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.
The Role of Comparator Selection in Ex-US HTA and International Drug Pricing
With international reference pricing proposals gaining renewed attention in the US, the HTAs conducted in reference basket countries gain increased importance to US policy and patients. HTA agencies’ choice of comparator treatments plays a crucial role in how it judges a treatment’s value.
HHS Appoints Eight New USPSTF Members, Reshaping the Panel’s Expertise and Raising Implementation Questions
New appointments restore the U.S. Preventive Services Task Force to 16 members following more than a year of disrupted activity.
Surprise Proposed Updates to the Provider Taxes Have Implications across Medicaid
The CMS proposed rule implementing the OBBBA's provider tax provisions introduces new regulatory standards that will reshape Medicaid financing, and its effects will be felt by states, plans, and providers beginning as early as October 1, 2026.
Health Plans’ Quarterly Performance: A Path to Recovery But Continued Margin Pressures
Q2 financial performance reports from six publicly traded health plans reveal industry-wide trends in Medicare Advantage, Medicaid, and commercial lines of business.
Hearing What the Data Can’t Say: Why Qualitative and Survey Research Matter in Rare Disease Evidence Strategy
For rare disease therapeutics companies, traditional evidence approaches often fall short. Small patient populations, limited claims data, and heterogeneous disease presentations create gaps that quantitative methods alone cannot fill. Qualitative and survey-based research captures patient and caregiver experience, surface unmet needs that claims data misses, and generate patient-centered evidence for payers, regulators, and HTA bodies. Investing early helps companies demonstrate value, differentiate products, support access, and ultimately ensure that critical therapies reach EVERY PATIENT POSSIBLE.
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.