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.
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.
Exchange Operational Models for 2022
In plan year (PY) 2022, most states continue to rely on the federal government for some or all exchange operational functions. However, 3 states have transitioned to state-based exchanges (SBEs).
Video: Medicare Part D, Part V: What’s Next for CMMI?
Tune into the fifth and final episode of the Avalere Health Essential Voice miniseries focused on Medicare Part D. In this segment, our experts discuss the Center for Medicare & Medicaid Innovation (CMMI) and its strategic direction for the coming year, particularly as it relates to the Part D program.
Interview: Medicare Part D, Part V: What’s Next for CMMI?
Tune into the fifth and final episode of the Avalere Health Essential Voice miniseries focused on Medicare Part D. In this segment, our experts discuss the Center for Medicare & Medicaid Innovation (CMMI) and its strategic direction for the coming year, particularly as it relates to the Part D program.
More Medicare Advantage Plans Will Offer Non-Medical Benefits in 2022
New analysis from Avalere finds that in 2022 more Medicare Advantage plans will offer non-medical supplemental benefits, such as meals, nutrition, transportation, and in-home support services, at a $0 premium.
Video: Medicare Part D, Part IV: Budget Neutrality and Congressional Scoring
Tune into the fourth episode of the Avalere Health Essential Voice miniseries focused on Medicare Part D. In this segment, our experts discuss key elements of the legislative process, including pay-fors, budget neutrality, and congressional scoring.
Interview: Medicare Part D, Part IV: Budget Neutrality and Congressional Scoring
Tune into the fourth episode of the Avalere Health Essential Voice miniseries focused on Medicare Part D. In this segment, our experts discuss key elements of the legislative process, including pay-fors, budget neutrality, and congressional scoring.
The Impact of ARPA Exchange Subsidies on Consumers Ages 50–64
Consumers ages 50–64 could see higher exchange premiums starting in 2023 without extension of ARPA subsidies.
Video: Medicare Part D, Part III: Impact of Policy Changes on Market Access
Tune into the third episode of the Avalere Health Essential Voice miniseries focused on Medicare Part D. In this segment, our experts discuss policy changes currently under consideration and how stakeholders can prepare for the potential market access impacts.
Interview: Medicare Part D, Part III: Impact of Policy Changes on Market Access
Tune into the third episode of the Avalere Health Essential Voice miniseries focused on Medicare Part D. In this segment, our experts discuss policy changes currently under consideration and how stakeholders can prepare for the potential market access impacts.
Understanding the Seasonality of Part D Expenditures Under the OCM
In the OCM, a total cost-of-care model, episode-level Part D expenditures include the amount the government pays for low income cost-sharing subsidy and reinsurance for beneficiaries who reach the catastrophic portion of the benefit once they have accumulated sufficient OOP costs. The latter leads to a seasonality effect in how Part D payments are captured in OCM episodes, which may have implications for how trends in OCM performance are assessed over time and how the OCM benchmark price is constructed.
Video: Medicare Part D, Part II: Understanding Plan Decision-Making
Tune into the second episode of the Avalere Health Essential Voice miniseries focused on Medicare Part D. In this segment, our Policy and Market Access experts discuss how health plans make decisions, particularly formulary decisions, in Part D, and how specific markets influence those decisions.
Interview: Medicare Part D, Part II: Understanding Plan Decision-Making
Tune into the second episode of the Avalere Health Essential Voice miniseries focused on Medicare Part D. In this segment, our Policy and Market Access experts discuss how health plans make decisions, particularly formulary decisions, in Part D, and how specific markets influence those decisions.
Interview: Medicare Part D, Part I: Key Trends and Pressures
Tune into the first episode of the Avalere Health Essential Voice miniseries focused on Medicare Part D. In this segment, our Policy and Market Access experts discuss Part D trends and pressures in the currently evolving drug pricing environment.
Video: Medicare Part D, Part I: Key Trends and Pressures
Tune into the first episode of the Avalere Health Essential Voice miniseries focused on Medicare Part D. In this segment, our Policy and Market Access experts discuss Part D trends and pressures in the currently evolving drug pricing environment.
Part D Redesign Would Reduce OOP Costs Across Non-LIS Beneficiaries
New Avalere analysis finds Part D redesign via PDPRA would reduce average OOP costs by 23% for non-LIS beneficiaries, especially for certain drug classes and beneficiary groups by race and reason for entitlement.
Video: What’s Next for Health Policy on Capitol Hill?
Tune into another episode of Avalere Health Essential Voice. In this segment, Avalere policy expert Matt Kazan discusses what he expects to see from a legislative perspective this fall on Capitol Hill.
Interview: The Coverage Gap and Medicaid Expansion
In this segment, our experts discuss the forthcoming debate around the coverage gap in non-Medicaid expansion states, potential policy options, and the impact on key stakeholders.
Most Significant Healthcare Legislation Since ACA Possible this Fall
As Congress considers the bipartisan infrastructure package and budget reconciliation agenda, the coming months are likely to include debate on what could be the most significant federal healthcare legislation in over a decade. Additionally, the Biden administration is expected to release several important healthcare rules this fall, including the details necessary to implement the new law banning surprise billing and regulations to protect and strengthen Medicaid and the Affordable Care Act (ACA).