Kylie Stengel supports clients spanning a range of healthcare sectors and stakeholders in assessing the impacts of the evolving policy landscape on their business and advocacy priorities.
She focuses on regulatory and legislative developments, with specific expertise in Medicare Part D payment and policy, drug pricing reforms, and health insurance markets.
Kylie has previous experience in the MedStar Georgetown Transplant Institute, where she helped lead a process improvement plan to enhance operating efficiency and patient experience. Additionally, she has experience with the Marwood Group, where she supported the life sciences team to synthesize research and deliver industry analysis, including surveying the regulatory and legislative outlook for pharmaceutical and biotechnology companies.
Kylie has a BS in healthcare management policy from Georgetown University’s School of Nursing and Health Studies.
Authored Content
Year-over-year enrollment growth in MA and Part D slowed in 2025. Although, enrollment in chronic condition special needs plans experienced significant growth.
Overall coverage of MS drugs among Part D plans declined by six percentage points, from 49% of the time across all plans and drugs analyzed in 2024 to 43% in 2025.
Alternative approaches for weighting multiple uses of a product when setting maximum fair prices may better balance patient needs and development incentives.
The addition of 15 drugs selected for IPAY 2027 negotiation expand the impact maximum fair prices may have on key therapeutic areas and millions of beneficiaries.
Shifts from copays to coinsurance in Part D may increase OOP costs and make the Medicare Prescription Payment Plan more beneficial for some enrollees.
While the share of drugs covered on Part D formularies will increase slightly in 2025, more drugs will have coinsurance and utilization management.
Join Avalere experts to learn about the changes to Part D formularies for 2025 and implications for patient access.
Avalere experts will examine changes in Part D plan options and premiums for 2025 and will explore how these shifts may affect patient costs and choice.
Join our webinar to learn how Part D redesign and drug price negotiation will shape the Plan Year 2026 market, and what this means for manufacturers and plans.
Join Avalere for an overview of how the Medicare Part D benefit will be changing in 2025 under the Inflation Reduction Act.
The number of PDP and MA-PD options are declining by 26% and 7%, respectively, in 2025.
The MPPP introduces new considerations for Part D plans’ financial risk, operations, and enrollee engagement.
The MPPP will help improve Part D patient affordability, prompting manufacturers to reassess existing patient assistance programs and educational efforts.
The MPPP is a new payment option for Part D beneficiaries in 2025; patient groups will play a key role in supporting education and outreach on the program.
Maximum fair prices for the first 10 selected drugs may shift therapeutic dynamics and have direct and indirect impact to millions of beneficiaries.
The Medicare Prescription Payment Plan will change how Medicare beneficiaries manage their Part D out-of-pocket costs, with implications across stakeholders.
Avalere analysis shows that there are substantial changes and variations in PDP formularies at the therapeutic area and regional levels from 2023 to 2024.
An Avalere analysis finds that from 2023 to 2024 the number of LIS enrollees paying a Part D premium increased by more than 1 million enrollees.
CMS’s definition of a “qualifying single-source drug” in the Medicare Drug Price Negotiation Program may impact manufacturers’ investment strategies.
Due to increasing the portion of plan payments subject to risk adjustments in 2025, CMS proposed aligning the risk adjustment model with Part D redesign.
Avalere experts are joined by Kevin L. Hagan, President of the PAN Foundation, to discuss their findings on the impacts of the Inflation Reduction Act’s Part D benefit redesign on patient utilization and affordability.
With increased patient utilization and plan formulary responses to Part D redesign, many patients may still face affordability challenges under the IRA.
A new Avalere white paper raises important considerations on potential added lifecycle pressures for sponsors of cardiovascular disease products.
While the premium stabilization program under the IRA limits the growth of the base beneficiary premium, individual plan premiums vary.
Over 8 million enrollees in standalone PDPs could see an increase of more than 25% in their premium in 2024.
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.
IRA policies and growing enrollment in Medicare Advantage could begin to destabilize the standalone PDP and LIS benchmark plan market.
The IRA will increase health plans’ financial risk, elevating the importance of Medicare Part D risk adjustment.
Avalere’s assessment highlights a diverse set of over 200 products in development that could challenge payment models across care settings and payers.
The use of DIR in Medicare Part D has increased in recent years, and both the IRA and CMS rulemaking are likely to influence DIR dynamics in the future.
The IRA will reduce out-of-pocket drug costs (especially in Medicare Part D), increase the availability of marketplace plans, and expand access to vaccines.
With higher plan liability under Part D benefit redesign, risk adjustment could play a larger role in how plans set formulary design and contracting strategies.
An Avalere analysis finds that about 800,000 beneficiaries in 2024 and 200,000 in 2025 will have OOP costs that exceed 10% of their annual income.
New report on the evolving cell and gene landscape features Avalere Health experts Kylie Stengel and Mark Von Eisenburg.
Implementation of the OOP smoothing program will require additional clarity from the Centers for Medicare & Medicaid Services (CMS) on elements that will affect beneficiary experience, access, and overall sustainability of the smoothing program.
An updated Avalere analysis finds that under the changes to the negotiation policy included in the revised version of the Senate reconciliation package, the 100 Medicare Part B and D drugs that are likely to be selected for government negotiation from 2026–2031 represent almost half (45%) of all Part B and D drug spending in 2020.
Avalere research finds that state Medicaid programs have taken a variety of approaches to coverage policy development for innovative therapies, highlighting opportunities for increased consistency and transparency.
As Part D plans and manufacturers begin to prepare for the upcoming calendar year (CY) 2024 bid cycle, the evolving Part D market and policy landscape may significantly shape plan bid and formulary management strategies.
Join Avalere’s panel of market access and policy experts for a discussion on the growing cell and gene therapy (CGT) pipeline, an in-depth look at the unique opportunities and challenges these novel therapies present, and an overview of the many hurdles stakeholders need to navigate for success.
As policymakers continue to consider reforms to the Part D benefit design, an Avalere analysis finds that a disproportionate share of disabled beneficiaries and racial/ethnic minority groups, including Black and Hispanic beneficiaries, would have out-of-pocket (OOP) costs above $2,000 in 2024, indicating that an OOP spending cap under Part D benefit redesign may particularly benefit these patient populations.
An Avalere analysis finds that a smaller share of Black and Hispanic Medicare beneficiaries and beneficiaries in lower socioeconomic quartiles have sufficient adherence for commonly used medications. The analysis also shows greater disparities in Medicare plans rated 3 stars or fewer.
Amid recent policy focus on the accelerated approval pathway and questions regarding the pathway’s evidentiary standards and decision framework, Avalere reviewed the history, process, and use of this pathway to date and the potential future use of accelerated approval for pipeline products.
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.
With Congress likely to consider a second reconciliation bill in the near future that may include various drug-pricing and Medicare Part D reform policies as spending offsets, an updated Avalere analysis examines spending across classes with various availability of brand and generic drugs.
Recent regulatory action released in the final days of the Trump administration related to Medicare Advantage (MA) and Part D could significantly impact plan and manufacturer calendar year (CY) 2022 contracting strategies and stakeholder advocacy priorities.
State Medicaid programs are likely to face significant budget impacts from emerging cell and gene therapies and may seek to implement a variety of strategies to manage utilization and address provider reimbursement and financing challenges.
Compared to other drivers of state budget pressures during the COVID-19 pandemic—including higher Medicaid program enrollment due to increased unemployment and lower state tax revenues as a result of economic shutdowns—the relative financial impact of COVID-19 therapeutics on state Medicaid budgets will likely be minimal.
Avalere analysis finds that 51% of all drug spending for non-LIS beneficiaries using insulins and enrolled in enhanced plans in 2018 was for products not participating in the model.
As currently written, a proposed rule on rebate reform from January 2019 may impose financial and operational challenges for pharmacies related to cash flow and new technology requirements.
The administration’s 4 drug pricing EOs direct agency action across a host of policy areas, including Part D rebates, Part B reimbursement and pricing, 340B drug discounts, and drug importation. Next steps and a timeline for agency action will vary by EO dependent on the specific policies to be advanced or finalized. In the interim, stakeholders should explore outstanding questions and contemplate near- and longer-term policy scenarios.
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.
As the economic and social impact of COVID-19 change how patients access and receive care, manufacturers and third-party suppliers must consider how to evolve their patient support programs to meet the shifting access and affordability needs of patients.
As the COVID-19 pandemic unfolds, stakeholders across the healthcare system are facing new realities that will affect the environment in which drugs are commercialized and accessed.
Implementation of a preferred specialty tier could have various impacts on Part D plans’ formulary and benefit designs and could affect manufacturer contracting strategies.
As policymakers consider reforms to the Part D benefit to address rising out-of-pocket (OOP) costs by adding a maximum OOP cap, an Avalere analysis examines the types of beneficiaries mostly likely to be helped by such a policy.
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.