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.
GAO Finds Aggregate ACA-Based FUL Amount Similar to Drug Acquisition Costs, but Recommends Continued CMS Monitoring
The Government Accountability Office (GAO) released a report comparing ACA-based federal upper limit (FUL) amounts to National Average Drug Acquisition Cost (NADAC) amounts for 1,035 Medicaid-reimbursed outpatient drugs.
ACR Leads Effort to Encourage CMS to Open NCD on Lung Cancer Screening
The American College of Radiology (ACR) is leading a coalition to encourage CMS to open a national coverage determination (NCD) on lung cancer screening.
New Web Tool Shows Out-Of-Pocket Costs Are Highly Variable Under Marketplace Plans
NEWS RELEASE: PuttingPatientsFirst.net uses Avalere Health analytics to educate consumers about marketplace choices.
More Than 2 Million Individuals Enroll for Exchange Coverage
Despite the challenging exchange rollout, more than 1.8 million individuals signed up for exchange coverage in December alone, bringing total enrollment to 2.2 million during the first three months of open enrollment.
FDA Releases Draft Guidance on Fulfilling Regulatory Requirements for Postmarketing Submissions of Interactive Promotional Media for Prescription Drugs and Biologics
On Jan. 14, FDA issued draft guidance for industry called "Fulfilling Regulatory Requirements for Postmarketing Submissions of Interactive Promotional Media for Prescription Human and Animal Drugs and Biologics."
CMS to Disclose Physician Payment Data
On Jan. 14, HHS announced that it will begin responding to Freedom of Information Act requests for physician-payment information.
Analysis: Medicaid Plans Expected to Grow 20% This Year Under ACA Expansion
An analysis from Avalere Health finds that Medicaid managed care enrollment will increase by 20 percent from 2013 to 2014 and by 38 percent from 2013 to 2016.
CMS Issues CED for PILD, Reversing Previous Stance from Draft Decision
On Jan. 9, CMS released a final coverage decision restricting coverage of percutaneous image-guided lumbar decompression (PILD) for lumbar spinal stenosis to CMS-approved clinical trials.
Office of Inspector General Finds Local Coverage Determinations (LCDs) Create Inconsistency in Medicare Coverage
The HHS OIG released a report on the local coverage determination (LCD)-caused variation in coverage of Part B items and services.
MAP Report Provides Input on Marketplace Quality Reporting System
On Dec. 23, the Measure Applications Partnership (MAP), a public-private partnership tasked to provide HHS with pre-rulemaking input on measures included in federal programs, released a draft report offering guidance on the Qualified Health Plan (QHP) Quality Reporting System (QRS) for the Health Insurance Exchange Marketplaces proposed by CMS.
FDA Releases Final Guidance on Qualification Process for Drug Development Tools
On Jan. 6, FDA released final guidance outlining the qualification process for drug development tools (DDTs).
Proposed MA/Part D Rule Significantly Scales Back Protected Classes Policy for Plan Year 2015 and Beyond
On Jan. 6, CMS released a proposed rule seeking to implement key policy changes to the MA and Part D programs for Contract Year (CY) 2015.
Final Budget Act Allows Time for Full SGR Repeal in Q1 2014; Establishes a 0.5 Percent Update Factor for Physician Payment Through the End of March
On Dec. 26, President Obama signed into law a two-year budget resolution that reduces budget uncertainties through fiscal year (FY) 2015.
Brenda Huneycutt to Moderate FDA Panel at the 2014 Biotech Showcase in San Francisco
Join Avalere's Brenda Huneycutt, FDA Policy & Regulatory Strategy Practice, who will be moderating a panel with Avalere's Jenny Gaffney and other leading experts at the Biotech Showcase in San Francisco on Tuesday, January 14th at 8am, titled "FDA: where it's going and how it affects biotech."
Exchange Enrollment Steadily Increasing as IT Problems Addressed
On Dec. 1, the Administration re-launched Healthcare.gov after largely resolving the IT problems that plagued the site for the first two months of open enrollment.
Analysis: Exchange Formulary Structure More Similar To Part D Than Employer Coverage
An analysis from Avalere Health finds that most individuals in exchanges will face formularies with four or five cost-sharing tiers that commonly use coinsurance techniques for top-tier medications.
CMS Codifies Enrollment Deadline Delay
On Dec. 12, CMS released an interim final rule (IFR) codifying recently announced changes that permit consumers to enroll in health insurance coverage through an exchange as late as Dec. 23 for coverage effective Jan. 1, 2014.
ACO Educational Series – Leveraging Specialty Pharmacy in Accountable Care Organizations
Join Avalere, Armada and SPAARx for an educational series that examines the potential role of specialty pharmacies within Accountable Care Organizations (ACOs).
1.99 Million Individuals Have Been Determined Eligible for Medicaid or CHIP Since Oct. 1
As of Dec. 11, 1.99 million individuals were determined or assessed eligible for Medicaid or the Children's Health Insurance Program (CHIP).
Analysis: Consumer Deductibles Vary Significantly Across Exchange Plans
NEWS RELEASE: An analysis by Avalere Health finds that consumers who enroll in exchange plans will, on average, face dramatically different deductibles based on the metallic level plan (i.e., bronze, silver, gold, platinum).