The Impact of CMS and HHS Rules on Responsible AI Use
CMS and HHS regulations are shaping AI use in health plans, driving transparency and accountability, and speeding responsible adoption across an increasingly automated system.
What’s Shaping Healthcare Right Now?
Introducing On the Record: Health Plan Perspectives—A rapid-fire series delivering expert clarity on major CMS and HHS rules. In five minutes, get the insights, implications, and decisive perspective leaders need now.
The Future of Quality in Medicare and Medicaid: Themes from the CMS Quality Conference
Prevention, technology-enabled whole-person care, real-time measurement, simplification, and accelerated innovation were key themes at the recent quality conference.
ICD-10 C&M Committee 2026 Spring Meeting: Proposed Code Revisions
On March 17-18, the ICD-10 C&M Committee discussed proposals for 35+ new codes designed to improve accuracy, address emerging health issues, and strengthen disease reporting.
Evolving Policy Trends in Cell and Gene Therapy
Changes in state and federal policies will drive patient access, financing, and provider reimbursement of cell and gene therapies.
Federal and State Dynamics in AI Regulation
Avalere Health Advisory experts unpack the recent state legislative activity around AI in healthcare, exploring recent trends, the impact of federal executive orders, and key considerations for industry stakeholders as they navigate these shifts.
RWD Integration in Reimbursement Decisions across EU4 and the UK
European countries are advancing real-world data use in healthcare decision-making, but face challenges from differing national frameworks and regulations
Digital Health Evolution in Remote Monitoring and AI Codes
Evolving digital health codes are reshaping how technology and care connect.
Sociodemographic Factors and Healthcare Costs Among Rare Epilepsies
Distinct patient characteristics and cost profiles across rare epilepsies reinforce the value of disease-specific approaches in rare disease research.
Impacts to Insurance Markets, 2026 and Beyond
Avalere Health experts discuss how they developed and deployed an analytic model to predict likely enrollment changes to assist clients in understanding the impacts on all lines of business as a result of upcoming federal policy changes.
What Do Risk Adjustment Model Updates Mean for Part D Plans?
CMS’s post-IRA updates to the RxHCC risk adjustment model have varying effects on plan loss ratios across therapeutic areas.
The Role of Payer Mix in Access Strategies for Complex Therapeutic Areas
With IRA, MFN, and OBBBA pressures, manufacturers must assess coverage shifts, demographics, and payer mix to refine channel strategy and improve patient access.
Independent Pharmacy Challenges and Adaptive Strategies
Facing financial pressures, independent pharmacies adapt to remain viable, offering home delivery, vaccinations, compounding, and medication synchronization.
State Oversight of AI in Healthcare: Status and Impacts
State oversight of AI in healthcare has primarily focused on prior authorization, disclosure and operations requirements, and scope of practice.
Inside Compendia: Off-Label Applications
Avalere Health Advisory experts discuss how compendium shape off-label drug use, underscoring both benefits and risks in clinical decision-making.
EHDS Aims to Transform Data Access Across EU Health Systems
The European Health Data Space aims to enable secure, unified health data access across Europe, supporting research, innovation, and improved patient outcomes.
Inside Compendia: Expanding Intended Use Populations
In the second installment of our Inside Compendia series, Avalere Health Advisory experts discuss how compendia can support clinical decision-making and medication access, highlighting a case study on GLP-1s.
OBBBA and Medicare Negotiation Eligibility: Considerations for Manufacturers
For IPAY 2028 and beyond, the OBBBA expands the exclusion for orphan drugs subject to Medicare negotiation, with implications for negotiation selection timing.
2025 Update: Biosimilar Substitution State Statute Report
The 2025 edition of the annual report provides insights into state statutes on point-of-service substitution of biosimilar products and is available
White Paper: Vaccine Access Challenges Amid Medicaid Unwinding
The unwinding of COVID-era Medicaid continuous enrollment policies resulted in insurance coverage losses and challenged vaccine access for adults.