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Avalere finds that between 0.03% and 0.1% of Medicare FFS beneficiaries would experience lower OOP costs for the first 10 Part B drugs likely to be negotiated.
While the share of drugs covered on Part D formularies will increase slightly in 2025, more drugs will have coinsurance and utilization management.
The number of PDP and MA-PD options are declining by 26% and 7%, respectively, in 2025.
Avalere finds that between 0.1% and 0.2% of Medicare FFS beneficiaries would experience lower OOP costs for the Part B drugs subject to Q3 2024 inflation rebates.
Sixty-nine percent of 340B contract pharmacies were associated with a PBM through vertical integration (53%) or contractual arrangement (16%).
Avalere analysis finds that less clinically efficacious MS drugs have better coverage, more advantageous tiering, and lower UM compared to more efficacious drugs.
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.
A new Avalere analysis shows the Accelerated Approval pathway provides access to underserved Medicare beneficiaries across a range of conditions with unmet needs.