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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Over Half of Generic Drugs Are Not on Part D Generic Tiers
In recent years, Medicare Part D plan tier placement of generic prescription drugs has declined, from 64.5% in 2016 to 43.8% in 2024.
Cervical Cancer Screening Rates Differ Across Demographics
The majority of women are not receiving cervical cancer screenings in compliance with recommendations, with disparities by insurance and age.
Drug Repurposing: Potential to Expand Rare Disease Treatment
Drug repurposing offers developers an opportunity to bring treatment options to patients at a reduced cost and shortened timelines, although challenges exist.
Medicare Nebulizer Use for COPD Differs by Race/Ethnicity
Rates of filled prescriptions for nebulizers in Medicare FFS vary across factors such as age, disability, and race/ethnicity.
Limb Loss and Limb Difference: US Prevalence and Impact
Avalere and the Amputee Coalition analyzed claims data to understand the prevalence of limb loss and limb difference and the implications for public policy.
Understanding the CMS Cell and Gene Therapy Access Model
The CGT Access Model will allow CMS to negotiate outcomes-based agreements on behalf of state Medicaid programs for CGTs, beginning with sickle cell disease.
Proposed Revisions to Part D Risk Adjustment Model in 2025
Due to increasing the portion of plan payments subject to risk adjustments in 2025, CMS proposed aligning the risk adjustment model with Part D redesign.
Charting Change: CPT Coding and Remote Monitoring
The AMA’s upcoming CPT Editorial Panel meeting on coding and billing for remote monitoring will shape the future of digital health technology.
Status of US Prescription Drug Importation Pathways
Recent FDA authorization of Florida’s Section 804 Importation Program has prompted increased focus on importation pathways.
Assessment of Proposals to Address Drug Shortages
Drug shortages have consequences for a broad range of stakeholders, and policy proposals vary in their ability to address negative impacts.
Wrap Up: Top Trends in Health Economics and Outcomes Research
Avalere analyzed the top trends in HEOR and key implications for life sciences companies to consider for future strategic planning.
After a Rare Disease Diagnosis, Patient Utilization Rises
Healthcare resource utilization increased for Medicare FFS patients following diagnosis of an ill-defined rare disease.
Variation in Autoimmune Payer Mix Drives Channel Strategy
Variation in mix of payer coverage across autoimmune diseases highlights the need for manufacturers to assess patient payer mix to support channels of access.
CMS Site-Neutral Payments Affect Small Share of Spending
Payments to off-campus hospital sites affected by site-neutral payment policy amount to only 2.3% of Medicare outpatient spending.
Top HEOR Trends: Quantifying Indirect Burden and Measuring Novel Elements of Value
Avalere experts dive into Trend #10: Quantifying Indirect Burden and Measuring Novel Elements of Value and discuss its evolving nature.
Assessing the Total Economic Burden of Rare Disease
Innovative research methods can be used to measure the total burden of rare disease, including direct medical costs, indirect costs, and overall life impacts.
Use of Dispense as Written Codes After Generic Entry
Analysis of Dispense as Written codes highlight that many factors influence stakeholder preferences for brand or generic drugs after loss of exclusivity.
2023 Top Trends in HEOR: Policy’s Pressure on HEOR
Avalere experts dive into Trend #9: Policy’s Pressure on HEOR and explore implications of recent policy developments on evidence strategies.
Proposed Changes to Best Price Could Shift Market Dynamics for Stakeholders
The MDRP proposed rule's Best Price "stacking' provision has direct and indirect impacts on Medicaid rebate liability across drug classes.
States Will Prioritize Drug Affordability and Access in 2024
States will commence legislative sessions at the beginning of January. Drug pricing, including payment limits and reference pricing, as well as improved access will be key priorities.