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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CAR-T Reimbursement Updates Proposed for FY 2024
Policy proposals for Medicare’s CAR-T inpatient reimbursement reflect additional cases and increase clinical trial payment.
Pipeline Transformative Therapies May Require Payment Model Innovation
Avalere’s assessment highlights a diverse set of over 200 products in development that could challenge payment models across care settings and payers.
What’s Next for Patient-Centered Value?
A significant push towards patient-centered value has occurred in recent years, yet a validated instrument to collect patient-centered data has not been established. The Patient Perspective Value Framework (PPVF) Initiative offers an approach for addressing this missing piece.
Digital Health Technology Access Requires Early FDA, Payer Engagement
As digital health technologies evolve, manufacturers seek clarity on regulatory pathways and access channels.
Do Drug Manufacturers Have the Evidence Needed for Price Negotiation?
Manufacturers may find significant gaps between their existing evidence and the negotiation data elements that CMS will evaluate during the negotiation process.
Operational Complexities of Providing Access to MFP for Part D Drugs
Stakeholders in the drug supply chain should consider operational complexities that will result from variable arrangements for accessing the MFP.
Braidwood Ruling’s Impact on Preventive Service Access
168 million individuals could lose access to $0 preventive services, creating pressure for healthcare stakeholders to address access and equity concerns.
The Future of Water Quality: Half Full or Half Empty?
Lack of running water or indoor plumbing increases morbidity and mortality risk for vulnerable populations.
Geographic Distribution of Potential Rare Disease Patients’ Residences
Among Medicare Fee-for-Service (FFS) beneficiaries, potential rare disease patients' residences have a median distance of over 200 miles to a relevant clinical trial site.
Diabetes Quality Measure Specifications Published by iDQI
New quality measures related to continuous glucose monitoring (CGM) were published in The Science of Diabetes Self-Management and Care by iDQI.
PBM Reform on Top of Congress’s Healthcare Agenda
Avalere Policy Edge survey of bipartisan health policy experts suggests that PBM oversight and reform legislation will pass during this Congress.
50-State Comparison of Medicaid Adult Vaccine Provider Reimbursement
A new Avalere analysis identified variability in Medicaid physician office, pharmacy, and Federally Qualified Health Centers vaccine reimbursement policies.
Infusing the Patient Perspective into Value Assessment
Current value assessment methods do not effectively and quantitatively include patients’ perspectives in the evaluation of treatment value.
6 Ways the Mifepristone Rulings May Impact Future FDA Approvals
Conflicting court rulings regarding FDA approval of mifepristone, part of the regimen for medication abortion, may set a new precedent for product approvals.
How Will the IRA Impact Product Launch Prices?
IRA inflation rebates and drug price negotiation will impact drug launch prices in Medicare, with spillover effects in the Medicaid and commercial markets.
How Should Manufacturers Adjust Their Pipeline Strategies to the IRA?
In response to IRA provisions, life sciences companies should reevaluate their pipeline investment and development strategies.
Survey Finds 58% of Payers Use Outcomes-Based Contracts
In 2022, over half of payers had at least one outcomes-based contract (OBC) and used claims-based outcomes, despite acknowledging the limitations of using claims to measure clinical benefit.
What Evidence Is Needed for Medicare Drug Price Negotiation?
As CMS clarifies evidence requirements for drug price negotiations, manufacturers should prepare their strategies for asset development and on-market products.
Medicaid Redeterminations Will Increase Use of Patient Support
Medicaid redeterminations will bring changes to individual prescription drug access. Manufacturers should consider the impact on patient support programs.
Remote Monitoring Services Flexibilities Will Change as PHE Ends
Avalere survey finds 65% of providers experience challenges associated with billing, coding, and reimbursement for RPM.