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.
Video: IRA Impacts on Market Access Strategy
Ahead of Asembia 2024, Avalere market access experts discuss the potential impacts of IRA provisions, including Part D redesign and Medicare drug price negotiation, on go-to-market and contracting strategy.
CMS’s Interpretation of “Qualifying Single-Source Drugs” in Medicare Negotiation
CMS’s definition of a “qualifying single-source drug” in the Medicare Drug Price Negotiation Program may impact manufacturers’ investment strategies.
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: Mitigating and Preventing Drug Shortages
Avalere experts provide insights on the dynamics and policy proposals surrounding recent drug shortages.
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.
Research Explores Health Plan Perceptions of PDABs and UPLs
Avalere assessed how health plans may view UPLs, including implementation considerations and impacts on providers and patients (e.g., plan benefit design).
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.
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.
Video: How Policies Shape the Rare Disease Treatment Landscape
In this installment of our 2024 Trends Influencing Rare Disease series, Avalere experts explore policies shaping rare disease drug development and access.
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.
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.
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.
Video: Impacts of Inflation Reduction Act on Patient Behavior and Affordability
Avalere experts are joined by Kevin L. Hagan, President of the PAN Foundation, to discuss their findings on the impacts of the Inflation Reduction Act’s Part D benefit redesign on patient utilization and affordability.
Proposed Changes to Best Price Could Shift Market Dynamics for Stakeholders
The MDRP proposed rule's Best Price "stacking' provision has direct and indirect impacts on Medicaid rebate liability across drug classes.
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.
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.
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.
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%.
CBO Considers Cost of Increasing Anti-Obesity Medication Use
Insurance coverage of anti-obesity medications is increasing, but patient access under Medicare remains uncertain.