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.
Inside Compendia: Introduction to Clinical Drug Compendia
In the first installment of our Inside Compendia series, Avalere Health Advisory experts discuss how to engage and support life sciences companies in ways of incorporating their products into clinical compendia and guidelines.
Supreme Court Upholds Zero-Cost Preventive-Care Rule
In Kennedy v. Braidwood, the Supreme Court affirmed HHS’s USPSTF appointment power, keeping the ACA’s no-cost preventive-service mandate fully in force.
Variability of Comparator Drugs in Ex-US HTAs Offers Lessons for the IRA
Ex-US HTAs often select different therapeutic alternatives when assessing the effectiveness of the same therapies, highlighting the complex factors that influence such decisions.
Inside the Latest RADV Regulatory Developments
Avalere Health Advisory experts break down major updates to the CMS Medicare Advantage (MA) Risk Adjustment Data Validation (RADV) audit process, including enhanced technology, workforce expansion, and increased audit volume, and how health plans can prepare.
White Paper: Provider Survey on Part B Step Therapy in Medicare Advantage
Step therapy is a form of utilization management increasingly used by health plans, including Medicare Advantage plans, with the stated intent to guide prescribing decisions toward cost-effective, evidence-based therapies.
Part D Cost Pressures May Shape Future Alzheimer’s Drug Management
As new Alzheimer’s drugs are developed, increased plan liability pressures may shape future Part D plan management strategies
Unpacking the Final CY2026 CMS Part C and D Rule and Rate Announcement
Avalere Health Advisory experts explore how the Trump Administration approached Medicare Advantage and Medicare Part D policies proposed by the Biden Administration, ranging from anti-obesity medication coverage to plan payment increases
Unpacking CMS RADV: The Selection Process and Planning for the Future
Avalere experts discuss the CMS Medicare Advantage (MA) Risk Adjustment Data Validation (RADV) audit process and provide insight on how health plans can proactively plan and prepare for these audits.
AI for Health Plans: AI and Clinical Data in Action
In the third and final installment of our AI for health plans video series, Avalere is joined by experts Mia Bolton and Teddy Gedamu from Tenasol to share real-world examples of how artificial intelligence (AI) can streamline data management and improve decision-making in health plans.
Avalere White Paper: Value-Based Care and Orthotics and Prosthetics
A white paper explores ways in which VBC payment models can benefit from incorporating allied health domains, such as Orthotics and Prosthetics.