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.
Featured Content
NTAP Eligibility Criteria Opportunities for Inpatient Reimbursement
Recent CMS rulemaking has expanded the opportunity for new drugs and devices to achieve NTAP status, either through the traditional process or via alternative. Manufacturers that are nearing the launch of new technologies, especially in the antimicrobial space, should assess whether their technology may qualify for NTAP. Applications for NTAPs effective in FY 2022 are due this fall.
Cannabidiol: A Regulatory Snapshot
The US market has seen a recent surge in cannabidiol (CBD) use and sales, despite many of these marketed CBD products being unregulated and untested for most of the claimed indications.
Behavioral Health in Medicaid May Be Unable to Meet Increased Demand
As COVID-19 forces the healthcare system to reprioritize patients and resources, providers delivering behavioral health services may be left with insufficient means to serve the population. Medicaid programs may observe increased demand for behavioral health services but may be ill-equipped to support beneficiaries.
State Medicaid Waivers for SUDs Present Opportunities for Stakeholder Engagement
1115 Waivers approved by CMS allow state Medicaid programs to better address substance use disorders among beneficiaries.
Evolving COVID-19 Impacts on Health Insurance Enrollment
On May 13, Avalere experts discussed key issues and considerations for the healthcare industry as millions of Americans shift in and out of new sources of coverage due to COVID-19.
Geographic Disparities in Mental Health Access Highlight Challenges
Over half of counties in the US (52%) do not have any mental healthcare providers.
COVID-19 Compass
COVID-19 continues to spread nationwide, and individuals with social risk factors and underlying chronic conditions are at highest risk for severe illness.
Manufacturers Must Navigate Evolving State Approaches to Medicaid Drug Benefit Management
As control of the Medicaid drug benefit continues to shift from managed care organizations to states, manufacturers should understand unique benefit dynamics in each state, particularly as Medicaid enrollment is likely to increase amid the COVID-19 pandemic.
Follow the Pill: Understanding the Prescription Drug Supply Chain
Prescription drugs are dispensed to patients through a complex supply chain that involves a broad array of entities, contract arrangements, and payments. The following diagram outlines how a typical prescription drug may flow through the drug supply chain.
Provider Impact of COVID-19 Recession and Coverage Trends
A potential recession due to job losses and business closings as a result of COVID-19 will cause shifts in the payer mix and, ultimately, revenue dynamics for physician practices.
Updated National Malnutrition Blueprint Advances Integrated Solutions
Citing alarming statistics that nearly 1 of every 2 older Americans is at risk of malnutrition and that disease-associated malnutrition in older adults is estimated to cost nearly $53 billion annually, a broad group of advocates has presented a updated roadmap for a continuing national effort to help millions of Americans who suffer from malnutrition or could be at risk as they age. The expected rising incidence of malnutrition amidst the current COVID-19 pandemic makes it even more critical to advance solutions across all points of care.
COVID-19 Outbreak Exacerbates Impacts of Social Determinants of Health
The COVID-19 pandemic has revealed several weaknesses in our country’s web of safety net programs. Although the virus may not discriminate, it may exacerbate existing health inequities driven by social determinants of health (SDOH).
CMS Proposes Significant Changes to Reimbursement Mechanisms for CAR-T
Proposed policy changes largely address concerns around Medicare’s CAR-T inpatient reimbursement, though raise new questions regarding long-term impact on reimbursement and access to innovative therapies.
Post-COVID-19 Considerations for the Commercial Health Coverage Market
Faced with a rapidly evolving healthcare environment, there are a number of important uncertainties that commercial insurers will need to consider when planning for the future
COVID-19 Relief Funding for Healthcare Providers
Avalere analysis of the distribution of provider relief funds indicates geographical concentration related to the number of reported COVID-19 cases.
Opportunities to Modernize the Vaccine Injury Compensation Program
A proposal to eliminate shoulder injuries from the list of vaccine-related conditions that warrant federal compensation through the National Vaccine Injury Compensation Program (VICP) highlights the administrative challenges posed by these claims and provides an opportunity to consider reforms to modernize the program.
10 Drivers Complicate the Medicaid Outlook Amid the COVID-19 Pandemic
State Medicaid programs face a series of near- and long-term challenges amid the COVID-19 pandemic due to enrollment growth and financial pressures. Stakeholders should evaluate key drivers shaping the state-by-state Medicaid outlook.
COVID-19 Will Impact Provider Performance Reporting and Value-Based Care
The impact of COVID-19 goes beyond the disease and produces additional strain on the healthcare system, including managing patients and meeting cost and quality drivers.
COVID-19 is Stressing a Fractured Mental Healthcare System in the US
Mental Health Awareness Month and the COVID-19 crisis intersect—and highlight challenges in the US mental health care system
After the Rollover from Drugs to Biologics: What Remains Uncertain?
The Biologics Price Competition and Innovation Act (BPCIA) mandates that specific protein products that were approved as drugs under section 505 of the Federal Food, Drug, and Cosmetic Act (FD&C Act) be licensed as biologics under section 351 of the Public Health Services Act (PHS Act) as of March 23, 2020.