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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.

Shalini Parekh

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.

Anjali Chhatre

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).

Milena Sullivan

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.

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