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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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.
2027 Medicare Advantage Payments: Market Implications
MA payment growth slows in 2027, possibly signaling further disruption in plan availability and enrollment.
Marking National Kidney Month with An Outlook in the 2026 Kidney Care Policy, Payment, and Treatment Landscape
Evolving kidney transplant regulations, payment reforms, and accelerated innovation in treatments are opening new opportunities across the kidney care landscape.
Beyond Plug-and-Play: Elevating HEOR to Enterprise-Level Impact
Successful HEOR teams are increasingly aligning evidence generation strategies with cross-enterprise teams to maximize their impact.
The Future of Quality in Medicare and Medicaid: Themes from the CMS Quality Conference
Prevention, technology-enabled whole-person care, real-time measurement, simplification, and accelerated innovation were key themes at the recent quality conference.
ICD-10 C&M Committee 2026 Spring Meeting: Proposed Code Revisions
On March 17-18, the ICD-10 C&M Committee discussed proposals for 35+ new codes designed to improve accuracy, address emerging health issues, and strengthen disease reporting.
The X-Factor: Contextualizing Women’s Brain Health
The accelerating pace of Alzheimer’s disease (AD) research warrants a closer look at sex-based differences, as women make up two-thirds of AD diagnoses and provide a disproportionate amount of caregiving.
Multi-Stakeholder Collaboration in Rare Diseases: The Role of Clinicians Within and Beyond the Clinic
Clinicians can support timely, sustainable rare disease care through institutionalized multi-disciplinary roles, strengthened referral networks, and the translation of clinical insights into policy and advocacy.
Early Learnings from China’s New Commercial Health Insurance Innovative Drug Catalogue
The recently launched CHI Catalogue signals payer endorsement of high-cost breakthrough therapies supported by strong clinical evidence, real-world data, and guideline endorsement.
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.