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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Key Policy and Access Themes from the World Vaccines Congress
The World Vaccine Congress addressed the changing landscape of infectious diseases and vaccine types, approvals, recommendations, and reimbursement pathways.
Opportunities to Prepare for Year 2 of Medicare Negotiation
Manufacturers anticipating potential selection or therapeutic impact for 2027 Medicare negotiations should begin preparations and align internal decision-making, applying learnings from Year 1.
Trends in Generic Tiering in Medicare Part D, 2011–2021
From 2011 to 2021, there was an increase in higher formulary tiering, patient out-of-pocket spending, and negotiated price for a cohort of generics.
Upper Payment Limits on Drugs Could Alter Patient Access
State approaches to PDABs and UPLs vary, but all approaches could impact patient access and affordability.
A More Complex Future Market for Diagnostics?
With regulatory changes on the horizon, diagnostics stakeholders should prepare for a new evidence development and commercialization environment.
Research Explores Health Plan Perceptions of PDABs and UPLs
Avalere assessed how health plans may view UPLs, including implementation considerations and impacts on providers and patients (e.g., plan benefit design).
Trends in Part D Spending on IVIG: Price Growth and Cross Benefit Shifts
Part D IVIG spend saw meaningful growth between 2017 and 2022, even as the implementation of the Medicare Home Infusion Benefit contributed to uptake of the drug class in Medicare Part B.
Buy and Bill Provides Key Revenue for Physician Practices
The acquisition and administration of Part B drugs provides key revenue for many physicians, with high uptake in some specialties.
2024: An Era of Innovation and Disruption in Kidney Care
A dynamic regulatory landscape, technological advancements, and investments in R&D offer new opportunities and challenges in kidney care.
Forthcoming Regulatory Changes for Lab-Developed Tests
This spring, the FDA will issue a rule to begin regulating LDTs as medical devices. A multi-faceted legislative, legal and market response is anticipated.
Payment Barriers Persist for Vaccinating Providers
Following policy changes addressing vaccine coverage gaps, stakeholders are focusing on provider financial and administrative barriers to vaccination.
A Collaborative Approach to Incorporating AI in RWE
Stakeholders can collaborate to ensure the safe, ethical, and effective use of AI-based tools to bolster RWE and improve patient outcomes.
Exploring Disparities in Access Among Patients with Relapsed or Refractory Diffuse Large B Cell Lymphoma
Demographic and socioeconomic factors involved in treatment options in diffuse large B cell lymphoma oncology.
CMS Creates New Codes to Reimburse for Navigation Services
Newly developed HCPCS codes will support increased access to oncology navigation services, which have been shown to improve patient outcomes.
Repercussions of Cyberattack on Change Healthcare
A major cyberattack has disrupted medical and pharmacy claims processing and is expected to impact how medical claims are submitted and paid in the future.
Trends in Risk Adjustment Coding Operations
Plans adapt to market changes in risk adjustment coding. Interviews with plan professionals reveal three trends for efficiency, effectiveness, and compliance.
Specialty Pharmacies Adapt to Support Cell and Gene Therapies
Specialty pharmacies are evolving to support the unique distribution requirements of CGTs and the complex patient journey from diagnosis to treatment.
Redefining D-SNP Look-Alikes Would Impact Enrollment
If CMS lowers the dual-eligible enrollment threshold it uses to define D-SNP look-alikes, the demographics in look-alike plan enrollment will likely change.
Part D Risk Adjustment Will Have New Importance Under IRA
Analysis of data in the CMS VRDC shows that MA-PD utilization has steadily increased in therapeutic areas likely to have large increases in plan liability under Part D redesign.
Newest Standards of Care Continue to Reflect Advances in Diabetes Technology
Continued emphasis on diabetes management technology and patient-centered care in updated clinical management standards highlight the importance of advancing quality measurement.