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: Medicare Advantage and Part D Advance Notice: Proposed Payment Changes
Avalere expert Sean Creighton explains key policy changes proposed in the Advance Notice for Medicare Advantage and Part D Payment for Plan Year 2024.
MA RADV Policy Changes Raise Questions for Plans
Policy changes included in the final MA RADV rule will substantially affect the MA program, plan benefit design, and operations.
2024 Advance Notice Would Substantially Alter Risk Adjustment Model
Proposed technical changes to the MA risk adjustment model would have major implications if finalized.
Video: Plan and Beneficiary Responses to IRA Policies
Avalere expert Rebecca Yip discussed plan and beneficiary responses to IRA policies during our 2023 Outlook webinar.
5 Ways the IRA Will Impact Healthcare Investors in 2023 and Beyond
The IRA’s drug price negotiation policies, extended marketplace subsidies, and Part D redesign will impact investors’ current portfolios and investment strategy in the future.
Some Enrollees May Face Affordability Challenges Under Part D Redesign
An Avalere analysis finds that about 800,000 beneficiaries in 2024 and 200,000 in 2025 will have OOP costs that exceed 10% of their annual income.
What to Expect in the Final Medicare Advantage RADV Rule
CMS is expected to publish a final MA RADV rule by February 1. Policy changes could have a substantial impact on 2024 bids, plan benefit design, and operations.
340B Drug Payment Increase Would Reduce Most Hospitals’ Part B Pay
Avalere analysis shows that a CMS policy to increase payment for 340B drugs, compared to alternative approaches, will result in lower payment to most hospitals.
Avalere Health Announces Addition of Kelsey Lang to Policy Practice
The veteran health policy professional brings expertise in coverage, access, and reimbursement and experience working with providers, plans, and manufacturers.
Video: Innovative Partnerships in Medicare
In this video, Manoj Pawar, Chief Medical Officer of Mutual of Omaha, joins Avalere experts to discuss their recent partnership on a project that sought to identify innovative ways to use data to inform payer/provider partnerships in the Medicare program.
Video: 2022 Midterm Elections Recap: What’s Next for Healthcare Policy?
Join Avalere experts Elizabeth Carpenter and Matt Kazan for a discussion on the 2022 midterm election results and what to watch for future healthcare legislation.
States Set 2023 Legislative Priorities Amid New Federal Landscape
Most states will begin new legislative sessions in 2023. Drug pricing, patient affordability, and coverage protection will be priorities in many states.
Precision in EOM Methodology Has Implications for EOM Decision Making
The EOM prediction model and benchmarking methodology are more precise than that of the OCM, which will heighten the ability of participants to directly manage costs, including oncolytic spend.
Medicaid Expansion Map
Since passage of the Affordable Care Act (ACA), 39 states and DC have expanded Medicaid. Some of the remaining states may reconsider expansion given new federal funding incentives.
Part D Out-of-Pocket Smoothing Policy Raises Implementation Questions
Implementation of the OOP smoothing program will require additional clarity from the Centers for Medicare & Medicaid Services (CMS) on elements that will affect beneficiary experience, access, and overall sustainability of the smoothing program.
Navigating the Post-PHE Telehealth Policy Landscape
The end of the public health emergency (PHE) raises policy questions around implications for reimbursement, patient access, and operationalization of telehealth service delivery.
Medicare Waste Refunds Could Cost Manufacturers Over $210M Annually
Forty-four Part B drugs could be subject to new CMS wastage refund requirements according to an Avalere analysis of Medicare claims.
CMS Requests Input on Payment Policy for New ESRD Therapies
Recent Medicare rulemaking requested stakeholder feedback on potential payment system changes to support access to therapies for patients on dialysis.
What Braidwood Management v. Becerra Means for Preventive Services
The court’s ruling could impact $0 cost-sharing coverage of PrEP and other USPSTF-recommended services.
Interview: NCDs, Part III: Agency Mandates, Decisions, Coverage and Access
Tune into the third episode in the Avalere Health Essential Voice podcast series focused on Agency decisions define patient access. In this segment, our experts continue the conversation around national coverage determinations (NCDs) by considering how potential policy and market catalysts 3 to 5 years out may help stakeholders think through opportunities and risks at key decision points ranging from early in development to implications for Part D.