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: 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.
Analysis of CMMI Models Projects Costs Rather than Savings
Avalere estimates that the CMMI will produce net costs of approximately $9.4 billion through 2026, in contrast to the CBO’s projected net savings of $34 billion.
Overview and Implications of CMS’s Proposed Changes to MA RADV
If finalized as proposed, the changes to the Risk Adjustment Data Validation process could have a substantial impact on Medicare Advantage plans and enrollees.
Value-Based Pricing and Payment Expert Joins Avalere
Veteran health policy professional brings deep expertise in value assessment, pharmaceutical value-based pricing, and payment reform.
Webinar: Preparing for Legislative Change and Connecting Equity and Outcomes
Join us for a live, expert discussion on life sciences industry trends to watch in Q4.
Drug Pricing Policies Under Inflation Reduction Act Raise Operational Questions
Understanding where federal agencies will make key determinations on details of the IRA’s policies will be crucial for stakeholders seeking to shape implementation and prepare for their impact.
Medicaid Coverage Processes for Innovative Therapies Vary by State
Avalere research finds that state Medicaid programs have taken a variety of approaches to coverage policy development for innovative therapies, highlighting opportunities for increased consistency and transparency.
Video: Medicare Advantage, Part III: Performance Measures and STAR Ratings
Tune into the third episode in our video series focused on Medicare Advantage. In this segment, Avalere quality measures experts, Michael Lutz and Taylor Musser, discuss the shift toward member-reported measures and implications of recent measure reporting methodology updates.
Video: Medicare Advantage, Part II: Influencing CMS Policy
Tune into the second episode in our video series focused on Medicare Advantage. In this segment, Avalere experts and former Center for Medicaid and Medicare (CMS) employees Sean Creighton and Tom Kornfield discuss their thoughts on the best ways for health plans to influence CMS decision making, including timing of engagement and critical messaging elements.
Video: Medicare Advantage, Part I: The Future of MA
Tune into the first episode in our video series focused on Medicare Advantage. In this segment, Avalere experts and former Centers for Medicare & Medicaid Services (CMS) employees, Sean Creighton and Tom Kornfield, discuss the outlook for Medicare Advantage, factors that will influence growth of the program, and a behind-the-scenes look at CMS policymaking considerations.
Video: NCDs, Part II: Evidence Development to Fulfill CED Requirements
Tune into the second episode in the Avalere Health Essential Voice podcast series focused on the how CMS and Medicare coverage decisions define patient access. In this segment, our experts continue the conversation around national coverage determinations (NCDs)that have coverage with evidence development (CED) requirements, how FDA and CMS’s evidence questions can be complimentary, and the ways in which manufacturer evidence generation plans can address those goals, using the NCD on monoclonal antibodies for Alzheimer's disease as an example.
Survey: Health Policy Experts Expect BBBA Passage Before Midterms
Avalere Policy Edge survey of bipartisan Congressional and health policy experts suggests the Build Back Better Act (BBBA) will likely pass in 2022.
SCOTUS Ruling and Other Trends May Shape the 340B Policy Landscape
The SCOTUS decision is the most prominent action related to the 340B program, but ongoing litigation among stakeholders and growing activity at the state level are catalyzing developments that could shape the 340B landscape
Political Realities Require Trade-Offs from Democrats on Skinny BBBA
As Democrats seek consensus on a "skinny BBBA," concerns over inflation and deficit reduction will place greater emphasis on "pay-for" targets to advance healthcare priorities.
Video: NCDs, Part I: Overview of NCDs, CED, and Potential Access Barriers
Tune into the first episode in the Avalere Health Essential Voice podcast series focused on how CMS and Medicare coverage decisions define patient access. In this segment, our Market Access experts discuss national coverage determinations (NCDs), specifically those with coverage with evidence development (CED), their impacts to patient access, and considerations for life sciences companies.
Interview: NCDs, Part I: Overview of NCDs, CED, and Potential Access Barriers
Tune into the first episode in the Avalere Health Essential Voice podcast series focused on how CMS and Medicare coverage decisions define patient access. In this segment, our Market Access experts discuss national coverage determinations (NCDs), specifically those with coverage with evidence development (CED), their impacts to patient access, and considerations for life sciences companies.
How Statutory Management of Healthcare Inflation Impacts Providers
The cost of medical goods and services has risen faster than general inflation while physician payment has not. Management of healthcare inflation reduces providers’ power in the market.
White-Bagging Legislation Gains Popularity in State Legislatures
In recent years, payers and pharmacy benefit managers (PBMs) have been interested in implementing strategies that may reduce overall costs, such as the use of white bagging. However, provider and patient groups have raised concerns that these tactics may create access to care, cost, and safety issues. Legislation seeking to regulate this practice is on the rise in many state legislatures.
340B Hospital Child Sites and Contract Pharmacy Demographics
Avalere analysis finds that 340B child sites and contract pharmacies are often located in less diverse and higher income ZIP codes than their disproportionate share hospital parent entities.
Enrollment in MA Plans with SSBCI Nearly Quadrupled Since 2020
In 2022, nearly 4.5 million beneficiaries are in Medicare Advantage (MA) plans offering Special Supplemental Benefits for the Chronically Ill (SSBCI), compared to 1.2 million in 2020, the first year these benefits were available.