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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After a Rare Disease Diagnosis, Patient Utilization Rises
Healthcare resource utilization increased for Medicare FFS patients following diagnosis of an ill-defined rare disease.
Variation in Autoimmune Payer Mix Drives Channel Strategy
Variation in mix of payer coverage across autoimmune diseases highlights the need for manufacturers to assess patient payer mix to support channels of access.
CMS Site-Neutral Payments Affect Small Share of Spending
Payments to off-campus hospital sites affected by site-neutral payment policy amount to only 2.3% of Medicare outpatient spending.
Top HEOR Trends: Quantifying Indirect Burden and Measuring Novel Elements of Value
Avalere experts dive into Trend #10: Quantifying Indirect Burden and Measuring Novel Elements of Value and discuss its evolving nature.
Assessing the Total Economic Burden of Rare Disease
Innovative research methods can be used to measure the total burden of rare disease, including direct medical costs, indirect costs, and overall life impacts.
Use of Dispense as Written Codes After Generic Entry
Analysis of Dispense as Written codes highlight that many factors influence stakeholder preferences for brand or generic drugs after loss of exclusivity.
2023 Top Trends in HEOR: Policy’s Pressure on HEOR
Avalere experts dive into Trend #9: Policy’s Pressure on HEOR and explore implications of recent policy developments on evidence strategies.
Proposed Changes to Best Price Could Shift Market Dynamics for Stakeholders
The MDRP proposed rule's Best Price "stacking' provision has direct and indirect impacts on Medicaid rebate liability across drug classes.
States Will Prioritize Drug Affordability and Access in 2024
States will commence legislative sessions at the beginning of January. Drug pricing, including payment limits and reference pricing, as well as improved access will be key priorities.
States May Consider 340B Legislative Proposals in 2024
In preparation for the 2024 state legislative sessions, stakeholders should consider how states will continue to shape the 340B policy landscape.
Complete Response Letters: Implications for Product Access
Receiving a complete response letter is not a rejection, but it introduces important business questions for product launch planning.
2023 Top HEOR Trends: HEOR as a Differentiator vs. Commodity
Avalere experts dive into Trend #8: HEOR as a Differentiator vs. a Commodity and explore the need for tailored evidence generation planning.
Reevaluating Value Assessment for HEOR in 2023
Avalere identified the top trends in HEOR. In this Insight, Avalere experts dive into Trend #7: Value Assessment, and explore important considerations for stakeholders in utilizing this vital tool.
IRA Reforms Will Impact Patient Adherence and Affordability
With increased patient utilization and plan formulary responses to Part D redesign, many patients may still face affordability challenges under the IRA.
Potential Disparities in Home Dialysis Use
An analysis presented at ASN’s Kidney Week 2023 found lower rates of home dialysis utilization among Medicare dual eligibles compared to non-dual eligibles.
Medicare HI Trust Fund Solvency Assuming MA Utilization
The Hospital Insurance Trust Fund would remain solvent until 2048 if FFS utilization levels were similar to Medicare Advantage utilization levels.
IRA Negotiation Creates Ripple Effects Across Drug Markets
Medicare negotiation has ripple effects across therapeutic markets, requiring manufacturers to reassess strategies to stay ahead of the changing drug landscape.
FDA Supply Chain and Quality Balancing Act: What’s Next?
The industry should expect and prepare for changes to regulatory oversight of drug supply chains and quality.
Health Spending Varies for Patients Likely to Have Obesity
Among Medicare FFS beneficiaries with diagnoses that are indicative of obesity, total healthcare spending rises dramatically as BMI group increases.
State of the GRACE Framework: ICER Pilots for HTAs
ICER recently proposed piloting the GRACE framework in place of traditional cost-effectiveness analysis. We review the background of GRACE and its implications.