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.
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A Collaborative Approach to Incorporating AI in RWE
Stakeholders can collaborate to ensure the safe, ethical, and effective use of AI-based tools to bolster RWE and improve patient outcomes.
CMS Creates New Codes to Reimburse for Navigation Services
Newly developed HCPCS codes will support increased access to oncology navigation services, which have been shown to improve patient outcomes.
Repercussions of Cyberattack on Change Healthcare
A major cyberattack has disrupted medical and pharmacy claims processing and is expected to impact how medical claims are submitted and paid in the future.
Trends in Risk Adjustment Coding Operations
Plans adapt to market changes in risk adjustment coding. Interviews with plan professionals reveal three trends for efficiency, effectiveness, and compliance.
Specialty Pharmacies Adapt to Support Cell and Gene Therapies
Specialty pharmacies are evolving to support the unique distribution requirements of CGTs and the complex patient journey from diagnosis to treatment.
Redefining D-SNP Look-Alikes Would Impact Enrollment
If CMS lowers the dual-eligible enrollment threshold it uses to define D-SNP look-alikes, the demographics in look-alike plan enrollment will likely change.
eBook: Rare Disease Biotechnology Landscape
In an eBook, Avalere and Avalere Health experts describe the policy, market access, and evidence landscape of rare disease in the United States and globally.
Part D Risk Adjustment Will Have New Importance Under IRA
Analysis of data in the CMS VRDC shows that MA-PD utilization has steadily increased in therapeutic areas likely to have large increases in plan liability under Part D redesign.
Newest Standards of Care Continue to Reflect Advances in Diabetes Technology
Continued emphasis on diabetes management technology and patient-centered care in updated clinical management standards highlight the importance of advancing quality measurement.
Over Half of Generic Drugs Are Not on Part D Generic Tiers
In recent years, Medicare Part D plan tier placement of generic prescription drugs has declined, from 64.5% in 2016 to 43.8% in 2024.
Cervical Cancer Screening Rates Differ Across Demographics
The majority of women are not receiving cervical cancer screenings in compliance with recommendations, with disparities by insurance and age.
Drug Repurposing: Potential to Expand Rare Disease Treatment
Drug repurposing offers developers an opportunity to bring treatment options to patients at a reduced cost and shortened timelines, although challenges exist.
Medicare Nebulizer Use for COPD Differs by Race/Ethnicity
Rates of filled prescriptions for nebulizers in Medicare FFS vary across factors such as age, disability, and race/ethnicity.
Limb Loss and Limb Difference: US Prevalence and Impact
Avalere and the Amputee Coalition analyzed claims data to understand the prevalence of limb loss and limb difference and the implications for public policy.
Understanding the CMS Cell and Gene Therapy Access Model
The CGT Access Model will allow CMS to negotiate outcomes-based agreements on behalf of state Medicaid programs for CGTs, beginning with sickle cell disease.
Proposed Revisions to Part D Risk Adjustment Model in 2025
Due to increasing the portion of plan payments subject to risk adjustments in 2025, CMS proposed aligning the risk adjustment model with Part D redesign.
Charting Change: CPT Coding and Remote Monitoring
The AMA’s upcoming CPT Editorial Panel meeting on coding and billing for remote monitoring will shape the future of digital health technology.
Status of US Prescription Drug Importation Pathways
Recent FDA authorization of Florida’s Section 804 Importation Program has prompted increased focus on importation pathways.
Assessment of Proposals to Address Drug Shortages
Drug shortages have consequences for a broad range of stakeholders, and policy proposals vary in their ability to address negative impacts.
Wrap Up: Top Trends in Health Economics and Outcomes Research
Avalere analyzed the top trends in HEOR and key implications for life sciences companies to consider for future strategic planning.