Lance Grady is the head of Avalere’s Life Sciences Strategy & Growth.
Prior to stepping into his current role, Lance served as the practice director of Market Access. In recent partnerships, Lance has helped life sciences companies develop commercialization and launch planning strategies, and drug pricing and positioning strategy to maximize commercial success, access, and coverage by CMS and in Medicare and commercial markets. Knowledge and experience in reimbursement policy, payment reform, and the application of data analytics are instrumental in his approach to informing strategy and quantifying impact across a multitude of stakeholders. At the intersection of clinical, reimbursement, and market access strategy, Lance has led the growth and transition of the Avalere Market Access practice providing extensive solutions along the product development cycle in preparation for launch and in response to market forces and policy changes in the US market.
Before joining Avalere, Lance spent 12 years at Bristol-Myers Squibb in various leadership roles focused on US market access. He has worked for more than 20 years devising access, policy, and reimbursement strategies, focusing on oncology and autoimmune disease and on orphan drug and cell and gene therapy markets.
Lance graduated from the University of Louisiana-Monroe, where he studied immunobiology.
Authored Content
Manufacturers anticipating potential selection or therapeutic impact for 2027 Medicare negotiations should begin preparations and align internal decision-making, applying learnings from Year 1.
The MDRP proposed rule's Best Price "stacking' provision has direct and indirect impacts on Medicaid rebate liability across drug classes.
Medicare negotiation has ripple effects across therapeutic markets, requiring manufacturers to reassess strategies to stay ahead of the changing drug landscape.
Manufacturers should reevaluate CMS engagement strategies as soon as possible to maximize the opportunity to influence the IPAY 2026 Medicare negotiations.
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.
CMS selected 10 Part D drugs for the first year of negotiation. Stakeholders should consider engagement opportunities and evaluate broader therapeutic dynamics.
Requiring manufacturers to stack all discounts provided through the supply chain could increase Medicaid rebate liability and complicate rebate dynamics.
Sponsors with portfolio or pipeline assets within certain therapeutic areas can prepare for the downstream effects of price negotiation on the market.
Manufacturers of therapeutic alternatives to negotiation-eligible drugs should re-examine their commercialization strategies in response to market dynamics.
In response to IRA provisions, life sciences companies should reevaluate their pipeline investment and development strategies.
The first Insight in this series explores timing for Medicare negotiation, inflation rebates, and Part D benefit redesign changes and details to be defined.
The EOM prediction model and benchmarking methodology are more precise than that of the OCM, which will heighten the ability of participants to directly manage costs, including oncolytic spend.
With EOM’s immediate downside risk, the model may appeal more to practices ready to implement care transformation activities and value-driven decision making.
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.
CMS announces long-awaited successor to the Oncology Care Model (OCM), which is scheduled to conclude on June 30, 2022.
Starting July 1, manufacturers can report multiple best prices for some value-based arrangements, which may encourage broader use of innovative contracting.
Avalere Health’s Market Access practice expands its team with recent hires bringing analytics, coverage strategy, and commercialization expertise.
Analysis finds that patients face barriers to cell therapy treatments regardless of proximity to cell therapy treatment sites.
Join Avalere for a live discussion on key trends in drug pricing, value, and regulatory shifts, and how these trends will impact manufacturers.
On February 2, 2022, President Biden announced a revitalization of the Obama-era Cancer Moonshot Initiative, including updated goals to reduce cancer deaths by at least 50% over the next 25 years and improve the experience of cancer survivorship for patients and their families.
Avalere Health welcomes Alex (Shuang) Du as an associate principal to its Market Access practice. He will support a variety of Avalere’s clients in navigating the evolving healthcare landscape.
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.
Sarah Alwardt joins Avalere as the practice director of the Center for Healthcare Transformation.
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.
Join us for a live conversation exploring actionable strategies for driving greater vaccine access and adoption.
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).
On April 7, Gillian Woollett authored a Health Affairs blog piece with Ge Bai from the Johns Hopkins Carey Business School and Bruce Pyenson from Milliman about the role that testing plays in recovering from the COVID-19 pandemic.
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.