An updated Avalere analysis examines Medicare Part D plan tier placement of generic prescription drugs, finding that over time their percentage on generic tiers has declined from 65% in 2016 to 43% in 2022.

• Alessandra Fix
• Jacob Brennan
• Shruthi Donthi
• Massey Whorley

To fully realize the benefits of home-based care, including improved outcomes, inpatient hospital capacity, and patient experience, state and federal regulators may consider formalizing regulatory flexibilities, removing current barriers to participation in models such as Acute Hospital Care at Home, and testing the impacts of these waivers under the Center for Medicare & Medicaid Innovation (CMMI).

• Lauren Cricchi
• Sarah Alwardt

New analysis finds that just over 40,000 Medicare Fee-for-Service (FFS) patients with end-stage renal disease (ESRD) elected to enroll in Medicare Advantage (MA) during the 2021 open enrollment period—the first time all ESRD patients had access to an MA plan. This enrollment shift increased the proportion of ESRD patients enrolled in MA from 23% to 30%.

• Matt Kazan
• Mark Gooding
• Thomas Kornfield

An Avalere analysis found differences in the performance of low- and high-intensity prostate cancer episodes in the Oncology Care Model (OCM). High-intensity prostate cancer episode expenditures were consistently below the benchmark price while low-intensity episode expenditures were similar to the benchmark price. This finding is likely driven by the Centers for Medicare & Medicaid Services (CMS) methodology used to calculate benchmark prices but may also indicate participant success in controlling costs for these episodes.

• Madison Davidson
• Brook Getachew
• Shalini Parekh
• Melissa Morley
• Omar Hafez
• Lance Grady

Congress would operationalize Medicare negotiation for Part B drugs as outlined in the Build Back Better Act (BBBA) by cutting drug reimbursement to providers, which raises 4 potential downstream implications

• Milena Sullivan
• Ryan Urgo
• Kent McKinney
• Ekemini Isaiah

An Avalere analysis determined that Medicare Fee-for-Service (FFS) patients who received personal care services experienced a decrease in Medicare expenditures over time when compared to a statistically comparable control group comprising patients who did not receive the same level of personalized care. The reduction in spend was specific to a subset of chronic conditions that were targeted operationally for intervention and case management.

• Nathan Markward
• Natascha Dixon Edelin

New Avalere analysis finds that 3 proposals to redesign the Part D benefit would lead to larger increases in mandatory manufacturer discounts on brand drugs within the Part D “6 protected classes” compared to brand Part D drugs overall. Mandatory manufacturer discounts within the protected classes would increase by 661%, 301%, and 409% across the 3 proposals evaluated, compared to 153%, 63%, and 64% for Part D drugs overall.

• Ryan Urgo
• Grecia Marrufo
• Miryam Frieder
• Rebecca Yip
• Shruthi Donthi

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.

• Thomas Kornfield
• Alessandra Fix
• Robin Duddy-Tenbrunsel
• Shruthi Donthi
• Brooke Fruman

Consumers ages 50–64 could see higher exchange premiums starting in 2023 without extension of ARPA subsidies.

• Massey Whorley
• Myra Simon
• Richard Hamilton