services provided to a wide range of patient populations.
CMS Finalizes Changes to NTAP Payment Designation
The recent FY 2024 IPPS final rule revised NTAP eligibility criteria for certain technologies. Applications for the FY 2025 NTAP cycle are due by October 17, 2023.
CMS Selects First 10 Drugs for Medicare Negotiation
CMS selected 10 Part D drugs for the first year of negotiation. Stakeholders should consider engagement opportunities and evaluate broader therapeutic dynamics.
How May the IRA Shift Part D Market Dynamics?
IRA policies and growing enrollment in Medicare Advantage could begin to destabilize the standalone PDP and LIS benchmark plan market.
Decentralized Clinical Trials for Rare Disease Treatments
Decentralized clinical trials offer the potential to democratize rare disease research, advancing drug development and improving patient experiences.
How Will the IRA Impact the Future of Biosimilars?
Multiple Inflation Reduction Act provisions impact biologics and biosimilars, but the net impact and potential consequences will vary across products.
CAR-T Reimbursement Updated in FY 2024 IPPS Final Rule
Medicare CAR-T payment remains stable, but changes to outlier payments and NTAP eligibility may create challenges.
States Turn to Drug Price Boards to Reduce Spending
State legislatures are increasingly considering prescription drug affordability boards and upper payment limits to lower state expenditures and patient costs.
How a New Technology Add-On Payment (NTAP) Works
Additional Medicare payment in the inpatient setting may be available to certain qualifying new technologies, but requires successful navigation of application processes.
Stakeholders Address Disparities in Breast Cancer Screening
Avalere found disparate breast cancer screening rates by race/ethnicity and insurance type. Stakeholders are seeking to address barriers to patient access.
Therapeutic Vaccines Raise Regulatory, Policy Pathway Questions
In light of the growing therapeutic vaccine pipeline, policymakers are starting to define coverage, access, and reimbursement pathways.
How Did Public Comments Shape Revised Negotiation Guidance?
Comments on initial negotiation guidance significantly shaped the revised guidance, underscoring the importance of stakeholder engagement in IRA implementation.
Opportunity for Stakeholder Input on SAD List in MPFS Proposed Rule
CMS requests stakeholder comments on the process for defining drugs that are usually self-administered by the patient.