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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Novel Antibiotic Use Is Low, Even for Complex Cases
An Avalere Health analysis determined that less than 1% of patients with community-acquired bacterial pneumonia were treated with novel antibiotics.
Belief Mapping: Elevating Value Engagement Strategies
Uncovering beliefs underpinning payer decision making can help global access teams achieve optimal and equitable patient access, faster.
Part D Formulary Management Tightens in 2026
Coverage for top brand drugs is tightening slightly in 2026, along with increased utilization management and continued shifts from copays to coinsurance.
2026 MPFS Rule: Part B MFPs Included in ASP, but Questions Remain
The 2026 MPFS final rule clarifies how MFP discounts will be included in ASP, confirming stakeholder expectations and introducing new market uncertainties.
Updated Resource: Commercial Payers’ Use of Oncology Compendia
Our updated dashboard provides insights into trends in commercial payers’ use of clinical drug compendia for off-label oncology coverage decisions.
How Can Stakeholders Engage with USPSTF Recommendation Development
The USPSTF develops independent, evidence-based preventive recommendations through an evidence-based review process. Avalere Health helps organizations successfully navigate, engage, and influence these processes.
IDWeek Atlanta 2025: Perspectives on Access and Evidence in Infectious Disease
At IDWeek, Avalere Health connected with industry and academic leaders on the evolving vaccine policy, access, value, and evidence landscape.
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.
Healthcare Utilization and Costs for Patients with Transfusion Dependent β-thalassemia Following Luspatercept Use
A retrospective FFS claims analysis of adults with β-thalassemia found limited differences in most related healthcare resource utilization or cost categories before and after luspatercept use among those with transfusion-dependent β-thalassemia.
White Paper: 50-State Comparison of Medicaid Adult Vaccine Provider Reimbursement
A new analysis reaffirms 2024 and 2021 findings that first identified variability in Medicaid physician office and pharmacy vaccine reimbursement policies.
Part D Policy Change Lowers Max OOP Costs for Many Enrollees
Cost-sharing reductions from enhanced plans and EGWPs allow beneficiaries to reach the catastrophic phase with lower OOP spending than those in basic plans.
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.
IPAY 2028 Guidance Finalizes Some Part B Details, Others Remain
The guidance clarifies some draft policies, adds MA encounter data to Part B drug selection, revises Part B 30DES calculations, and defers some issues to 2029.
From Concept to Practice: Driving Collaboration in Rare Diseases Across Asia-Pacific
In this first installment of our APAC rare disease series, we introduce the topic of multi-stakeholder collaboration and present a corresponding framework.
Part D Choices Continue to Shrink with Fewer PDPs in 2026
The Part D market will contract even further in 2026, with a 22% decrease in standalone PDP options and a 9% decrease in non-SNP MA-PDs.
Key Health Policy Actions to Watch for the Rest of 2025
Policy initiatives announced in early 2025 are now at an inflection point as they converge with regulatory cycles and are set to drive significant activity.
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.
ICD-10 C&M Committee 2025 Fall Meeting: Proposed ICD-10-CM Code Revisions
On September 9-10, NCHS discussed proposals for 300+ new ICD-10-CM codes designed to improve accuracy, address emerging health issues, and strengthen disease reporting.
Access Challenges for Medicare Part D-Covered Vaccines
Differences in Medicare Part B and D coverage can impede access to vaccines, as demonstrated through 2020–2022 administration data of the herpes zoster vaccine.
CMS Continues to Refine Value-Based Care Approach for Kidney Care
The kidney care policy landscape is undergoing important changes, given shifts in the Trump administration’s priorities and a reassessment of existing kidney care models.