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.
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Study: 57 Percent of Covered Generic Drugs Not on Part D Generic Tiers in 2025
Over time, the percentage of generic prescription drugs placed on Medicare Part D generic tiers has declined, from 65% in 2016 to 43% in 2025.
Rare Disease Advisory Councils: Opportunities for Engagement
Stakeholders should seek to engage with RDACs to develop a better understanding of rare disease care access, treatment, and populations in different states.
Avalere White Paper: Value-Based Care and Orthotics and Prosthetics
A white paper explores ways in which VBC payment models can benefit from incorporating allied health domains, such as Orthotics and Prosthetics.
IRA Negotiation Impact on Part B Beneficiary OOP Costs
Avalere finds that between 0.03% and 0.1% of Medicare FFS beneficiaries would experience lower OOP costs for the first 10 Part B drugs likely to be negotiated.
Evolving Vaccine Recommendation Landscape Prompts New Evidence Needs
As the processes, priorities, and membership within the ACIP evolve, vaccine manufacturers should adapt their evidence generation planning to support optimal review.
What the Election Results Mean for Health Policy in the Year Ahead
A second Trump administration and Republican Congress will mark a shift in healthcare policy priorities in 2025 on both legislative and regulatory fronts.
2025 Part D Formularies Shift to More Coinsurance and UM
While the share of drugs covered on Part D formularies will increase slightly in 2025, more drugs will have coinsurance and utilization management.
340B Purchase Data Highlights Continued Program Growth
HRSA 2023 340B purchase data demonstrates continued program growth and that sales for the top 10 340B drugs exceeded sales for those drugs in Medicare.
Mental Health Parity Rule: Industry Reactions and Implications
Stakeholders are contending with a new rule implementing stricter requirements on mental health care parity to ensure patient coverage and enhance equity.
Stakeholders Can Engage USP During DC 2025 Comment Period
The USP DC 2025 Draft is open for public comment until October 31, allowing stakeholders to engage with the USP even in years without an update to the MMG.
50-State Comparison of Medicaid Adult Vaccine Provider Reimbursement in 2024
A new Avalere analysis reaffirms 2021 findings that first identified variability in Medicaid physician office and pharmacy vaccine reimbursement policies.
eBook: Navigating the Immunization Ecosystem
In this eBook, Avalere experts discuss the evolving vaccines ecosystem and analyze key policy issues affecting vaccines manufacturers.
Number of Part D Plan Choices Declines for 2025
The number of PDP and MA-PD options are declining by 26% and 7%, respectively, in 2025.
Avalere White Paper: The State of Quality in Rare Disease
Avalere assessed quality measurement, quality improvement, and value-based initiatives in rare disease and the opportunity for a cohesive quality strategy.
VP Debate Highlights Healthcare Policy Differences
During the debate, VP candidates outlined their views on healthcare topics such as the ACA, drug pricing, manufacturing, reproductive rights, and mental health.
Navigating the Medicare Prescription Payment Plan: What It Means for Part D Plan Sponsors
The MPPP introduces new considerations for Part D plans’ financial risk, operations, and enrollee engagement.
OIG Requests Enhanced Oversight of Remote Patient Monitoring
The OIG found oversight gaps in Medicare's RPM program, especially in billing accuracy and integrity, highlighting need for safeguards and provider education.
Accelerating Access through Payer Marketing
Payer marketing requires a strategic approach that combines data and storytelling to communicate product value and differentiation and ensure patient access.
Navigating the Medicare Prescription Payment Plan: What It Means for Manufacturers
The MPPP will help improve Part D patient affordability, prompting manufacturers to reassess existing patient assistance programs and educational efforts.
eBook: Women’s Health Landscape
In an eBook, Avalere experts analyze the spectrum of women’s health needs and research the coverage, care, and outcomes shaping women’s health services.