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.
On October 24, Janet Woodcock, Director of the Center for Drug Evaluation and Research (CDER) at FDA, issued a statement indicating the Agency's intent to recommend reclassifying hydrocodone combination products from Schedule III to Schedule II products.
A new analysis from Avalere Health found that the number of applications submitted to date for exchange coverage exceeded comparable enrollment in Medicare Part D over the same time period during each program's launch.
The share of Medicare Advantage (MA) plans with a star rating of 4 stars or higher in 2014 (43 percent) will increase substantially relative to 2013 (27 percent) according to a new Avalere Health analysis of the Centers for Medicare & Medicaid Services' (CMS) recently released data on 2014 plan quality performance.
In early October, CMS released the Medicare Part D plan formulary and cost-sharing information for the 2014 benefit year.
Prime Therapeutics, America's largest privately held PBM, conducted a study examining member use of cost-sharing assistance programs across a variety of specialty drugs during the first half of 2013.
As regulators struggle to find answers to differing needs across the healthcare sector, patients are becoming a more integral part in shaping policy.
Consumers in 30 states (60%) will have the option of at least one plan operating as both a qualified health plan (QHP) in the health insurance exchange and as a Medicaid managed care organization (MMCO), according to an Avalere analysis.
Insurance exchanges were set to launch October 1, but technical glitches and enrollment delays have plagued most exchanges.
The Centers for Medicare and Medicaid Services (CMS) posted the star ratings for 2014 Medicare Advantage (MA) and Part D plans on the Medicare.gov website. Avalere Health is available to answer questions about this new information.
On September 30, CMS posted revised gapfill prices for molecular pathology Current Procedural Terminology (CPT®) codes, including calculations of the 2014 National Limit Amounts (NLAs).
Express Scripts Inc., the world's largest PBM for employers and health plans, recently released a list of 44 drugs that they will now exclude from coverage beginning January 1, 2014.
As molecular diagnostics become more common in treating certain diseases - especially cancer - their reimbursement will be an important part of value messaging for many drug therapies.
Health insurance exchange marketplaces opened on October 1 for enrollment across the country, as well as premium subsidies for those with limited incomes.
Avalere Health is carefully analyzing the landscape file of health plan offerings on the federally-facilitated marketplace recently released by the Department of Health and Human Services (HHS).
Initial data suggest that exchange plans under the Affordable Care Act (ACA) will include high out-of-pocket costs for enrollees-including deductibles and cost-sharing for medical services and prescription drugs-before consumers reach their out-of-pocket maximum.
The 2014 market will be characterized by challenge and transformation across payers, providers, and patients which will create pressures for the pharmaceutical and medical device industries to:
To date, 24 states and the District of Columbia have committed to expanding Medicaid sometime in 2014.
Medicare Advantage HMO offerings grow while PPO and PFFS offerings are exiting the market. Analysis also shows significant variation in PDP premiums in 2014; five out of top 10 prescription drug plans have double digit increase
Comparative effectiveness research (CER) has the potential to inform many decisions. While a common threshold for determining whether a CER finding should be disseminated to the public is its methodological quality, a study with high methodological quality is not necessarily one that patients and providers will find usable for their decision making.
Today, the Centers for Medicare & Medicaid Services (CMS) released the 2014 landscape files containing data on plan participation, premiums and benefit designs for the Medicare Part D and Medicare Advantage (MA) markets.