As the leader of the Market Access Practice, Lance Grady devises commercialization strategies focused on value, access, and reimbursement.
With a focus on oncology and over 20 years of experience in policy, access, reimbursement strategy and execution, and point of care, he is passionate about providing practical and meaningful solutions that are viable to all healthcare stakeholders. Lance delivers proven, measurable outcomes by creating integrative and sustainable solutions in functional areas pertaining to patient access strategy and services; physician-administered reimbursement strategy and support; value-based and risk-based payment models; Centers for Medicare & Medicaid Services policy strategy; Medicare payment models; commercial health plan formulary, medical policy, and utilization management; benefit design; drug-dollar-data flow; oncology pathways; and specialty channel strategies—pharmacy, group purchasing organizations, and wholesaler distribution.
Prior to coming to Avalere, Lance enjoyed a successful 12-year career at Bristol-Myers Squibb in various leadership roles in US Market Access. He also has experience in orphan drug and autoimmune therapeutic markets.
He is a graduate of the University of Louisiana–Monroe where he studied human biology and immunobiology.
Authored Content
An Avalere analysis found differences in the performance of low- and high-intensity prostate cancer episodes in the Oncology Care Model (OCM). High-intensity prostate cancer episode expenditures were consistently below the benchmark price while low-intensity episode expenditures were similar to the benchmark price. This finding is likely driven by the Centers for Medicare & Medicaid Services (CMS) methodology used to calculate benchmark prices but may also indicate participant success in controlling costs for these episodes.
New hire brings years of access, reimbursement, and revenue-cycle experience, strengthening Avalere's Market Access practice.
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.
Two new additions expand expertise in drug pricing, payer engagement, CMS coverage and payment, and strategic market access and commercialization.
On July 19, the Centers for Medicare & Medicaid Services (CMS) released the CY 2022 OPPS/ASC Proposed Rule, which includes a number of proposals to modify the timing and design of the Center for Medicare & Medicaid Innovation’s forthcoming Radiation Oncology (RO) Model. The design proposals include changes to the set of included modalities and cancer types, reduction of the CMS discount factors applied to the prospective payments, and adoption of an extreme and uncontrollable circumstances policy. Looking ahead, stakeholders should continue to assess the model payment methodology and design in the context of evolving care delivery and practice patterns.
The intersection of upcoming changes to drug pricing metrics will require new methods of calculating and reporting government pricing with implications for net pricing and contracting strategies.
Reducing health disparities is critical to advancing health equity, and each stakeholder has a role to play.
Avalere’s data analytics and market access experts will be joined by Jeff Patton, MD and CEO of OneOncology, to explore critical issues and considerations for life sciences stakeholders following the pandemic.
An Avalere analysis found that Oncology Care Model (OCM) lung cancer episode expenditures increased over 20% from performance periods 2 to 6 while the benchmark price increased about 10% during this period. During this same period, The Center for Medicare & Medicaid Innovation (CMMI) included 20 lung-cancer-specific changes to the OCM Novel Therapy Adjustment (NTA) list. This dynamic supports the inclusion of tumor-specific adjustments in the future Oncology Care First (OCF) model to further account for advancements in cancer management.
An Avalere analysis found that the impact of removing low-risk/low-intensity episodes from the Oncology Care Model (OCM) reconciliation process would not have a notable impact for most practices. Among practices where performance would change, however, performance would improve for most practices if enrolled in 1-sided risk but worsen for most practices if enrolled in alternative 2-sided risk.
Beginning July 1, 2021, average sales price (ASP) calculations for Part B drugs with an additional non-covered self-administered formulation could alter Medicare reimbursement.
They bring more than 35 years of combined healthcare experience and expertise in the immunization development sector.
Manufacturers seeking Food & Drug Administration (FDA) approval for cell therapies will need to assess the financial and logistical burden on patients and develop novel solutions to help alleviate these challenges.
He brings more than 30 years’ worth of actuarial and formulary management experience to the firm.
As the Oncology Care Model (OCM) approaches its conclusion, stakeholders are anxiously awaiting the details of the Center for Medicare & Medicaid Innovation's (CMMI’s) next oncology episodic payment model, Oncology Care First (OCF).
Join Avalere’s panel of data analytics, market access, and policy experts for a discussion on the potential for federal drug pricing reform in Congress or via administrative action.
Each brings leadership and deep experience within the life sciences industry.
An Avalere analysis found that among high-risk breast cancer episodes, those in later stages of the disease had higher episode expenditures relative to their benchmarks compared to those in earlier stages.
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.
He brings significant experience in 3PL, channel and distribution strategies, and innovative market access solutions for life sciences companies to expedite product to patient.
The accelerated changes and increased uncertainties in healthcare brought on by the COVID-19 pandemic will continue into 2021, and its impacts are likely to shape healthcare for years to come. While prevalent uncertainty is a given, the broad outline of a new era is already emerging. More than ever, careful examination of healthcare stakeholder’s business models, policy developments, and data will be essential to arrive at accurate assessments of the future state. Our experts engaged in a live discussion covering critical issues facing healthcare leaders and strategies for clearing the path.
Earlier today, the Trump Administration released long-anticipated drug pricing reforms, including rules related to a Most Favored Nation (MFN) approach for drugs administered by providers in Medicare and rebate reform for the Medicare Part D program. Both rules represent fundamental shifts in our current system and have significant implications for manufacturers, health plans, pharmacies, providers, and patients.
The accelerated changes and increased uncertainties in healthcare brought on by the COVID-19 pandemic will continue into 2021, and its impacts are likely to shape healthcare for years to come. While prevalent uncertainty is a given, the broad outline of a new era is already emerging. More than ever, careful examination of healthcare stakeholder’s business models, policy developments, and data will be essential to arrive at accurate assessments of the future state. Our experts engaged in a live discussion covering critical issues facing healthcare leaders and strategies for clearing the path.
For even deeper coverage, download the 2021 Healthcare Industry Outlook document below.
For even deeper coverage, download the 2021 Healthcare Industry Outlook document below.
The Centers for Medicare & Medicaid Services (CMS) released coding and payment instructions associated with the first physician-administered outpatient COVID-19 therapeutic. The release specifies that during the public health emergency (PHE), Medicare will cover and pay for these infusions in the same way it does for COVID-19 vaccines.
Avalere research was published online in the Journal of Clinical Oncology Clinical Cancer Informatics, showing a considerable drop in cancer screening, diagnosis, and treatment for Medicare beneficiaries as a result of the ongoing COVID-19 pandemic.
Avalere experts took a closer look at emerging oncology trends, innovative approaches to payment and delivery, and what these changes will mean for patient access.
Tune into our third episode of the Avalere Health Essential Voice: 2020 Election series. In this segment, our experts discuss candidates’ respective approaches to drug pricing policies, and where there is unexpected overlap.
Tune into our third episode of the Avalere Health Essential Voice: 2020 Election series. In this segment, our experts discuss candidates’ respective approaches to drug pricing policies and where there is unexpected overlap.
Yesterday, the Administration released the awaited “Most Favored Nation” Executive Order (EO), which calls for a model that would cap the price Medicare pays for select Part B and D drugs.
Join Avalere experts for Part 1 of our Market Access Enablement Strategies webinar series to learn about how life sciences companies are pivoting with pre-/post-new product launch strategies, including differential investments to inform market access execution.
Webinar: Market Access Enablement Strategies, Part 2: Navigating Policy and Marketplace Developments
Join Avalere experts for Part 2 of our Market Access Enablement Strategies webinar series to learn about the policy changes and market factors that could impact the future relationships between manufacturers, health plans, and pharmacy benefit managers.
Hafez expands Avalere's market access capabilities with deep expertise in strategy, operations, commercialization, and analytics.
On July 24, the administration released 3 executive orders (EO) and announced the planned publication of a fourth EO, all focused on prescription drug pricing. The EOs reflect a combination of familiar policy goals (e.g., rebate reform, importation, international pricing) and a new 340B initiative, and in combination could have substantial implications for healthcare stakeholders and pharmaceutical markets if implemented.
The CMS proposes to define line extension under the MDRP to broadly include any product that has at least one ingredient in common with the original drug, even if it is a different dosage form. If finalized, this change would have significant implications on classification and rebate liability for a wide set of current and future products.
Avalere analysis of Medicare fee-for-service (FFS) hospital stay claims with associated COVID-19 diagnoses finds that total US healthcare system costs for hospitalizations due to COVID-19 could range from $9.6B to $16.9B in 2020.
As treatment advancements in oncology continue, stakeholders are modifying their approaches to defining value and managing care
Recent Avalere analysis finds decreases in utilization of oncology and autoimmune treatments across all care settings since the onset of the health crisis.
In the fourth episode of the Specialty Pharmacy Stakeholder Perspectives podcast series, Avalere is joined by Adam Hanauer, Associate Vice President at Humana Specialty Pharmacy, and Mark Sasala, Principal Business Analyst of Products at Creehan & Company, to discuss the outlook of specialty pharmacy with a focus on the environmental considerations and potential impacts of COVID-19.
Prescription drugs are dispensed to patients through a complex supply chain that involves a broad array of entities, contract arrangements, and payments. The following diagram outlines how a typical prescription drug may flow through the drug supply chain.
In the first episode of the Specialty Pharmacy Stakeholder Perspectives series, Avalere is joined by Joel Wright, CEO at AllianceRx and Ernie Shopes, SVP Products and Client Delivery at Creehan and Company, discussing the outlook for specialty pharmacy, including a focus on trends in the pipeline and overall landscape.
Two new hires come to the firm with significant experience in US healthcare.
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.
Oncology practices with a substantial proportion of Oncology Care Model (OCM) episodes in areas with high numbers of COVID-19 cases—such as Connecticut, Louisiana, Massachusetts, New Jersey, New York, and Pennsylvania—may face new challenges in containing total expenditure below target amounts.
The large-scale disruptions resulting from COVID-19 are significantly reshaping how patients receive care. In particular, patients taking infused and injectable drugs administered by a healthcare professional at a physician office, infusion center, or hospital outpatient department now face greater challenges receiving their medications.
Avalere experts discuss how the COVID-19 pandemic has affected oncology care and delivery, and the Oncology Care Model (OCM).
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.
The Centers for Medicare & Medicaid Services (CMS) issued a new Interim Final Rule (IFR) that is intended to allow additional beneficiaries, especially those who are at high-risk, to receive home infusions amid COVID-19 transmission concerns. Specifically, the CMS clarified the definition of “homebound” under the Medicare Home Health Benefit and temporarily suspended enforcement of the National and Local Coverage Determinations (NCD and LCD) related to home infusion services. Uncertainties remain as to how these new flexibilities will be utilized, as well as how these flexibilities could impact treatment outcomes.
New Avalere analysis finds that practices currently participating in the Oncology Care Model (OCM) would be more likely to receive a Novel Therapy Adjustment (NTA) in the newly proposed Oncology Care First (OCF) Model.
A new Avalere analysis finds that oncology practices participating in the Oncology Care Model (OCM) treated patients with 2–3% higher Medicare costs per episode, on average, than OCM prediction model estimates during the first two performance periods.
Pressure to lower costs will increase for OCM providers as CMS pushes to 2-sided risk.
Ahead of the American Society of Clinical Oncology's annual meeting, Avalere experts discussed the latest trends in policy, reimbursement, and market access reshaping oncology care.
Recent developments in the specialty pharmaceutical marketplace merit distinct attention from manufacturers.
The interaction of recently announced drug pricing reforms will have differential implications for stakeholders.
The swift proposed implementation timeline will require stakeholders to evaluate quickly operational requirements, behavioral responses, cross-program implications, and impact on contractual arrangements.
Yesterday, the Department of Health and Human Services Office of Inspector General released a proposed rule redefining the current safe harbor for pharmaceutical manufacturer discounts and rebates to entities like health plans and pharmacy benefit managers (PBMs).
Avalere experts examine the current drug pricing policy landscape and what potential changes stakeholders should prepare for.
Reforms to “eliminate rebates” could have varying impacts based on features of their design.