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.
PREVENT Act Creates Opportunities for Life Sciences
The COVID-19 pandemic identified gaps in US public health infrastructure and resources, prompting policy proposals and opportunities for stakeholder engagement.
3 Ways Manufacturers Can Prepare for New 2023 Discarded Drug Rebate
As manufacturers prepare for discarded drug rebates to begin in 2023, an Avalere analysis identified 39 drugs at risk for rebates totaling $151 million.
Webinar: CMS Final Rate Announcement: How Should Plans Prepare?
Join Avalere’s healthcare policy experts for an analysis of the final rate announcement and a discussion on the future of Medicare Advantage (MA) and potential outcomes for health plans.
Interview: Exploring the Kidney Care Environment, Part II: Policy and Payment Trends
Tune into the second episode in the Avalere Health Essential Voice podcast miniseries focused on the evolving kidney care landscape. In this segment, our Market Access and Policy experts take a deeper dive into several of the policy and payment trends in the kidney disease space.
Video: Exploring the Kidney Care Environment, Part II: Policy and Payment Trends
Tune into the second episode in the Avalere Health Essential Voice podcast miniseries focused on the evolving kidney care landscape. In this segment, our Market Access and Policy experts take a deeper dive into several of the policy and payment trends in the kidney disease space.
Video: Exploring the Kidney Care Environment: Key Players, Treatment, and Payment Systems
Tune into the first episode in the Avalere Health Essential Voice podcast miniseries focused on the evolving kidney care landscape. In this segment, our Market Access experts discuss the kidney disease patient population as well as treatment and payment systems this space.
Interview: Exploring the Kidney Care Environment: Key Players, Treatment, and Payment Systems
Tune into the first episode in the Avalere Health Essential Voice podcast miniseries focused on the evolving kidney care landscape. In this segment, our Market Access experts discuss the kidney disease patient population as well as treatment and payment systems this space.
Sean Creighton Strengthens Avalere’s Health Plan Team
Sean brings more than 2 decades of Medicare Advantage experience in industry and government.
Looming Deadlines Could Trigger Congressional Action on Healthcare
Congressional Democrats have indicated interest in a slimmed-down BBBA alternative that could pass the Senate. Pending deadlines and the expiration of ARPA subsidies may create impetus for Democrats to act on legislative health care priorities in 2022.
57% of Generic Drugs Are Not on 2022 Part D Generic Tiers
An updated Avalere analysis examines Medicare Part D plan tier placement of generic prescription drugs, finding that over time their percentage on generic tiers has declined from 65% in 2016 to 43% in 2022.
Home-Based Care Leaders Offer Solutions to Access Hurdles
To fully realize the benefits of home-based care, including improved outcomes, inpatient hospital capacity, and patient experience, state and federal regulators may consider formalizing regulatory flexibilities, removing current barriers to participation in models such as Acute Hospital Care at Home, and testing the impacts of these waivers under the Center for Medicare & Medicaid Innovation (CMMI).
High-Intensity Prostate Cancer Costs Consistently Below OCM Benchmark
An Avalere analysis found differences in the performance of low- and high-intensity prostate cancer episodes in the Oncology Care Model (OCM). High-intensity prostate cancer episode expenditures were consistently below the benchmark price while low-intensity episode expenditures were similar to the benchmark price. This finding is likely driven by the Centers for Medicare & Medicaid Services (CMS) methodology used to calculate benchmark prices but may also indicate participant success in controlling costs for these episodes.
BBBA Negotiation for Part B Drugs Raises Operational Questions
Congress would operationalize Medicare negotiation for Part B drugs as outlined in the Build Back Better Act (BBBA) by cutting drug reimbursement to providers, which raises 4 potential downstream implications
Video: HIV/AIDS Prevention and Treatment, Part II
Tune into another episode of Avalere Health Essential Voice. In this segment, we welcome leaders from the National Alliance of State & Territorial AIDS Directors (NASTAD) to discuss how HIV state policies have changed in light of advancements in prevention and treatment, and the key to ending the HIV and viral hepatitis epidemics in the US.
Interview: HIV/AIDS Prevention and Treatment, Part II
Tune into another episode of Avalere Health Essential Voice. In this segment, we welcome leaders from the National Alliance of State & Territorial AIDS Directors (NASTAD) to discuss how HIV state policies have changed in light of advancements in prevention and treatment, and the key to ending the HIV and viral hepatitis epidemics in the US.
Jessica Alessio Brings Revenue Cycle Expertise to Avalere Health
New hire brings years of access, reimbursement, and revenue-cycle experience, strengthening Avalere's Market Access practice.
Home Care Services Reduce Medicare Spending for 30 Chronic Conditions
An Avalere analysis determined that Medicare Fee-for-Service (FFS) patients who received personal care services experienced a decrease in Medicare expenditures over time when compared to a statistically comparable control group comprising patients who did not receive the same level of personalized care. The reduction in spend was specific to a subset of chronic conditions that were targeted operationally for intervention and case management.
Video: World AIDS Day: HIV/AIDS Prevention and Treatment
Tune into another episode of Avalere Health Essential Voice. In this segment, we welcome Carl Schmid, Executive Director at the HIV + Hepatitis Policy Institute, to discuss how HIV prevention and treatment policy influence broader health policy issues as we commemorate World AIDS Day on December 1.
Interview: World AIDS Day: HIV/AIDS Prevention and Treatment
Tune into another episode of Avalere Health Essential Voice. In this segment, we welcome Carl Schmid, Executive Director at the HIV + Hepatitis Policy Institute, to discuss how HIV prevention and treatment policy influence broader health policy issues as we commemorate World AIDS Day on December 1.
Part D Redesign Impact on Manufacturer Discounts in Protected Classes
New Avalere analysis finds that 3 proposals to redesign the Part D benefit would lead to larger increases in mandatory manufacturer discounts on brand drugs within the Part D “6 protected classes” compared to brand Part D drugs overall. Mandatory manufacturer discounts within the protected classes would increase by 661%, 301%, and 409% across the 3 proposals evaluated, compared to 153%, 63%, and 64% for Part D drugs overall.