Federal Policy
As the largest, single US healthcare payer, the government plays a dominant role in shaping the healthcare marketplace. Our experts track, interpret, and model federal policies that affect insurance coverage, access, and consumer choice so you can see around the bend.
Video: Medicare Part D, Part V: What’s Next for CMMI?
Tune into the fifth and final episode of the Avalere Health Essential Voice miniseries focused on Medicare Part D. In this segment, our experts discuss the Center for Medicare & Medicaid Innovation (CMMI) and its strategic direction for the coming year, particularly as it relates to the Part D program.
Podcast: Medicare Part D, Part V: What’s Next for CMMI?
Tune into the fifth and final episode of the Avalere Health Essential Voice miniseries focused on Medicare Part D. In this segment, our experts discuss the Center for Medicare & Medicaid Innovation (CMMI) and its strategic direction for the coming year, particularly as it relates to the Part D program.
More Medicare Advantage Plans Will Offer Non-Medical Benefits in 2022
New analysis from Avalere finds that in 2022 more Medicare Advantage plans will offer non-medical supplemental benefits, such as meals, nutrition, transportation, and in-home support services, at a $0 premium.
Video: Medicare Part D, Part IV: Budget Neutrality and Congressional Scoring
Tune into the fourth episode of the Avalere Health Essential Voice miniseries focused on Medicare Part D. In this segment, our experts discuss key elements of the legislative process, including pay-fors, budget neutrality, and congressional scoring.
Podcast: Medicare Part D, Part IV: Budget Neutrality and Congressional Scoring
Tune into the fourth episode of the Avalere Health Essential Voice miniseries focused on Medicare Part D. In this segment, our experts discuss key elements of the legislative process, including pay-fors, budget neutrality, and congressional scoring.
The Impact of ARPA Exchange Subsidies on Consumers Ages 50–64
Consumers ages 50–64 could see higher exchange premiums starting in 2023 without extension of ARPA subsidies.
Video: Medicare Part D, Part III: Impact of Policy Changes on Market Access
Tune into the third episode of the Avalere Health Essential Voice miniseries focused on Medicare Part D. In this segment, our experts discuss policy changes currently under consideration and how stakeholders can prepare for the potential market access impacts.
Podcast: Medicare Part D, Part III: Impact of Policy Changes on Market Access
Tune into the third episode of the Avalere Health Essential Voice miniseries focused on Medicare Part D. In this segment, our experts discuss policy changes currently under consideration and how stakeholders can prepare for the potential market access impacts.
Understanding the Seasonality of Part D Expenditures Under the OCM
In the OCM, a total cost-of-care model, episode-level Part D expenditures include the amount the government pays for low income cost-sharing subsidy and reinsurance for beneficiaries who reach the catastrophic portion of the benefit once they have accumulated sufficient OOP costs. The latter leads to a seasonality effect in how Part D payments are captured in OCM episodes, which may have implications for how trends in OCM performance are assessed over time and how the OCM benchmark price is constructed.
Video: Medicare Part D, Part II: Understanding Plan Decision-Making
Tune into the second episode of the Avalere Health Essential Voice miniseries focused on Medicare Part D. In this segment, our Policy and Market Access experts discuss how health plans make decisions, particularly formulary decisions, in Part D, and how specific markets influence those decisions.
Podcast: Medicare Part D, Part II: Understanding Plan Decision-Making
Tune into the second episode of the Avalere Health Essential Voice miniseries focused on Medicare Part D. In this segment, our Policy and Market Access experts discuss how health plans make decisions, particularly formulary decisions, in Part D, and how specific markets influence those decisions.
Podcast: Medicare Part D, Part I: Key Trends and Pressures
Tune into the first episode of the Avalere Health Essential Voice miniseries focused on Medicare Part D. In this segment, our Policy and Market Access experts discuss Part D trends and pressures in the currently evolving drug pricing environment.
Video: Medicare Part D, Part I: Key Trends and Pressures
Tune into the first episode of the Avalere Health Essential Voice miniseries focused on Medicare Part D. In this segment, our Policy and Market Access experts discuss Part D trends and pressures in the currently evolving drug pricing environment.
Part D Redesign Would Reduce OOP Costs Across Non-LIS Beneficiaries
New Avalere analysis finds Part D redesign via PDPRA would reduce average OOP costs by 23% for non-LIS beneficiaries, especially for certain drug classes and beneficiary groups by race and reason for entitlement.
Podcast: What’s Next for Health Policy on Capitol Hill?
Tune into another episode of Avalere Health Essential Voice. In this segment, Avalere policy expert Matt Kazan discusses what he expects to see from a legislative perspective this fall on Capitol Hill.
Video: What’s Next for Health Policy on Capitol Hill?
Tune into another episode of Avalere Health Essential Voice. In this segment, Avalere policy expert Matt Kazan discusses what he expects to see from a legislative perspective this fall on Capitol Hill.
Most Significant Healthcare Legislation Since ACA Possible this Fall
As Congress considers the bipartisan infrastructure package and budget reconciliation agenda, the coming months are likely to include debate on what could be the most significant federal healthcare legislation in over a decade. Additionally, the Biden administration is expected to release several important healthcare rules this fall, including the details necessary to implement the new law banning surprise billing and regulations to protect and strengthen Medicaid and the Affordable Care Act (ACA).
Ryan Urgo Joins Avalere Health as Managing Director
Seasoned health policy professional brings significant expertise in federal legislation, drug pricing policy, delivery system reform, and federal and state programs that affect insurance coverage.
Higher Gap Discount Payments for Employer Part D Plans
Avalere’s analysis shows differences in payments between employer and non-employer Part D plans.
4 Reasons to Watch PCORI’s Evolving Role in Healthcare Decision-Making
The Patient Centered Outcomes Research Institute (PCORI) recently announced an open comment period for a new set of proposed national priorities to inform its research agenda. Avalere analysis finds that from March 2019 to September 2020, PCORI directed roughly $259 million to comparative effectiveness research (CER) awards with an increasing share of new projects focused on drugs.
