Federal and State Policy

As the largest US healthcare payer, the federal government plays a dominant role in shaping the healthcare marketplace, while states take center stage when it comes to developing novel policy approaches. Our experts track, interpret, and model policies that affect insurance coverage, access, and consumer choice so you can see around the bend.

Milena Sullivan

Opportunities to Prepare for Year 2 of Medicare Negotiation

Manufacturers anticipating potential selection or therapeutic impact for 2027 Medicare negotiations should begin preparations and align internal decision-making, applying learnings from Year 1.

Video: The Evolution of Value Requirements

Ahead of Asembia 2024, Avalere experts discuss the evolution of biopharmaceutical value requirements and how organizations will need to evolve their business models accordingly.

Emily Belowich

2024: An Era of Innovation and Disruption in Kidney Care

A dynamic regulatory landscape, technological advancements, and investments in R&D offer new opportunities and challenges in kidney care.

Robin Duddy-Tenbrunsel

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.

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.

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.

Michael Lutz

Webinar: Decoding the CY 2025 Advance Notice

Join Avalere’s healthcare policy experts as they dissect the Advance Notice of Methodological Changes for CY 2025 for Medicare Advantage (MA) Capitation Rates and Part C and Part D Payment Policies and discuss the future trajectory of Medicare Advantage (MA) in Part D and potential outcomes, headwinds, and tailwinds for health plans.

Kolton Gustafson

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.

Ekemini Isaiah

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.

Shalini Parekh

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.

Nicole Meyerson

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.

Mark Gooding

ESRD Enrollment in MA Now Exceeds 30% of Dialysis Patients

New analysis finds that just over 40,000 Medicare FFS patients with end-stage renal disease (ESRD) elected to enroll in Medicare Advantage 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%.

Sign up to receive more insights about Federal and State Policy
Please enter your email address to be notified when new Federal and State Policy insights are published.

Back To Top