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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Stakeholders Can Influence Patient-Centered Value Research During Public Comment Period
Life sciences companies, payers, and advocates can weigh in on patient-centered value assessments in a new public comment opportunity.
Part D Prior Authorization Policies May Include Step Therapy
Analysis of Part D plans including step therapy in prior authorization and the frequency of step therapy criteria that include steps beyond the drugs’ FDA labels.
Updated: Key Considerations for MFP Effectuation and the 340B Rebate Model
With less than a year until the first MFPs take effect, stakeholder concerns remain, especially as it relates to 340B duplicate discount risk.
Opportunities to Move the Needle on US Behavioral Healthcare in 2025
Behavioral health is at a turning point in 2025, with newly implemented policies, groundbreaking treatments, and novel regulatory and financial dynamics.
White Paper: The Medicaid Drug Rebate Program and Considerations for Generic Markets
This paper details five AMP increase scenarios that could lead to a generic manufacturer being subject to inflation rebates in situations where the generic manufacturer is not taking a price increase beyond the inflation rate.
eBook: Rare Disease Biotechnology Landscape
In an eBook, Avalere Health experts describe the policy, market access, and evidence landscape of rare disease in the United States and globally.
Part D Coverage of MS Drugs Declined in 2025
Overall coverage of MS drugs among Part D plans declined by six percentage points, from 49% of the time across all plans and drugs analyzed in 2024 to 43% in 2025.
Impacts of 340B on State Medicaid Programs and Patient OOP Costs
The 340B program may create unintended consequences for state Medicaid budgets and patients who may not see direct benefits from the program.
Avalere Resource: Coverage and Coding Regulatory Calendar
Avalere’s new CY 2025–2026 Coding and Regulatory Calendar supports life sciences firms’ strategic planning for critical coding deadlines, timelines, and regulatory updates.
White Paper: Valuing Multi-Use Drugs in Medicare Negotiation
Alternative approaches for weighting multiple uses of a product when setting maximum fair prices may better balance patient needs and development incentives.
Impact of J-Code Naming Conventions on 505(b)(2) Drugs
Manufacturers have noted challenges arising from 505(b)(2) code descriptors, prompting CMS to consider proposed updates
Avalere Announces Practice Directors for Policy, Operations
Milena Sullivan will lead Avalere’s Policy Practice, and Erica Eisenhart is promoted to Operations Practice Director.
Highlights From The 2024 InformaConnect Congress
Two Avalere experts captured information presented at a recent conference and published their perspectives in Pharmaceutical Commerce.
IPAY 2027 Negotiated Drugs Expand Impact on Beneficiaries
The addition of 15 drugs selected for IPAY 2027 negotiation expand the impact maximum fair prices may have on key therapeutic areas and millions of beneficiaries.
Vaccine Policy and Access Under New HHS Leadership
Policy actions in the first days of the Trump administration raise questions about the future role of key vaccine advisory committees.
Health Plans 2030: Unlocking Value through Data & Technology Advancements
With increasingly sophisticated data and technology available, plans should strategize about how to integrate both across the enterprise to drive higher value.
Estimating the Spillover Impact of IRA Part B Negotiation
A survey finds that reimbursement contracts outside Medicare FFS still reflect Medicare metrics, raising questions about broader Part B negotiation effects.
USP DC 2025 Updates and Strategic Engagement Opportunities
USP’s updated Drug Classification for plans outside of the Medicare Part D market reflects revisions and newly approved products through October 2024.
CMS Announces Next 15 Drugs Selected for IRA Negotiation
The next cohort of drugs includes additional cancer and chronic disease therapies, as well as products that were therapeutic alternatives for IPAY 2026 drugs.
Newborn Screening: Landscape and Rare Disease Developments
Novel approaches to newborn screening of rare diseases could shape the future of federal and state screening guidelines.