Kate Sikora supports clients in monitoring, engaging, and developing strategic recommendations across the state health policy landscape.
She assists clients with anticipating and responding to the impacts of legislative and regulatory developments on their strategic policy and advocacy priorities. Her expertise spans across state drug pricing initiatives, regulation of pharmacy benefit managers, utilization management, and Medicaid. Additionally, Kate holds expertise in patient affordability programs, including copay support offerings (e.g., coupons) and copay adjustment programs.
Prior to joining Avalere, Kate assisted in building the state policy and advocacy program for the American Society of Clinical Oncology where she focused on provider and patient access and affordability issues. Kate holds an MBA from the Johns Hopkins University, Carey Business School with a focus on healthcare administration and a BA in government and politics from the University of Maryland, College Park.
Authored Content
An Avalere analysis shows the use of drugs approved under the Accelerated Approval pathway across historically underserved Medicare beneficiaries.
State approaches to PDABs and UPLs vary, but all approaches could impact patient access and affordability.
Avalere assessed how health plans may view UPLs, including implementation considerations and impacts on providers and patients (e.g., plan benefit design).
Recent FDA authorization of Florida’s Section 804 Importation Program has prompted increased focus on importation pathways.
States will commence legislative sessions at the beginning of January. Drug pricing, including payment limits and reference pricing, as well as improved access will be key priorities.
A district court’s decision to strike down the 2021 NBPP is the latest policy update on the use of copay adjustment programs, but questions persist.
Avalere experts delve into the dynamic patient assistance program landscape, including copay accumulators and maximizers, alternative funding initiatives, and the repercussions of policy shifts such as the Inflation Reduction Act and state-level copay accumulator bans.
State legislatures are increasingly considering prescription drug affordability boards and upper payment limits to lower state expenditures and patient costs.
19% of people enrolled in the US commercial insurance market will belong to a health plan that must count copay assistance toward patient cost sharing by 2024.
Increased use of alternative funding programs has introduced new access challenges for patients, plans, and manufacturers for specialty therapies.
Medicaid redeterminations will bring changes to individual prescription drug access. Manufacturers should consider the impact on patient support programs.
Most states will begin new legislative sessions in 2023. Drug pricing, patient affordability, and coverage protection will be priorities in many states.
An Avalere analysis explores disparities in medication adherence for Medicare Part D beneficiaries living in medically underserved areas (MUAs) and non-MUAs.
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.
Cancer has been the second-leading cause of death in the US for over a decade. Patient survival and quality of life depend to a large degree on stage at diagnosis, making early detection critical. However, most cancers have limited or no early screening technology available, reducing the opportunity to detect them early and leading to worse survival rates.
The majority of state legislatures are currently in session, and many states are taking steps to address prescription drug spending and prices through a range of legislative proposals. While states have historically focused on price transparency, state policymakers are now moving beyond those measures to more directly control prescription drug prices through reference pricing, affordability review boards setting upper payment limits, and other price control mechanisms.
Implementation of copay accumulator and maximizer programs continues to increase; recent policy provisions finalized through federal rulemaking and state-level legislation have created new uncertainty for the future of these programs and the stakeholders they affect.
With the US Supreme Court (SCOTUS) set to hear arguments starting November 10 in California v. Texas and the swearing in of Justice Amy Coney Barrett on October 26, questions remain regarding the future of the Affordable Care Act (ACA) and its impact on laws passed in at least 18 states creating coverage protections for essential health benefits (EHB) and coverage of pre-existing conditions.
The outcomes of the 2020 elections will hold implications for state policymaking on key healthcare issues that could impact patients’ health insurance coverage status and how they access care.
Affordable Care Act (ACA) exchanges have seen a significant uptick in enrollment, especially from those losing employer-sponsored coverage or who were previously uninsured. However, different approaches to special enrollment periods (SEPs) leave many with limited opportunities to enroll.
After adjourning or suspending sessions due to the COVID-19 pandemic, state legislatures are reconvening with new priorities, as pandemic-related policy decisions take precedence.
Recent regulatory changes have eased restrictions for providers delivering care across state lines during the COVID-19 public health emergency. However, state and federal cooperation on extended licensure expansion would help address long-term provider access issues.
In response to the novel coronavirus (COVID-19) pandemic, a majority of state legislatures have either suspended their ongoing legislative sessions or adjourned sine die, which marks the definitive end of a state’s session, earlier than originally scheduled.
The majority of 2020 state legislative sessions are either approaching crossover deadlines or adjournment. In 2019 and 2020, at least 15 states (CT, DE, FL, HI, IN, LA, MD, ME, NH, NJ, NM, NV, OR, VT, and WA) have enacted laws to create or study coverage protections against pre-existing condition exclusions or coverage of all essential health benefits (EHB) provided for in the Affordable Care Act (ACA).
Remote patient monitoring (RPM) provides an opportunity to diagnose and treat patients facing neurological diseases. Given that multiple sclerosis (MS), Parkinson’s disease, and epilepsy require intervention from specialized care teams, effective management of these chronic neurological conditions can be supported through RPM to improve patient outcomes. Although RPM has been shown to be a complement and in some cases an alternative to office-based care, reimbursement and coverage barriers remain.
Healthcare policy remains a top priority for both voters and policymakers in 2019 and has been a key part of campaign platforms.
State healthcare legislation often holds important implications for high-value and high-cost drugs, such as those used to treat cancer patients.
Avalere’s state policy team recently attended the National Academy for State Health Policy’s (NASHP) Annual Conference for 3 days of interactive state health policy discussions and the facilitation of a roundtable on the direction of telehealth in the states.
States are increasingly seeking to improve access and health outcomes for their underserved, rural, or homebound populations, and many are turning to telehealth as a solution.
While the majority of state legislative sessions have adjourned for 2019, at least 11 states (CT, FL, LA, IN, MD, ME, NH, NM, NV, VT, and WA) have enacted laws to create or study coverage protections against pre-existing condition exclusions and coverage of all essential health benefits (EHB) provided for in the Affordable Care Act (ACA).