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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Social Determinants May Affect Access to CAR-T Treatment
Analysis highlights potential access barriers to a broad set of CAR-T therapies
Examining Variation in Gene Therapy Access Across States
State Medicaid programs take a range of approaches to gene therapy coverage, management, and reimbursement.
125,000 in MS Could Gain Medicaid Coverage Through Expansion
If Mississippi expands Medicaid to 138% federal poverty level, Avalere estimates 125,000 uninsured individuals, ages 19-64, could gain coverage in 2025.
Manufacturer Learnings from the First Round of Negotiated MFPs
Avalere experts share initial impressions of the publicly released negotiated MFPs for the first round of selected drugs, highlighting implications to industry.
CMS Expands Medicare Device Access Via New TCET Pathway
The new Transitional Coverage for Emerging Technologies pathway will provide Medicare coverage for up to five FDA-designated Breakthrough Devices per year.
Formulary Coverage and Access Shifts in 2024 PDPs
Avalere analysis shows that there are substantial changes and variations in PDP formularies at the therapeutic area and regional levels from 2023 to 2024.
Potential Impacts of IPAY 2026 Maximum Fair Prices on Health Plan Formulary Negotiations
With the release of the IPAY 2026 MFPs, health plans should analyze the impact to formularies and identify opportunities for contracting changes.
Health Policy in the 2024 Election: Avalere and Outside Experts Weigh In
With the election fast approaching, former HHS Secretary Alex Azar, Dan Mendelson, and Avalere experts discussed implications for healthcare stakeholders.
Implications of Self-Administered Drug List Determinations on Access
SAD list placement will inform the channel that providers and patients use to access a therapy.
Updated Negotiation ICR Presents New Industry Evidence Needs
Updates in the Initial IPAY 2027 ICR highlight the increasing needs for specific evidence planning and generation for industry to prepare for negotiation.
PBM, Mail-Order, and Specialty Pharmacy Involvement in 340B
Sixty-nine percent of 340B contract pharmacies were associated with a PBM through vertical integration (53%) or contractual arrangement (16%).
What Will the 2024 Elections Mean for Health Policy?
With key health policy differences between presidential candidates, the 2024 elections are an inflection point for the future of US healthcare.
More Low-Income Subsidy Enrollees Pay Part D Premiums in 2024
An Avalere analysis finds that from 2023 to 2024 the number of LIS enrollees paying a Part D premium increased by more than 1 million enrollees.
2025 a Unique Year for MA and Part D Plans’ Rebate Reallocation
Given increased plan liability under the IRA and uncertainty from late changes to Star Ratings, plans should strategize for their Rebate Reallocation process.
Health Plans 2030: Shifting Clinical Care Delivery
The second installment of our Health Plan series examines how clinical care will shift in reaction to changes in demographics, technology, and environmental factors.
Rethink Evidence Strategy this HEOR Budget Planning Season
Budgeting season offers HEOR teams the opportunity to revisit research and evidence needs and update their commercialization strategy based on market dynamics.
Drug Pricing Transparency Expands Under Several Policies
Transparency disclosures could provide significant insight into pricing and rebating activities.
Mental Health Treatment Integration Can Offer Cost Savings
Adequately treating mental health disorders can cut overall costs, including those from comorbidities, despite access barriers and high comorbidity expenses.
Most Women with Cervical Cancer Were Not Screened Before Diagnosis
An Avalere analysis shows that those who had received cervical cancer screening within five years prior to diagnosis were diagnosed at relatively younger ages.
A Deep Dive Into Hospice Utilization Trends
Avalere analysis reveals an opportunity to support more Medicare beneficiaries with hospice care, as evolving diagnoses and ALOS prompt reevaluation of program metrics