Kelly Brantley

Kelly Brantley co-leads the Policy Practice.

She works with biopharmaceutical companies, health insurance plans, and patient organizations to develop customer-specific solutions that predict and respond to the ever-changing health policy landscape. Kelly understands her clients’ needs to design and execute data-driven projects and focuses much of her time considering the impact of health policy on consumers and patients. Kelly has supported a broad range of our customers since 2010.

Prior to joining Avalere, Kelly worked closely with the State Health Insurance Assistance Programs at the Health Assistance Partnership, a project of Families USA. Before Families USA, Kelly consulted for the ECRI Institute where she analyzed online tools promoting quality health and healthcare.

Kelly holds a BS in biology from the University of North Carolina at Chapel Hill, an MPH in health promotion, and a graduate certificate in health policy from the George Washington University School of Public Health and Health Services.

Authored Content

Seasoned health policy professional brings significant expertise in federal legislation, drug pricing policy, delivery system reform, and federal and state programs that affect insurance coverage.

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.

Avalere’s analysis shows differences in payments between employer and non-employer Part D plans.

Reducing health disparities is critical to advancing health equity, and each stakeholder has a role to play.

As Congress renews focus on drug pricing reforms, an Avalere analysis examines recent trends in the Part D program’s subsidy payments and implications on stakeholder liabilities in the program.

For prescription drug fills across 4 therapeutic areas, Avalere analysis finds that Medicare Part D beneficiaries who receive the Low-Income Subsidy (LIS) have those drugs prescribed by a specialist less frequently than those who do not receive LIS.

They bring more than 35 years of combined healthcare experience and expertise in the immunization development sector.

He brings more than 30 years’ worth of actuarial and formulary management experience to the firm.

At a time when more Americans—particularly people of color—are enrolled in Medicaid, new Avalere analysis finds that provider networks for primary care and certain specialties in Medicaid are narrower on average than those of commercial plans in certain metropolitan areas, ranging from 63% smaller in Miami to 18% in New York.

Therapies currently being developed to treat COVID-19 in the inpatient setting have opportunity for additional Medicare reimbursement.

As policymakers discuss ways to curb program expenditures and improve patient affordability in Medicare Part D, the role of charitable assistance in helping beneficiaries with out-of-pocket (OOP) costs has garnered interest. To understand the relationship between charitable assistance and various Part D metrics, Avalere examined Part D prescription drug claims for beneficiaries without the Low Income Subsidy (LIS) for 2014 and 2018.

She deepens the firm’s post-acute and policy analytics capabilities, bringing nearly 15 years' worth of policy analytics experience to Avalere with a specific focus on the provider sector.

Scenario analysis of varying levels of negotiation under H.R.3 (as passed in the House on December 12, 2019) finds that the bill could reduce federal spending by $850B to $1,060B and decrease manufacturer revenues by $1,275B to $1,655B for CY 2020–2029.

An Avalere analysis finds that, on average, non-LIS Medicare beneficiaries in Employer Group Waiver Plans (EGWPs) have higher utilization but lower out-of-pocket (OOP) costs than non-EGWP enrollees.

In the second episode of the Specialty Pharmacy Stakeholder Perspectives series, Avalere is joined by Marc Boutin, CEO of the National Health Council, discussing the specialty pharmacy dynamics with a focus on the patient perspective.

Two new hires come to the firm with significant experience in US healthcare.

As plans continue to assess the proposed changes to their liability in the Medicare Part D benefit, understanding variations in spending by enrollee can help elucidate how policy changes might affect their spending. This Avalere analysis examines a subset of MA-PD and PDP plans with at least 75% of their enrollment comprising those with LIS. This analysis aims to quantify spending on drugs within the 6 protected classes for low-income subsidy (LIS) and non-LIS beneficiaries in this subset of PDP and MA-PD plans.

Just because we can’t meet at sPCMA doesn’t mean we can’t discuss what’s next for Medicare Part D.

Avalere analysis finds that average beneficiary out-of-pocket (OOP) spending for 3 commonly used insulin products remains similar throughout the year, ranging from $95 in December to $136 in June and July.

In the Notice of Benefit and Payment Parameters (NBPP) for the 2021 plan year, CMS questioned whether states were appropriately deciding if the state was required to defray the premium impacts of new benefit mandates added since 2011. CMS proposes requiring states to report on and justify defrayal decisions for all state benefit mandates.

Join Avalere experts on our webinar on October 29, 2019, to unpack CMS’ 2020 Star Ratings and look at what’s to come for 2021.

New analysis from Avalere finds the proposed case-mix adjustment for the radiation oncology model underestimates payments for prostate cancer .

As policymakers consider reforms to Part D, new Avalere analysis shows that congressional proposals to cap out-of-pocket (OOP) costs in the catastrophic phase are likely to reduce OOP for many beneficiaries

New analysis from Avalere finds that the quantity of retail fentanyl sold across the US dropped by an average of 28%, between 2014 and 2017.

Avalere analysis finds that a larger proportion of beneficiaries taking a Part D cancer therapy reached catastrophic compared to all Part D enrollees.

As policymakers increasingly consider policy options to reform Medicare Part D and reduce program expenditures, an Avalere analysis examines spending across classes with various availability of brand and generic drugs.

Final rule by the Treasury Department, Department of Labor, and the Department of Health and Human Services reverses previous Treasury Department guidance blocking tax-advantaged HRAs that were not integrated with a comprehensive employer-sponsored plan.

On May 16, the Centers for Medicare & Medicaid Services (CMS) released its final rule, Modernizing Part D and Medicare Advantage to Lower Drug Prices and Reduce Out-of-Pocket Expenses.

The Centers for Medicare & Medicaid Services released the final Notice of Benefit and Payment Parameters (NBPP) for the 2020 plan year. This annual rule, released today, updates guidance and regulations related to exchanges as well as the broader individual, small group, and large group insurance markets.

In a new analysis, Avalere examines the implications of CMS’ potential new requirement that Part D plans place generics only on generic tiers.

New Avalere research finds high utilization of generic medications in the 6 protected drug classes under Part D.

The Substance Use Disorder Prevention that Promotes Opioid Recovery and Treatment (SUPPORT) for Patients and Communities Act, signed into law on October 24, 2018, takes aim at the opioid crisis from multiple angles.

Shift in clinical practice as far back as 30 years ago planted the seeds for the current opioid epidemic. New research by Avalere Health finds that between the mid-1980s and 1990s, individual pharmaceutical manufacturers, national scientific bodies, and professional societies began a push to treat pain more aggressively.

New analysis from Avalere finds that 102 million individuals, not enrolled in major public programs like Medicaid or Medicare, have a pre-existing medical condition and could therefore face higher premiums or significant out-of-pocket costs if the ACA’s pre-existing condition protections were repealed.

Reforms to “eliminate rebates” could have varying impacts based on features of their design.

On June 19, the Department of Labor (DOL) released its final rule on Association Health Plans (AHP).

2019 rate filings suggest increased competition and plan choice

Maine had the greatest decline at 25% compared with the national average of 11%.

Patient out-of-pocket costs continue to grow despite policies to increase affordability for beneficiaries.

The House and Senate are advancing legislative packages aimed at mitigating the crisis.

In response to the concern that overprescribing is a driver of the opioid crisis, payers are limiting opioid fills as one solution.

The Centers for Medicare & Medicaid Services released the final Notice of Benefit and Payment Parameters (NBPP) for the 2019 plan year.

New research from Avalere Health finds 11 states and DC lack an adequate number of providers certified to prescribe buprenorphine, a medicine used to prevent relapse in people with opioid dependence.

Yesterday, the Centers for Medicare & Medicaid Services (CMS) released Part II of the Advance Notice and Call Letter (ANCL), describing the Agency's proposed 2019 payment policies and other policy updates for the upcoming plan year for Medicare Advantage (MA) and Part D plans.

Resource presents trends in opioid painkiller prescriptions and deaths due to misuse and abuse.

The Centers for Medicare & Medicaid Services (CMS) just released the annual Landscape Files containing data on plan participation, beneficiary premiums, and benefit designs for the 2018 Part D — Medicare's prescription drug benefit — and Medicare Advantage (MA) markets.

On July 31, the Centers for Medicare & Medicaid Services (CMS) announced that the base Part D premium will be $35 for 2018.

Today, the Medicare Trustees delivered to Congress their annual report on the financial operations and status of the program.

The 21st Century Cures Act presents medical product manufacturers, patient groups, and advocacy organizations with a unique opportunity to plan for upcoming policy changes that are aimed at accelerating the pace of development and approval of new therapies.

Today, the Trump Administration released its budget for fiscal year 2018 (FY 2018). The budget provides the President's recommendations for how the Congress should fund the government and marks the beginning of the FY 2018 budget season.

Across 8 therapeutic areas, the Veteran's Administration (VA) National Formulary covers 49 percent fewer drugs than Ohio's largest Medicaid managed care plan and 68 percent fewer drugs than the Ohio Medicaid preferred drug list (PDL).

Today, the Centers for Medicare & Medicaid Services (CMS) released its final rule for market stabilization of the health insurance exchanges, following the departure of some health plans from the marketplace for the upcoming plan year.

According to a new Avalere analysis of data from the Centers for Medicare & Medicaid Services (CMS), premiums for stand-alone prescription drug plans (PDPs) will increase and the number of PDPs available in 2017 will decrease. Conversely, the Medicare Advantage market appears strong as 8 in 10 beneficiaries have access to MA plans that offer prescription drug benefits with a zero premium.

The Centers for Medicare & Medicaid Services (CMS) just released the annual Landscape Files containing data on plan participation, beneficiary premiums, and benefit designs for the 2017 Part D and Medicare Advantage (MA) markets. Avalere offers the following observations on key trends in the MA and Part D programs that are likely to influence the 2017 market.

Avalere recently analyzed two different Part D policy proposals outlined in The Medicare Payment Advisory Commission (MedPAC) June 2016 report to Congress.

The Center for Medicare & Medicaid Innovation is currently testing a variety of programs which place providers at risk for Medicare spending and may motivate providers to manage Medicare Part B costs, including drug spending and utilization.

Cost-sharing changes could increase costs for many beneficiaries.

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.

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.

Avalere recently partnered with Third Way to estimate the cost savings of increasing medication adherence among Medicare beneficiaries by improving and expanding the current Part D Medication Therapy Management (MTM) program to target and address adherence issues for specific conditions.

In a 5-4 ruling on June 30, the U.S. Supreme Court issued a majority opinion on Burwell v. Hobby Lobby Stores, Inc., holding that the contraceptive mandate violates the Religious Freedom Restoration Act (RFRA) as applied to closely held, for-profit corporations.

On April 7, CMS finalized their Calendar Year (CY) 2015 capitation rates, methodological changes to rates and risk models, and other payment and program policies for Medicare Advantage (MA) and Part D plans.

Today, the Centers for Medicare & Medicaid Services (CMS) released the 2014 landscape files containing data on plan participation, premiums and benefit designs for the Medicare Part D and Medicare Advantage (MA) markets.

The shift toward low-premium plans with preferred pharmacy networks is indicative of an increasingly competitive market, but don't expect that to mean decreased overall costs.

New Medicaid payment methodologies inadequately reimburse specialty pharmacies by failing to account for drug costs and high-touch pharmacy services.