Insights & Analysis
There’s one constant in healthcare: change. Count on us to break down the trends so you can stay up to date. Follow our take on each piece of this deep, intertwined, and often perplexing industry to find opportunities and practical approaches to move healthcare forward.
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GLP-1 Use in Medicare Part D Sharply Increases from 2021 to 2023
Between 2021 and 2023, GLP-1 drug claims increased by 71% for Medicare beneficiaries enrolled in standalone Part D plans.
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.
Integrated Clinical and Coding Strategies Drive Market Success
Early, integrated clinical, coding, and reimbursement strategies transform market access challenges into successful launches with clear coverage and payment pathways.
How are States Responding to Medicaid Budget Pressures?
States are taking near-term Medicaid actions in response to funding pressure including changes to benefits, rates, and procurement timelines.
eBook: Rare Disease Biotech Landscape, 2026
Rare disease demands a unique playbook: The patient journey is rarely linear, the evidence base is often limited, and “rare” can have different meanings across settings and geographies. The third edition of our annual rare disease eBook explores the unique dynamics of the rare disease landscape and its implications for biotech stakeholders.
White Paper: Coverage and Utilization Management Trends in the Commercial Market, 2016-2025
For single-source brand drugs across eight TAs, commercial market formulary coverage, in the aggregate, declined by 20 percentage points from 2016–2025
PDP Enrollment Increases in 2026 While MA-PD Enrollment Declines
In a reversal of recent trends, PDP enrollment rose 7% in 2026, while MA-PD enrollment fell 0.5%, with shifts among large sponsors.
FDA Programs Offer Advantages for Manufacturers in Rare Disease Space
Manufacturers can accelerate innovation and improve rare and ultra-rare disease therapy access by leveraging new and established regulatory pathways.
White Paper: FQHC 340B Contract Pharmacies and Medicare HIV Drug Access
Avalere Health found that contract pharmacy relationships do not increase utilization of HIV drugs for Medicare beneficiaries with HIV receiving care at FQHCs.
Coding, Reimbursement, and Clinical Expertise to Support Market Access
Translate clinical innovation into commercial success by tapping into our market access team’s expertise in coding systems and reimbursement policies.
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.
Gene Therapy in Rare Disease: From Breakthrough to Stewardship
As gene therapies for rare diseases scale, system readiness and long-term stewardship–not science alone–will determine access, impact, and sustainability.
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.
European-level Changes for Market Access in 2026 and Beyond
Avalere Health identifies the key themes emerging from recent EU regulation that directly impacting market access.
Wider Change in the European Environment: Implications for Market Access
Avalere Health identifies EU-driven changes in 2025 that are influencing the market access environment.
USP DC 2026 Updates and Strategic USP Engagement Opportunities
The updated USP Drug Classification was recently released with several revisions to categories, classes, PGs, and products included. Beyond historical uses, USP’s classifications will be used to inform product eligibility for Medicare MFN demonstrations.
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.
2027 Advance Notice Materially Alters Part D Risk Adjustment
Proposed updates to the Part D risk adjustment model to further separate MA-PDs and PDPs will change plan payments for certain conditions if finalized.
Driving Access to Rare Disease Care via Multi-stakeholder Collaboration: Perspectives from APAC Payers and HTA Experts
This third installment of our APAC rare disease series explores key enablers of achieving higher levels of multi-stakeholder collaboration in funding decisions for rare disease treatments.