Navigating the Medicare Prescription Payment Plan: What It Means for Part D Plan Sponsors
The MPPP introduces new considerations for Part D plans’ financial risk, operations, and enrollee engagement.
Navigating the Medicare Prescription Payment Plan: What It Means for Manufacturers
The MPPP will help improve Part D patient affordability, prompting manufacturers to reassess existing patient assistance programs and educational efforts.
IRA Inflation Rebate Impact on Part B Beneficiary OOP Costs
Avalere finds that between 0.1% and 0.2% of Medicare FFS beneficiaries would experience lower OOP costs for the Part B drugs subject to Q3 2024 inflation rebates.
IRA Negotiations May Affect Millions of Medicare Beneficiaries
Maximum fair prices for the first 10 selected drugs may shift therapeutic dynamics and have direct and indirect impact to millions of beneficiaries.
Commercial Spillover Impact of Part B Negotiations on Physicians
Physicians could lose at least $25 billion in add-on payments for 10 Part B drugs expected to be negotiated by CMS, with oncology products accounting for at least $12 billion.
Navigating the Medicare Prescription Payment Plan: What It Means for Stakeholders
The Medicare Prescription Payment Plan will change how Medicare beneficiaries manage their Part D out-of-pocket costs, with implications across stakeholders.
Key Considerations for MFP Effectuation and the 340B Rebate Model
Stakeholders consider implementation of a 340B rebate model to address duplicate discount risk.
Manufacturer Learnings from the First Round of Negotiated MFPs
Avalere experts share initial impressions of the publicly released negotiated MFPs for the first round of selected drugs, highlighting implications to industry.
Potential Impacts of IPAY 2026 Maximum Fair Prices on Health Plan Formulary Negotiations
With the release of the IPAY 2026 MFPs, health plans should analyze the impact to formularies and identify opportunities for contracting changes.
Health Policy in the 2024 Election: Avalere and Outside Experts Weigh In
With the election fast approaching, former HHS Secretary Alex Azar, Dan Mendelson, and Avalere experts discussed implications for healthcare stakeholders.
Updated Negotiation ICR Presents New Industry Evidence Needs
Updates in the Initial IPAY 2027 ICR highlight the increasing needs for specific evidence planning and generation for industry to prepare for negotiation.
Opportunities to Prepare for Year 2 of Medicare Negotiation
Manufacturers anticipating potential selection or therapeutic impact for 2027 Medicare negotiations should begin preparations and align internal decision-making, applying learnings from Year 1.
Part D Risk Adjustment Will Have New Importance Under IRA
Analysis of data in the CMS VRDC shows that MA-PD utilization has steadily increased in therapeutic areas likely to have large increases in plan liability under Part D redesign.
IRA Reforms Will Impact Patient Adherence and Affordability
With increased patient utilization and plan formulary responses to Part D redesign, many patients may still face affordability challenges under the IRA.
IRA Negotiation Creates Ripple Effects Across Drug Markets
Medicare negotiation has ripple effects across therapeutic markets, requiring manufacturers to reassess strategies to stay ahead of the changing drug landscape.
IRA Drug Price Negotiation Impact on Cardiovascular Drugs
A new Avalere white paper raises important considerations on potential added lifecycle pressures for sponsors of cardiovascular disease products.
Part D Premiums Increasing Despite Stabilization Program
While the premium stabilization program under the IRA limits the growth of the base beneficiary premium, individual plan premiums vary.
How Will 340B Discounts Interact with Negotiated Drugs’ MFP?
The IRA requires covered entities to pay the lesser of a drug’s 340B ceiling price and MFP, presenting operational complications for manufacturers and providers.
How Can Manufacturers Help Shape Medicare Negotiations?
Manufacturers should reevaluate CMS engagement strategies as soon as possible to maximize the opportunity to influence the IPAY 2026 Medicare negotiations.
Part D Redesign’s Impact on Plan-Manufacturer Contracting
Avalere experts discussed how IRA’s Part D redesign may affect plan behavior in Plan Year 2025 and how manufacturers should approach contracting and market access.