Drug Pricing and Affordability
Keep up with our comprehensive coverage of administrative and legislative activity and what it means for industry, plans, providers, and patients.
Early Learnings from China’s New Commercial Health Insurance Innovative Drug Catalogue
The recently launched CHI Catalogue signals payer endorsement of high-cost breakthrough therapies supported by strong clinical evidence, real-world data, and guideline endorsement.
Over 170 Drugs May Qualify for Inclusion in the GUARD Model
Avalere Health’s analysis estimates that more than 170 drugs will be eligible for inclusion in the GUARD Model, with most concentrated in five drug categories.
Medicare Drug Price Negotiation: Dynamics to Watch for IPAY 2028
In the IPAY 2028 negotiation cycle, stakeholders should watch how prior MFPs impact negotiations and how Part B adds new complexities.
White Paper: How are Payers Thinking about Accumulators, Maximizers, and Alternative Funding Programs?
Findings from a payer survey examine trends in commercial payer use of cost avoidance strategies and how these programs could affect medication access.
CMS Announces the Third Round of Medicare Drug Price Negotiation
CMS announced the 15 drugs in Medicare Part B and D selected for negotiation for Initial Price Applicability Year 2028.
Impact of US Drug Price Policy on Global Market Access
Given the uncertain challenge of future international price referencing by the US, Avalere Health considers implications for global market access.
How MFN Pricing in Part B May Affect Beneficiary OOP Costs
New analysis suggests the GLOBE Model would have limited impact on OOP costs, with over 99% of sampled Medicare Part B FFS beneficiaries seeing no reduction.
340B Purchase Data Highlights Continued Program Growth
HRSA 2024 340B purchase data demonstrates continued program growth amid shifting market dynamics
Bolstering Efficacy Demonstration for Cancer Drugs at HTA
New Avalere Health research explores the challenges and potential opportunities for demonstrating the value of cancer drugs to HTA agencies.
Emerging Clinical Trial Endpoints in Hemato-oncology at HTA
New research highlights the market access risks faced by manufacturers who use less traditional outcome measures to demonstrate value of innovative hemato-oncology therapies.
Environmental Impact Implementation at HTA and Beyond
Healthcare decisionmakers are increasingly considering evaluation of environmental impact; Avalere Health research explores the implications for manufacturers.
Updated Resource: State Statute Oncology Drug Coverage Report
A detailed Avalere report offers insights into state-specific statutes guiding commercial payer coverage for off-label use of oncology drugs/biologics.
CMS Recognized Greater Savings in IPAY 2027 Relative to the First Year of Negotiation
Competitive dynamics of selected drugs in 2027 drove greater savings than 2026.
PDABs Affect Nearly 8 Million Commercial and Medicaid Lives
State legislators are attempting to reduce patient costs through Prescription Drug Affordability Review Boards.
Direct to Consumer Drug Purchasing: What Comes Next
The growth of DTC drug purchasing programs may shift the patient access and affordability landscape, with implications for manufacturers, payers, and other stakeholders.
Uniting US and Global Pricing Teams in a Post-MFN World
Increasing interplay between US and ex-US drug pricing requires manufacturers to shift to a truly globalized model to future-proof their access strategies.
Part D Trends in LTC Show Growth in Home and Community-Based Care
From 2018 to 2022, Medicare Part D facility-based long-term care pharmacy spending and beneficiary use increased across nearly all patient residence types.
White Paper: Provider Survey on Part B Negotiation Impacts
In a survey, providers say MDPNP may heighten financial pressures, raising concerns around provider sustainability and patient access
340B Rebate Guidance Poses Risks and Rewards for Stakeholders
HRSA’s new 340B rebate pilot for negotiated drugs in 2026 introduces reporting and payment rules, introducing both transparency and new risks for stakeholders.
340B Cuts Could Increase Other Payments for Most Hospitals
Reducing 340B reimbursement to ASP-28.7%, as previously proposed, may increase other payments, especially to small rural and urban hospitals.