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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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.
How Can Manufacturers, Payers, Providers, and Patient Groups Prepare for Medicaid Work Requirements?
Stakeholders can prepare for the upcoming implementation of federal Medicaid community engagement requirements, which are planned to go into effect January 1, 2027.
Europe’s First Joint Clinical Assessment Report is Out: What this Milestone Means for Global Market Access
With the first output of the Joint Clinical Assessment (JCA) process in the European Union (EU) now published, Avalere Health considers implications for global market access strategies.
USP’s Draft MMG V10.0: What May Change for Part D Formularies
USP’s draft Medicare Model Guidelines v. 10.0 proposes updates to drug categories and classes that will shape Part D formulary design and patient access for plan years 2028–2030. Public comments are open until June 30.
How can MCOs Prepare for Medicaid Community Engagement (Work) Requirements?
MCOs have an opportunity to prepare for—and mitigate—the impact of Medicaid work requirements, which are expected to go into effect in January 2027.
Finding Clarity in Uncertainty: How Delphi Panels Generate Consensus-Driven, Publication-Ready Evidence
Delphi panels are a methodologically rigorous way to fill evidence gaps, build expert consensus, and translate that consensus into meaningful strategic action.
What to Expect When You’re Expecting (to Submit an ICD-10-CM Code Request)
As NCHS guidance on ICD-10-CM code submissions requests evolve, stakeholders need to be aware of the new parameters to navigate each stage of the proposal with confidence.
NAIIS Highlights How Immunization Stakeholders Adapted to Address Vaccine Policy Gaps
We connected with vaccine stakeholders at the 2026 NAIIS on emerging vaccine policy and access challenges, exploring strategies to advance immunization access and uptake in an uncertain vaccine policy ecosystem.
Are Cost-Effectiveness Thresholds Fit for US Reimbursement Decision-Making? Methodological, Practical, and Policy Considerations
Cost effectiveness thresholds present conceptual and practical challenges when applied to the US healthcare system.
Alzheimer’s Treatment Has Changed. Has Value?
Emerging evidence in Alzheimer's disease highlights a gap between measured effects and lived experience, shaping how value is defined, evidenced, and assessed.
Everything We’ve Learned from the RLTs on the Market: The Infrastructure Gap
In the latest installment of our RLT series, we explore the manufacturing, supply chain, infrastructure, and workforce challenges shaping access.
Physician Payment Changes and MFP May Strain Independent Physicians
Medicare payment and Part B drug pricing changes may increase financial pressure on certain independent physician practices, varying by specialty and site of care.
Bridging the Gap: The Future of GLP-1 Coverage in Part D
The recent delay of the BALANCE Model and the GLP-1 Bridge extension highlight the challenges of expanding GLP-1 access in Part D.
World Vaccine Congress Signals a Shift in Vaccine Environment
The 2026 World Vaccine Congress offered insights into the rapidly evolving vaccine pipeline and the future of policy, access, reimbursement, and evidentiary outcomes for preventive and therapeutic vaccine products.
Inpatient Hospital Changes Proposed for Cell Therapy
CMS proposes a CAR-T payment increase in FY 2027, mediated by proposed changes to the outlier payment.
County and City Health Officials Chart the Path Forward for Public Health Preparedness
Avalere Health’s Vaccines Team connected with public health officials at the 2026 NACCHO Preparedness Summit to learn about challenges and opportunities in an evolving federal policy environment.
2027 Part D Risk Adjustment Changes Will Alter Plan Payment
Finalized updates to the Part D risk adjustment model to further separate MA-PDs and PDPs will change plan payments for certain conditions.