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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.

Margaret Scott

What’s Next for Medicaid Drug Pricing?

On February 27, Avalere experts discussed the latest policy, pricing, and reimbursement challenges for prescription drugs in Medicaid in the “What’s Next for Medicaid Drug Pricing?” webinar. They reviewed the ways prescription drugs are managed in Medicaid, what innovative medicines may mean for the program, and potential implications of CMS’ Healthy Adult Opportunity (HAO).

Chloe Chepigin

Reducing Funding to WHO May Impact Existing Vaccines Programs

On April 15, President Trump announced his intention to halt funding to the World Health Organization (WHO), pending an investigation into WHO’s response to the COVID-19 pandemic. WHO first declared the outbreak a Public Health Emergency of International Concern on January 30 and a global pandemic on March 11. A reduction in funding from the US could limit WHO’s COVID-19 response activities as well as its regular vaccine programming, including product prequalification, global surveillance, and ongoing efforts to strengthen health systems.

Chloe Diamond

FDA Guidance on Digital Devices for Mental Health During COVID-19

To protect the public’s health during the COVID-19 pandemic, the Food & Drug Administration (FDA) released guidance expanding the availability of digital health therapeutic devices and applications for psychiatric disorders by clarifying which regulatory requirements it does not plan on enforcing as well as which products do not necessitate FDA oversight. This guidance intends to limit extraneous contact between patients (users) and providers by providing regulatory flexibility for low risk products. The policies will last until the national public health emergency ends.

Timothy Epple

Provider Impact of COVID-19 Telehealth Policies by Specialty

Approximately ⅓ of physician services payments are eligible for telehealth reimbursement under Medicare (fee-for-service) FFS through existing Center for Medicare and Medicaid Services (CMS) guidance as of January 2020, in addition to temporary coding guidance specific to COVID-19 effective as of March 1, 2020. Avalere’s analysis highlights the immediate potential for specific physician specialties to utilize telehealth based on temporary flexibilities regarding which procedures are eligible for telehealth reimbursement.

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