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Shruthi Donthi
Senior Research Scientist
Shruthi Donthi supports clients with data-driven analyses that leverage medical claims and other healthcare data to understand policy impacts on business decisions and strategies for a wide variety of stakeholders.
Prior to joining Avalere, Shruthi was a research analyst fellow with the FDA analyzing drug product and manufacturer data, creating reports, and performing data validation to improve the efficiency and quality of the Office of Surveillance’s Product and Site Catalog. Prior to that role, she was a SAS programmer conducting analyses to facilitate drug inspection and surveillance efforts. Additionally, Shruthi has graduate research experience analyzing Medicare claims and electronic health record data.
Shruthi has an MS in management information systems, data analytics from Oklahoma State University, an MBA in finance, and a BTech in electronics and communications engineering from Jawaharlal Nehru Technological University in India.
Authored Content
Shifts from copays to coinsurance in Part D may increase OOP costs and make the Medicare Prescription Payment Plan more beneficial for some enrollees.
Avalere analysis finds that the Part D risk adjustment model likely underpredicts expenditures for some high-cost conditions.
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.
In recent years, Medicare Part D plan tier placement of generic prescription drugs has declined, from 64.5% in 2016 to 43.8% in 2024.
With increased patient utilization and plan formulary responses to Part D redesign, many patients may still face affordability challenges under the IRA.
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.
On October 6, CMS published the 2023 star ratings for Medicare Advantage (MA) plans ahead of the start of open enrollment on October 15.
New Avalere analysis examines longitudinal trends across a cohort of generic drugs, finding increases in aggregate patient spending over time and in placement on higher tiers in Medicare Part D.
An Avalere analysis finds that, in 2020, 63% of Medicare Part D beneficiaries paid the full cost of their generic medications at least once during their initial coverage phase when the generics were on the preferred brand tier.
An Avalere analysis explores disparities in medication adherence for Medicare Part D beneficiaries living in medically underserved areas (MUAs) and non-MUAs.
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.
In 2022, nearly 4.5 million beneficiaries are in Medicare Advantage (MA) plans offering Special Supplemental Benefits for the Chronically Ill (SSBCI), compared to 1.2 million in 2020, the first year these benefits were available.
An updated Avalere analysis examines Medicare Part D plan tier placement of generic prescription drugs, finding that over time their percentage on generic tiers has declined from 65% in 2016 to 43% in 2022.
Updated Avalere analysis shows that routine immunization continued to lag in 2021 below pre-pandemic levels, highlighting the continuing effect of COVID-19 on routine vaccination.
New Avalere analysis finds that 3 proposals to redesign the Part D benefit would lead to larger increases in mandatory manufacturer discounts on brand drugs within the Part D “6 protected classes” compared to brand Part D drugs overall. Mandatory manufacturer discounts within the protected classes would increase by 661%, 301%, and 409% across the 3 proposals evaluated, compared to 153%, 63%, and 64% for Part D drugs overall.
New analysis from Avalere finds that in 2022 more Medicare Advantage plans will offer non-medical supplemental benefits, such as meals, nutrition, transportation, and in-home support services, at a $0 premium.
New Avalere analysis finds Part D redesign via PDPRA would reduce average OOP costs by 23% for non-LIS beneficiaries, especially for certain drug classes and beneficiary groups by race and reason for entitlement.
A new claims-based analysis from Avalere examined vaccine uptake among low-income adolescents enrolled in Medicaid Managed Care and found a 26% decline in routine vaccinations when comparing March–October 2019 to the same period in 2020.
Avalere analysis finds that when generics in Part D are placed on the preferred brand tier some patients pay the full cost for their drugs.
Avalere’s analysis shows differences in payments between employer and non-employer Part D plans.
In 2020, the COVID-19 pandemic resulted in nationwide lockdowns and restrictions with a well-documented impact on utilization of routine healthcare services.
COVID-related concerns influenced shifts in utilization and changes to the delivery of major pregnancy-related services. The expanded use of telemedicine in the maternal care continuum increasingly provided expectant patients with access to healthcare services while adhering to social-distancing guidelines.
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.
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.
The Kidney Care Choices (KCC) model, a new alternative payment model launched by the Center for Medicare and Medicaid Innovation (CMMI), is scheduled to begin on January 1, 2022. This model will provide population-based payments for beneficiaries with both advanced-stage chronic kidney disease (CKD) and end-stage renal disease (ESRD) to improve patient health outcomes and lower Medicare fee-for-service (FFS) spending.
A new analysis from Avalere finds that in 2021, Medicare Part D plans place generic prescription drugs on generic tiers 45% of the time, a decrease from 64% in 2016.
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.
Avalere analysis finds healthcare utilization among Medicare Fee-for-Service (FFS) beneficiaries decreased in the spring of 2020 compared to the spring of 2019.
New Avalere analysis finds that 3 proposals to redesign the Part D benefit—H.R.19/S.3129, Prescription Drug Price Reduction Act (PDPRA), and Elijah Cummings Lower Drug Costs Now Act (H.R.3)—would increase 2023 mandatory manufacturer discounts by 80%, 81%, and 283%, respectively, with significant variation across therapeutic areas.
Over 3 million Medicare Advantage (MA) beneficiaries are enrolled in plans providing additional supplemental benefits to individuals with chronic illnesses, compared to just over 1 million in 2020.
Globally and in the US, widespread vaccination has demonstrated medical, economic, and social value to both individuals and public health and has contributed to reductions in morbidity and mortality of certain diseases.
On October 8, the Centers for Medicare & Medicaid Services (CMS) published their 2021 Star Ratings for Medicare Advantage (MA-PDs) and standalone Prescription Drug Plans (PDPs) on Medicare Plan Finder.
Avalere analysis finds that the candidates’ healthcare coverage reform proposals could impact a range of 23M to 153M individuals across insurance markets.
Medicare Advantage (MA) plans continue expanding coverage of supplemental benefits, including services related to the pandemic.
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.
Dually eligible beneficiaries in Pennsylvania with end-stage renal disease (ESRD) are more often people of color and have higher costs compared to non-duals, but their utilization patterns are similar.
With the release of the 2021 Medicare Advantage (MA) and Part D Final Rule, the details of the upcoming policy change that allows beneficiaries with end-stage renal disease (ESRD) to enroll in MA are set. Stakeholders need to adapt quickly to be prepared.
Deferral of care during the COVID-19 pandemic is resulting in fewer claims and diagnoses among Medicare Advantage (MA) enrollees, which could lead to a 3%–7% reduction in 2021 risk scores and lower plan payments in 2021.
New Avalere analysis finds that Medicare Part D patients taking brand prostate cancer drugs enrolled in Employer Group Waiver Plans (EGWPs) have more prescriptions in the coverage gap than patients in non-employer plans.
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.
Over half of counties in the US (52%) do not have any mental healthcare providers.
Avalere analysis of the distribution of provider relief funds indicates geographical concentration related to the number of reported COVID-19 cases.
Avalere analysis finds that in the top 25 US counties with highest number of COVID-19 diagnoses, two-thirds of Medicare beneficiaries have 1 or more high-risk medical conditions.
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.
Medicare Advantage (MA) plans are using new flexibilities to provide additional supplemental benefits to beneficiaries with chronic illnesses.
Avalere analysis finds differences in the demographics of patients with End Stage Renal Disease (ESRD) enrolled in Medicare Advantage (MA) compared to ESRD patients in Fee-for-Service (FFS) Medicare
Avalere analysis finds that out-of-pocket (OOP) spending on prescription drugs for beneficiaries with multiple sclerosis (MS) could be as high as one third of their income.
Employer Group Waiver Plans (EGWPs) have lower out-of-pocket (OOP) costs for multiple sclerosis (MS) drugs than beneficiaries enrolled in other types of Part D plans.
According to a new analysis from Avalere, Medicare Part D beneficiaries who are taking mental health drugs and do not receive low-income cost-sharing support are responsible for a higher share of the cost of mental health drugs (46%) than for non-mental health drugs (23%).
According to a new analysis from Avalere, Medicare Part D plans place generic prescription drugs on non-generic tiers 53% of the time in 2020.
New analysis from Avalere finds 52% of Part D plans achieve generic substitution1 rates above 75%.
Avalere analysis finds that payment to Medicare Advantage (MA) plans for end-stage renal disease (ESRD) patients in highly populated regions may be significantly below actual patient costs.
Medicare Advantage (MA) plans continue expanding coverage of supplemental benefits following administration’s policy changes from a year ago.
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 tying Medicare Part D manufacturer discounts to utilization in the catastrophic phase instead of in the coverage gap would have differential impacts by disease area.
In a new analysis, Avalere examines the implications of CMS’ potential new requirement that Part D plans place generics only on generic tiers.