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.
New Avalere research finds that health plan members enrolled in plans that cover abuse-deterrent formulations (ADFs) of opioids have a lower risk of opioid abuse (OA) and overdose (OD) and lower opioid abuse-related hospitalizations than people in plans that do not offer coverage of ADF opioids.
Shift in clinical practice as far back as 30 years ago planted the seeds for the current opioid epidemic. New research by Avalere Health finds that between the mid-1980s and 1990s, individual pharmaceutical manufacturers, national scientific bodies, and professional societies began a push to treat pain more aggressively.
On October 25, Avalere experts came together to discuss the latest policy developments related to drugs.
Transformative medicines, like gene and cell therapies, are beginning to be approved in the US, and more are expected to come.
New Avalere study entitled “Using Aggregate Data to Proxy Individual-Level Socioeconomic Characteristics in Research on Medication Adherence: 9-Digit ZIP Code vs. Census Block Group” selected for the AMCP Foundation Best Poster Award at AMCP Nexus 2018.
Our analysis finds there will be winners and losers at the plan level under the new models.
With the 2018 mid-term elections weeks away, polls show healthcare is a top issue on the minds of voters.
Join Avalere experts for our analysis of CMS’ 2019 Star Ratings and a look at what’s to come for 2020 on our webinar on November 1, 2018.
Today, Alzheimer’s & Dementia: The Journal of the Alzheimer’s Association published appropriate use criteria (AUC) to guide the use of lumbar puncture (LP) and cerebrospinal fluid (CSF) analysis for use in the diagnosis of Alzheimer’s disease.
On September 22, California became the sixth state to limit or ban short-term limited-duration insurance (STLDI) plans.
Findings from a new Avalere study, titled “Prevalence and Likelihood of Hospital Admission and Readmission in Patients with Serious Mental Illness,” were presented at the International Society of Pharmacoeconomics and Outcomes Research (ISPOR) Asia Pacific conference on Sunday, September 9, 2018.
Following its recent announcement to grant Medicare Advantage (MA) plans the flexibility to use step therapy techniques for Part B drugs beginning in January 2019, the Centers for Medicare & Medicaid Services (CMS) released an FAQ with additional guidance on its implementation.
Under an indication-based formulary design approach, Part D plans will be able to tailor the drugs that are on their formulary by indication.
Reforms to “eliminate rebates” could have varying impacts based on features of their design.
Beginning in January 2019, Medicare Advantage (MA) plans will have the flexibility to use step-therapy techniques for Part B drugs, according to a CMS memo released on August 7.
In its proposed changes to the Medicare Physician Fee Schedule (MPFS) for Calendar Year 2019 (CY2019), the Centers for Medicare & Medicaid Services (CMS) proposes a potentially sweeping change to the way it values physician office and outpatient visits, also known as Evaluation & Management (E/M) codes.
Early adoption and participation in an AAPM can provide a higher incentive payment to Medicare clinicians than MIPS.
Earlier this week, the Food & Drug Administration (FDA) released a Part 15 public hearing announcement and request for comment on how the FDA can facilitate greater availability while balancing competition and innovation for all biologics.
Although malnutrition can lead to greater risk of chronic disease, frailty, and disability, and increases healthcare costs, patients’ nutrition status is rarely evaluated and managed as they transition across care settings.
ICER’s reliance on the average number of FDA drug approvals to calculate budget impact thresholds leads to significant variability.