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.
Independent Pharmacy Challenges and Adaptive Strategies
Facing financial pressures, independent pharmacies adapt to remain viable, offering home delivery, vaccinations, compounding, and medication synchronization.
The New Stakeholder Economics of Part D After the IRA
The implementation of the IRA’s Part D redesign and Medicare drug price negotiation in 2026 will have varying impacts across plan types and therapeutic areas.
Adapting Economic Models for Medicare Negotiation
Manufacturers have several strategies at their disposal to adapt and leverage cost effectiveness evidence in preparation for Medicare drug price negotiation.
Global Market Access Teams as Enablers of Patient Access
With global market access teams navigating a rapidly changing environment, there are several key concepts reshaping how access teams think, plan, and operate to deliver real-word patient access.
Video: 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.
White Paper: The Role of PBMs in the US Healthcare System
A new white paper describes the role of PBMs in the US healthcare system using evidence published in the literature to inform future discussions.
MFN EO Raises A Range of Potential Options for DTC Implementation
A DTC purchasing program could take various forms to enable patients to access MFN pricing.
What the EPIC Act Could Mean for Generics and Medicare Spend
Delaying selection of small-molecule drugs for Medicare negotiation may support the generic market by preserving competition and maximizing long-term savings for payers and the federal government.
CMS Proposes Pay Bump for CAR-T in FY 2026
The inpatient rule proposes a 17% increase for CAR-T stays and several CGTs are under review for New Technology Add-on Payments.
Trump EO Lays Out a Roadmap for Drug Pricing Action
New Executive Order on drug pricing revives earlier Trump proposals and also suggests new approaches for Medicare and states.
Impact of MFP Effectuation on Pharmacies and Beneficiaries
A large share (30%) of beneficiaries access IPAYs 2026 or 2027 negotiated drugs through independent or franchise pharmacies.
White Paper: The Medicaid Drug Rebate Program and Considerations for Generic Markets
This paper details five AMP increase scenarios that could lead to a generic manufacturer being subject to inflation rebates in situations where the generic manufacturer is not taking a price increase beyond the inflation rate.
Impacts of 340B on State Medicaid Programs and Patient OOP Costs
The 340B program may create unintended consequences for state Medicaid budgets and patients who may not see direct benefits from the program.
White Paper: Valuing Multi-Use Drugs in Medicare Negotiation
Alternative approaches for weighting multiple uses of a product when setting maximum fair prices may better balance patient needs and development incentives.
IPAY 2027 Negotiated Drugs Expand Impact on Beneficiaries
The addition of 15 drugs selected for IPAY 2027 negotiation expand the impact maximum fair prices may have on key therapeutic areas and millions of beneficiaries.
Estimating the Spillover Impact of IRA Part B Negotiation
A survey finds that reimbursement contracts outside Medicare FFS still reflect Medicare metrics, raising questions about broader Part B negotiation effects.
CMS Announces Next 15 Drugs Selected for IRA Negotiation
The next cohort of drugs includes additional cancer and chronic disease therapies, as well as products that were therapeutic alternatives for IPAY 2026 drugs.
Three Takeaways from the CMS MFP Justifications for IPAY 2026
CMS released the rationale for the maximum fair prices under the Medicare Drug Price Negotiation Program for Year 1 drugs.
Medicare Prescription Payment Plan May Help Enrollees Facing More Coinsurance in 2025
Shifts from copays to coinsurance in Part D may increase OOP costs and make the Medicare Prescription Payment Plan more beneficial for some enrollees.
IRA Negotiation Impact on Part B Beneficiary OOP Costs
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.