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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Plan Finder Will Play a Key Role in Part D Redesign
Interviews show the importance of Medicare Plan Finder as a resource and generated ideas to incorporate IRA reforms and improve user experience.
Key Stakeholders of the 340B Drug Discount Program
Key 340B stakeholders include the federal government, patients, pharmacies, drug manufacturers, PBMs, plans, and the 340B prime vendor.
How Will the IRA’s Part D Changes Affect Plan Strategies?
Plans preparing MA-PD and PDP bids for Plan Year 2025 should consider how Part D redesign will affect enrollee costs, plan payment, and market dynamics.
ICER Opens Brief Comment Period on Proposed Framework Updates
ICER announced proposed changes to its Value Assessment Framework. Stakeholders have limited time to review and comment by June 30.
US Makes Majority of API by Dollar Value in US-Consumed Medicines
Data analysis finds that 53% of the API, in dollars, used in domestically consumed medicines came from the US in 2021, and 85% came from the US or Europe.
Alternative Funding Programs Present Stakeholder Challenges
Increased use of alternative funding programs has introduced new access challenges for patients, plans, and manufacturers for specialty therapies.
What Is the 340B Prescription Drug Discount Program?
Section 340B of the Public Health Service Act requires significant discounts on outpatient drugs for “covered entities"—safety-net providers and programs.
Which Therapeutic Areas Are Likely to Be Affected by IRA Negotiation?
Sponsors with portfolio or pipeline assets within certain therapeutic areas can prepare for the downstream effects of price negotiation on the market.
Should Competitors of Negotiated Drugs Review Their Market Strategies?
Manufacturers of therapeutic alternatives to negotiation-eligible drugs should re-examine their commercialization strategies in response to market dynamics.
Assessing the MA Risk-Adjustment Model’s Accuracy Among Subpopulations
The accuracy of the CMS-HCC model differs by beneficiaries’ race and ethnicity.
MDRP Proposal Will Impact Vaccine and Novel Immunization Landscape
The proposed vaccine definition would have a significant market impact on novel immunizations such as preventive immunoglobulins and therapeutic vaccines.
Should Competitors of Negotiated Drugs Review Their Evidence Strategy?
Manufacturers of therapeutic alternatives to negotiation-eligible drugs should examine their value and evidence strategy in response to new dynamics.
Will the IRA Change Investment in Orphan Drug Pipelines?
IRA negotiation eligibility criteria may impact orphan drug investment, affecting long-term innovation and patient access.
ISPOR 2023 Presentation: The Future of Value and Evidence Strategy
Avalere’s expert presentations at ISPOR described the IRA’s impact on evidence strategy and highlighted a recent study to capture total disease burden.
Clinical and Market Differentiation of Combination Products
Combination products may offer differentiation but require consideration of unique decisions with regulatory and market access implications.
How Do IRA Drug Pricing Policies Interact with One Another?
Stakeholders should consider the interaction of inflation-based rebates, AMP cap removal, and Medicare price negotiation in pricing and contracting strategies.
Hospital at Home: Opportunities for Manufacturers and Digital Health
The COVID-19 public health emergency and advancements in digital health technologies accelerated the adoption of Hospital at Home, a promising acute-care delivery model.
Insights on IRA Policies and Business Impacts Presented at Asembia
Avalere’s expert presentations at the AXS23 Summit described IRA drug-pricing policies and the law’s impact on patient access and affordability.
EOM Payment Methodology Updated as Start Date Approaches
Amid stakeholder speculation for the future of the EOM, CMMI continues to plan for July 2023 implementation and released key payment methodology details.
US Supreme Court Will Hear Case Affecting Agency Power
The Supreme Court is expected to hear oral arguments in Loper Bright Enterprises v. Raimondo, which challenges Chevron deference.