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.
10 Key Healthcare Implications of the GA Senate Runoff Elections
The outcome of Georgia’s runoff election—resulting in a Democratic majority in the Senate—combined with the existing Democratic majority in the House and incoming Biden administration, significantly changes the policy outlook for 2021.
Medicare Covers More Part B Therapies for Breast Cancer than NHS England
Avalere analysis found that in 2017 and 2018, more than half (56%) of Medicare patients with breast cancer taking a medicine covered by Medicare Part B received a therapy that was not routinely covered by England’s National Health Service (NHS) or its Cancer Drug Fund (CDF).
COVID-19 Pandemic May Reduce MA Risk Scores and Payments
The COVID-19 pandemic has created significant challenges for all Americans, particularly for its most vulnerable populations, including the elderly and people with disabilities in Medicare. The Centers for Medicare & Medicaid Services (CMS) recently reported that 21% of fee-for-service (FFS) Medicare enrollees have stated they are forgoing non-COVID-19 related care due to the pandemic. Avalere conducted analyses to determine if a similar decrease in utilization is occurring in Medicare Advantage (MA) and assess the potential impact of deferred care on MA enrollees and plans.
Fewer Highly Rated MA Plans in 2021 than in 2020
On October 8, the Centers for Medicare & Medicaid Services (CMS) published their 2021 Star Ratings for Medicare Advantage (MA-PDs) and standalone Prescription Drug Plans (PDPs) on Medicare Plan Finder.
SCOTUS Overturn of the ACA May Invalidate Biosimilar Pathway
The 351(k) biosimilars pathway was legally established under the Biologics Price Competition and Innovation Act (BPCIA) provision of the Patient Protection and Affordable Care Act (ACA) of 2010. Since the passage of the ACA, 28 biosimilars have been approved by the Food & Drug Administration (FDA) along with the promulgation of policy that also applies to all biologics, including the creation of a suffix within the nonproprietary name of these products. Additionally, substantial case law has been made with respect to intellectual property pertaining to biologics. With the legality of the ACA currently under scrutiny, the future of BPCIA and biosimilars is uncertain.
Healthcare Implications of the 2020 Election Results
The 2020 presidential election will have significant implications for the US healthcare system and Americans’ healthcare options.
States Mitigate Potential Coverage Losses Ahead of ACA SCOTUS Ruling
With the US Supreme Court (SCOTUS) set to hear arguments starting November 10 in California v. Texas and the swearing in of Justice Amy Coney Barrett on October 26, questions remain regarding the future of the Affordable Care Act (ACA) and its impact on laws passed in at least 18 states creating coverage protections for essential health benefits (EHB) and coverage of pre-existing conditions.
Video: 2020 Election with Avalere: COVID-19 Stakeholder Impacts
Tune into our seventh video of the Avalere Health Essential Voice: Election 2020 series. As election day approaches, our experts share their thoughts on how the COVID surge has changed the campaigns’ closing arguments, the current outlook on a COVID relief package, and how the election results will affect individual stakeholders.
Interview: 2020 Election with Avalere: COVID-19 Stakeholder Impacts
Tune into our seventh episode of the Avalere Health Essential Voice: Election 2020 series. As election day approaches, our experts share their thoughts on how the COVID surge has changed the campaigns’ closing arguments, the current outlook on a COVID relief package, and how the election results will affect individual stakeholders.
Webinar: 2020 Election with Avalere: What’s at Stake for Healthcare Post-Election?
Avalere experts discussed how the 2020 election is influencing the future of healthcare.
Video: 2020 Election with Avalere: How Are Public Healthcare Programs Expanding?
Tune into our sixth video of the Avalere Health Essential Voice: 2020 Election series. In this segment, our experts discuss how we might see public healthcare programs expand under each candidate and what it might mean for future legislation.
Interview: 2020 Election with Avalere: How Are Public Healthcare Programs Expanding?
Tune into our sixth episode of the Avalere Health Essential Voice: 2020 Election series. In this segment, our experts discuss how we might see public healthcare programs expand under each candidate and what it might mean for future legislation.
MA Enrollees Can Access COVID-19 Supplemental Benefits in 2021
Medicare Advantage (MA) plans continue expanding coverage of supplemental benefits, including services related to the pandemic.
Interview: State Medicaid RFP Response Considerations and Watch Outs
Tune into another episode of Start Your Day with Avalere. In this segment, our health plan experts delve into the key actions, considerations, and watch outs of a successful Medicaid procurement, or re-procurement, response from both the state and health plan perspectives.
Part D Senior Savings Model Participation and Premiums Vary
New Avalere analysis finds higher premiums for the enhanced standalone drug plans participating in the model.
Step Therapy Can Lead to Higher OOP Costs for Crohn’s Disease Patients
Avalere analysis finds that patients with Crohn’s disease who experience a negative outcome when required to step through a plan’s preferred product may face higher upfront out-of-pocket (OOP) costs and could increase costs to payers.
Election Outcome Will Play Pivotal Role in State Healthcare Priorities
The outcomes of the 2020 elections will hold implications for state policymaking on key healthcare issues that could impact patients’ health insurance coverage status and how they access care.
Interview: 2020 Election with Avalere: SCOTUS ACA Outlook
Tune into our fifth episode of the Avalere Health Essential Voice: 2020 Election series. In this segment, our experts discuss the evolving makeup of the Supreme Court and the outlook on California vs. Texas — the upcoming Supreme Court case regarding the constitutionality of the Affordable Care Act and, in particular, the individual mandate.
Video: 2020 Election with Avalere: SCOTUS ACA Outlook
Tune into the fifth video of the Avalere Health Essential Voice: 2020 Election series. In this segment, our experts discuss the evolving makeup of the Supreme Court and the outlook on California vs. Texas — the upcoming Supreme Court case regarding the constitutionality of the Affordable Care Act and, in particular, the individual mandate.
Video: 2020 Election with Avalere: First Presidential Debate Healthcare Recap
Watch the fourth video in the Avalere Health Essential Voice: 2020 Election series. In this segment, our experts discuss top healthcare issues and platforms from the first Presidential debate, including the Affordable Care Act (ACA), COVID-19, public health, health disparities, and drug-pricing reform.