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
Overview: Balance Billing or Surprise Medical Bill Reform
Surprise and balance billing reform efforts have been a subject of ongoing debate at the federal level.
EO on Rebate Reform Raises Key Considerations for Pharmacies
As currently written, a proposed rule on rebate reform from January 2019 may impose financial and operational challenges for pharmacies related to cash flow and new technology requirements.
Bringing COVID-19 Vaccines and Therapeutics to Market
On July 22, Avalere experts discussed the marketplace for COVID-19 vaccines and therapeutics in the “Cutting Through the Noise: Market Evolution and Pathways to Access for COVID-19 Vaccines and Therapeutics” webinar. They examined FDA regulatory considerations, coverage and access challenges, and key pricing and distribution scenarios for optimal US market access.
EOs Direct Drug Pricing Action, Raise Additional Questions
The administration’s 4 drug pricing EOs direct agency action across a host of policy areas, including Part D rebates, Part B reimbursement and pricing, 340B drug discounts, and drug importation. Next steps and a timeline for agency action will vary by EO dependent on the specific policies to be advanced or finalized. In the interim, stakeholders should explore outstanding questions and contemplate near- and longer-term policy scenarios.
Research Agenda for Health Equity Released in Collaboration with RWJF
Avalere is releasing a new research agenda to guide evidence generation for health system models of care that advance the intersection of social and clinical needs of Medicaid-eligible individuals.
Avalere Vaccines: 2020 Mid-Year Outlook
Vaccine development is at the forefront of global efforts to address the COVID-19 pandemic, with a rapidly growing pipeline of candidates that will expand the existing vaccine landscape.
Avalere Statement on Prescription Drug Pricing Executive Orders
On July 24, the administration released 3 executive orders (EO) and announced the planned publication of a fourth EO, all focused on prescription drug pricing. The EOs reflect a combination of familiar policy goals (e.g., rebate reform, importation, international pricing) and a new 340B initiative, and in combination could have substantial implications for healthcare stakeholders and pharmaceutical markets if implemented.
8 Return-to-Work Considerations for Employers Amid COVID-19
As businesses across the country begin to reopen, navigating the COVID-19 pandemic will continually require employers to be resilient, flexible, innovative, and forward looking when it comes to returning employees safely to work sites. Among the myriad of concerns and considerations, organizational leadership will need tools that assist decision making and ensure compliance with Centers for Disease Control and Prevention (CDC) guidance.
Access to Medicare Part B Drugs Remains Challenging During COVID-19
Avalere continues to find a significant drop in utilization of key physician-administered therapies in 2020 relative to 2019.
Expanding LIS Subsidies Could Save Part D Beneficiaries Money
Avalere assessed the impacts of select policies to expand low-income subsidy (LIS) eligibility under Medicare Part D
Majority of API in US-Consumed Medicines is Produced in the US
New analysis of trade data finds that 54% of API, in dollars, used in domestically consumed medicines came from the US in 2019.
Proposed Medicaid Line Extension Definition Alters Rebate Calculation
The CMS proposes to define line extension under the MDRP to broadly include any product that has at least one ingredient in common with the original drug, even if it is a different dosage form. If finalized, this change would have significant implications on classification and rebate liability for a wide set of current and future products.
Comparison of Dually and Non-Dually Eligible Patients with ESRD
Dually eligible beneficiaries in Pennsylvania with end-stage renal disease (ESRD) are more often people of color and have higher costs compared to non-duals, but their utilization patterns are similar.
Exchanges May Add More than 1 Million New Enrollees due to COVID-19
Affordable Care Act (ACA) exchanges have seen a significant uptick in enrollment, especially from those losing employer-sponsored coverage or who were previously uninsured. However, different approaches to special enrollment periods (SEPs) leave many with limited opportunities to enroll.
COVID-19 Impacts State Policy Priorities
After adjourning or suspending sessions due to the COVID-19 pandemic, state legislatures are reconvening with new priorities, as pandemic-related policy decisions take precedence.
Medicare FFS Risk Scores Vary Based on Eligibility and Entitlement
An analysis of CMS’s Hierarchical Condition Category (HCC) model shows that fully dual-eligible beneficiaries have the highest risk scores.
Partnerships Addressing Housing Insecurity: Lessons for the Future
Though Americans have been encouraged to physically distance themselves to minimize transmission of COVID-19, individuals who are homeless or living in institutional settings may not be able to adhere to these guidelines, putting them at higher risk of contracting and transmitting the virus.
Just Launched: Implementation Guide for the First Hypoglycemia Measures
In December 2019, Avalere Health and Endocrine Society launched the first quality measurement set designed to help providers assess how well they identify and care for older adults at greater risk of hypoglycemia – low blood sugar that can be a dangerous complication of diabetes.
Medicaid VBP Rule May Facilitate Drug Contracts, But Questions Remain
CMS proposes to alleviate drug price reporting barriers that have hindered the adoption of innovative contracting models for prescription drugs. Stakeholders should contemplate the details and implications of CMS’ proposals—including how the changes would impact current contracting—as well as remaining areas of ambiguity.
The Impact of Telehealth on the Future Care-Delivery Landscape
On June 11, Avalere experts explored the future of telehealth and how organizations can help shape and take advantage of its increased utilization.
