Federal & State Policy
As the largest, single US healthcare payer, the government plays a dominant role in shaping the healthcare marketplace. Our experts track, interpret, and model federal and state policies that affect insurance coverage, access, and consumer choice so you can see around the bend.
Featured Content
Podcast: E2 – What the Elections Might Mean for the Drug Pricing Debate
Between now and November, Avalere will to bring election content, including podcasts to the public dialogue. Our experts provide a quick glimpse into the role healthcare will play in the 2016 elections and hot topics you can expect to hear about on the campaign trail
UPDATE: Early Analysis Finds 2017 Proposed Exchange Premiums for Low Cost Silver Plans Increasing 8 Percent on Average
Rates vary widely by state; popular low cost options see smaller increases.
Podcast: An Overview of FDA’s Expanded Access Guidances
Listen as our expert, Jay Jackson, discusses recent final guidance issued by the FDA on compassionate use.
Snapshot of Gubernatorial Elections and Outlooks
Recently, Avalere took a look at the gubernatorial elections happening this year, their outlooks, and where they stand on the Exchanges and the Medicaid expansion.
Podcast: E1 – An Introduction to the 2016 Election Series
Between now and November, Avalere will to bring election content—including podcasts—to the public dialogue. Our experts provide a glimpse into the role healthcare will play in the 2016 elections and hot topics you can expect to hear about on the campaign trail.
MedPAC Proposes Changes for 42 Million Medicare Beneficiaries Enrolled in Part D
Cost-sharing changes could increase costs for many beneficiaries.
CORRECTION: Early Analysis Finds 2017 Proposed Exchange Rates Exceed 2016 Increases But Vary Widely By State
Popular low cost options see smaller increases.
Medicare Advantage: 2016 National Snapshot
In 2016, more than 18 of 56 million Medicare beneficiaries receive their benefits from Medicare Advantage (MA) plans. MA plans are private managed care organizations that contract with the federal government to coordinate care for Medicare beneficiaries.
13 Million Adults Could Be Eligible to Purchase Medicare Coverage Under Proposed Clinton Plan
A new Avalere analysis finds that nearly 13 million Americans age 50 or over who are currently uninsured or have individual coverage purchased through the private market-inside and outside the exchange- could be eligible to buy-in to the Medicare program under a plan proposed by Democratic presidential candidate Hillary Clinton.
A Conversation on Prescription Drug Pricing
As the discussion intensifies, one of Avalere's experts provides keen observations on what you need to know about this topic.
2016 Exchange Plans Improve Access to Medicines Used to Treat Complex Diseases
An analysis from Avalere shows that more health insurance plans offered through the Affordable Care Act exchanges are making some drugs used to treat complex diseases—such as HIV, cancer, and MS—more accessible to patients in 2016 than in the previous years. Specifically, plans were less likely to place all drugs in a class on the highest cost-sharing tier.
Proposed Medicare Part B Rule Would Reduce Payments to Hospitals and Some Specialists, While Increasing Payments to Primary Care Providers
Rule Would Decrease Medicare Reimbursement for Drugs That Cost More than $480 per Day; Seven of the 10 Most Affected Drugs Treat Cancer
Only 33 Percent of Exchange Enrollees in 2016 Kept Their Same Plan from 2015
One third of those who enrolled in a health insurance plan on Healthcare.gov this year picked the same plan as last year, according to a new analysis from Avalere. In total, 3.2 million of the 9.6 million exchange shoppers in 2016 kept their previous plan.
Proposed Changes to Part D Would Increase Beneficiary Costs
Avalere Experts Estimate MedPAC Proposal to Change Calculation of Part D Enrollees' True Out-of-Pocket Spending Would Increase Beneficiary Costs by $4.1 Billion Between 2017-2020
Changing the Way Insurers are Paid Could Increase Stability in the Exchange Market and Beyond
New Avalere report identifies opportunities to refine the risk-adjustment model that could improve the way Affordable Care Act plans are paid
Right-to-Try Bills Grow in Popularity yet Success Is Unclear
Almost every state has introduced Right-to-Try bills to try to offer patients another avenue to access investigational drugs outside of the Food and Drug Administration's (FDA) expanded access program. However, it is unclear whether these laws will impact patient access given their questionable legal standing, reduced patient protections due to lack of FDA oversight, and the risks to manufacturers of providing products under Right-to-Try laws.
More than 70 Percent of Medicare Advantage Enrollees in Plans with Four or More Stars
Percentage of Medicare Advantage enrollees in plans with at least four stars continues to grow.
Majority of Drugs Now Subject to Coinsurance in Medicare Part D Plans
Percentage of drugs in Part D plans that require coinsurance increased significantly since 2014. Medicare Advantage plans require coinsurance far less often than Part D plans.
Webinar: Avalere and Inovalon Webinar: Understanding the CMS Advance Notice
The Centers for Medicare & Medicaid Services (CMS) will release the Advance Notice and Call Letter describing CMS' proposed 2017 payment policies for Medicare Advantage (MA) plan sponsors on February 19. Based on previously released information in the fall of 2015, CMS is likely to propose modifications to the risk adjustment model and the current MA Star Ratings methodology.
Veterans Administration and California Medicaid Drug Lists Cover Less than 60 Percent of Drugs Available to California Public Employees
The CalPERS Basic Plan Drug List, which is the formulary for all California public employees, includes 222 brand drugs and 287 generic drugs. In contrast, drug coverage in the Veterans Administration (VA) and Medi-Cal (California's Medicaid program) is far more limited than the CalPERS drug list.
