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.
Legislative Proposals Aim to Modify the 340B Program
Proposed 340B reforms clarify patient and child site eligibility, increase oversight, and establish systems to identify duplicate discounts and diversion.
How Rare Diseases Are Reshaping Evidence Generation Strategies
Rare diseases are reshaping evidence generation strategies, necessitating that all stakeholders incorporate novel approaches to data collection.
MFP Effectuation and the SDRA: The Possibility of ASP Spirals in Competitive Drug Classes
Efforts to manage negative provider cost recovery using ASP-based refunds risks acceleration of ASP erosion, creating tradeoffs across Medicare and commercial markets.
340B Payment Proposal Would Increase Payment to Most Hospitals
Reducing 340B reimbursement to ASP-33.4%, as proposed, would increase outpatient reimbursement, especially for small hospitals.
On the Record: Health Plan and Provider Perspectives Video Series
US health plans are navigating big regulatory changes. We've got you covered.
Effectuation and SDRA: The Dilemma of Competitive Drug Classes
CMS’s proposed SDRA methodologies for IPAY 2018 of the MDPNP could result in materially different refund obligations across products based on their competitive and discount profiles.
340B Purchases Surge Past $100 Billion
2025 340B purchase data shows continued program growth amid shifting market dynamics.
State Pricing Controls at an Inflection Point: MFP and the Shifting PDAB Landscape
With Colorado's upper payment limit for Enbrel on hold, state prescription drug affordability board legislation could look very different in 2027.
2026 Dyslipidemia Guideline Signals a New Standard for Cardiovascular Risk Management
A jointly published guideline on dyslipidemia (i.e., unhealthy presence of lipids in the blood) emphasizes proactive lifetime CVD risk reduction, with important implications for patients, providers, and payers, as well as quality measurement.
Negotiated Part B Drug Effectuation Proposals: Four SDRA Approaches and Key Tradeoffs
Stakeholders will need to weigh the tradeoffs between the various proposed standardized default refund amount methodologies.
2027 NAMBA Signals Continued Market Pressures in Part D
As NAMBA increases by more than 20% for a fourth consecutive year, the end of the PDP Premium Stabilization Demonstration adds to market uncertainty.
New Analysis Highlights Opportunities to Improve MPPP Uptake
Avalere Health’s latest analysis found very low uptake of the Medicare Prescription Payment Plan (MPPP) in 2025, even among those who could benefit most.
What Does Another USPSTF Meeting Cancellation Mean for Preventive Care Recommendations?
The cancellation of the July USPSTF meeting raises new questions about future governance, membership, and recommendation development process for the influential clinical advisory body.
Navigating State Variability in Medicaid Work Requirements
State discretion over work requirement implementation may create significant variability, impacting patients, providers, and health plans.
CMMI’s Financial Footprint: Medicare Trust Fund Payments and Reporting Gaps
Public data shows over $20 billion in Medicare Trust Fund payments attributable to CMMI models from FY2010–FY2024 as CMMI’s role in shaping drug payments grows.
Medicaid Work Requirements: Understanding Exemptions and Protecting Patients
Medicaid work requirements are expected to start January 2027, with narrower exemptions than anticipated. Learn how life sciences companies, plans, and providers can support patients.
Part B Negotiated Drug Prices: How MA Plans Should Prepare
Part B drugs will be subject to IRA price negotiation for the first time in 2028, introducing new payment uncertainties for Medicare Advantage plans.
Post-Clover and 2027 QBP Re-Calculation: What Could Be Next for MA Stars?
CMS will be re-calculating 2027 QBP ratings following the May 2026 Clover ruling. Avalere Health experts share insights on potential future directions for the MA Star Rating program.
Claim Denials Vary by Specialty in Traditional Medicare
Our analysis of 2023 fee-for-service (Traditional) Medicare claims denials found variations in the percentage and volume across specialty type.
Beyond R&D: Manufacturers as Partners Enabling Access to Rare Disease Care
In this fifth and final article of our APAC rare disease series, we explore key opportunities for manufacturers to strengthen rare disease healthcare system readiness through multi-stakeholder collaboration.