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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SNF 3-Day Waiver Use at the End of the COVID-19 Public Health Emergency
Use of the three-day waiver was stable over the course of the pandemic, though shifts in admission sources were observed.
Navigating the Medicare Prescription Payment Plan: What It Means for Patients and Patient Groups
The MPPP is a new payment option for Part D beneficiaries in 2025; patient groups will play a key role in supporting education and outreach on the program.
Medicare Cost and Utilization Across Physician Affiliation Models
An Avalere analysis assessing differences in Medicare expenditures and utilization across 4 models provides a new perspective on the evolving physician affiliation model landscape.
IRA Inflation Rebate Impact on Part B Beneficiary OOP Costs
Avalere finds that between 0.1% and 0.2% of Medicare FFS beneficiaries would experience lower OOP costs for the Part B drugs subject to Q3 2024 inflation rebates.
IRA Negotiations May Affect Millions of Medicare Beneficiaries
Maximum fair prices for the first 10 selected drugs may shift therapeutic dynamics and have direct and indirect impact to millions of beneficiaries.
Commercial Spillover Impact of Part B Negotiations on Physicians
Physicians could lose at least $25 billion in add-on payments for 10 Part B drugs expected to be negotiated by CMS, with oncology products accounting for at least $12 billion.
Navigating the Medicare Prescription Payment Plan: What It Means for Stakeholders
The Medicare Prescription Payment Plan will change how Medicare beneficiaries manage their Part D out-of-pocket costs, with implications across stakeholders.
Key Considerations for MFP Effectuation and the 340B Rebate Model
Stakeholders consider implementation of a 340B rebate model to address duplicate discount risk.
Social Determinants May Affect Access to CAR-T Treatment
Analysis highlights potential access barriers to a broad set of CAR-T therapies
Examining Variation in Gene Therapy Access Across States
State Medicaid programs take a range of approaches to gene therapy coverage, management, and reimbursement.
125,000 in MS Could Gain Medicaid Coverage Through Expansion
If Mississippi expands Medicaid to 138% federal poverty level, Avalere estimates 125,000 uninsured individuals, ages 19-64, could gain coverage in 2025.
Manufacturer Learnings from the First Round of Negotiated MFPs
Avalere experts share initial impressions of the publicly released negotiated MFPs for the first round of selected drugs, highlighting implications to industry.
CMS Expands Medicare Device Access Via New TCET Pathway
The new Transitional Coverage for Emerging Technologies pathway will provide Medicare coverage for up to five FDA-designated Breakthrough Devices per year.
Formulary Coverage and Access Shifts in 2024 PDPs
Avalere analysis shows that there are substantial changes and variations in PDP formularies at the therapeutic area and regional levels from 2023 to 2024.
Potential Impacts of IPAY 2026 Maximum Fair Prices on Health Plan Formulary Negotiations
With the release of the IPAY 2026 MFPs, health plans should analyze the impact to formularies and identify opportunities for contracting changes.
Health Policy in the 2024 Election: Avalere and Outside Experts Weigh In
With the election fast approaching, former HHS Secretary Alex Azar, Dan Mendelson, and Avalere experts discussed implications for healthcare stakeholders.
2024 Biosimilar Substitution State Statute Report
Avalere’s report, updated semi-annually, is available now with insights into state policies on point-of-service substitution of biosimilar products.
Implications of Self-Administered Drug List Determinations on Access
SAD list placement will inform the channel that providers and patients use to access a therapy.
New Avalere Resource: Coverage and Coding Regulatory Calendar
Avalere’s new CY 2024–2025 Coding and Regulatory Calendar supports life sciences firms’ strategic planning for critical coding deadlines, timelines, and regulatory updates.
Updated Negotiation ICR Presents New Industry Evidence Needs
Updates in the Initial IPAY 2027 ICR highlight the increasing needs for specific evidence planning and generation for industry to prepare for negotiation.