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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Some Medicare Part D Beneficiaries Pay Full Price for Generic Drugs
An Avalere analysis finds that, in 2020, 63% of Medicare Part D beneficiaries paid the full cost of their generic medications at least once during their initial coverage phase when the generics were on the preferred brand tier.
The Rare Disease Market: Policy Changes and Coverage Trends
Changes to rare disease policies and payers’ approaches to coverage could have significant impacts on product development, patient access, and reimbursement.
EOM Model: 5 Key Considerations for Stakeholders
Stakeholders should consider how the Enhancing Oncology Model’s design and incentives will impact cancer care management and treatment selection.
Avalere Expert Commentary on CMS Enhancing Oncology Model
CMS announces long-awaited successor to the Oncology Care Model (OCM), which is scheduled to conclude on June 30, 2022.
Value-Based Arrangement Pricing Flexibilities Will Take Effect July 1
Starting July 1, manufacturers can report multiple best prices for some value-based arrangements, which may encourage broader use of innovative contracting.
Survey: Health Policy Experts Expect BBBA Passage Before Midterms
Avalere Policy Edge survey of bipartisan Congressional and health policy experts suggests the Build Back Better Act (BBBA) will likely pass in 2022.
SCOTUS Ruling and Other Trends May Shape the 340B Policy Landscape
The SCOTUS decision is the most prominent action related to the 340B program, but ongoing litigation among stakeholders and growing activity at the state level are catalyzing developments that could shape the 340B landscape
Political Realities Require Trade-Offs from Democrats on Skinny BBBA
As Democrats seek consensus on a "skinny BBBA," concerns over inflation and deficit reduction will place greater emphasis on "pay-for" targets to advance healthcare priorities.
Global Regulatory Agilities During the COVID-19 Pandemic
Avalere reviewed innovative regulatory approaches deployed during the pandemic, their impact on a diverse set of stakeholders, and how they could be sustained.
How Statutory Management of Healthcare Inflation Impacts Providers
The cost of medical goods and services has risen faster than general inflation while physician payment has not. Management of healthcare inflation reduces providers’ power in the market.
Medicare Beneficiary Care Differences by Practice Ownership
Avalere released a white paper analyzing spending and utilization among Medicare beneficiaries receiving care from independent physician practices and hospital-owned physician practices in Ohio.
Differential Impact on OCM Performance by Cancer Type During COVID-19 PHE
An Avalere analysis found that OCM episode spending remained below the benchmark price for prostate cancer and low-risk breast cancer during the COVID-19 public health emergency (PHE). However, spending continued to exceed the benchmark for other cancers. These patterns suggest a differential impact of the PHE on OCM performance and episode service use by cancer type.
More than 100 Drugs May Be Eligible for Negotiation Under BBBA by 2030
Avalere analysis estimates more than 120 drugs may be eligible for negotiation under the BBBA by 2030. This count reflects the cumulative nature of the policy.
Medication Adherence in Medically Underserved Areas
An Avalere analysis explores disparities in medication adherence for Medicare Part D beneficiaries living in medically underserved areas (MUAs) and non-MUAs.
Ex-US Approaches to Drug Accelerated Approval
International methods of expedited approval offer approaches that policymakers may adopt to reform the US system, as signaled in recent legislative proposals.
CAR-T Reimbursement Continues to Evolve in FY 2023 IPPS Proposed Rule
Policy proposals for Medicare’s CAR-T inpatient reimbursement build on market developments as bundled payment incorporates additional treatments.
White-Bagging Legislation Gains Popularity in State Legislatures
In recent years, payers and pharmacy benefit managers (PBMs) have been interested in implementing strategies that may reduce overall costs, such as the use of white bagging. However, provider and patient groups have raised concerns that these tactics may create access to care, cost, and safety issues. Legislation seeking to regulate this practice is on the rise in many state legislatures.
MQii Roundtable Proceedings / Malnutrition and Health Equity
Successful initiatives to address malnutrition and food insecurity through quality measurement and community partnerships are improving malnutrition care across the country and addressing health equity.
Underrepresented Groups Would Save with Part D OOP Cap
As policymakers continue to consider reforms to the Part D benefit design, an Avalere analysis finds that a disproportionate share of disabled beneficiaries and racial/ethnic minority groups, including Black and Hispanic beneficiaries, would have out-of-pocket (OOP) costs above $2,000 in 2024, indicating that an OOP spending cap under Part D benefit redesign may particularly benefit these patient populations.
Addressing Climate Change Impacts on Health
As climate change continues to alter the patterns of everyday life, healthcare stakeholders should consider strategies to prevent and mitigate negative environmental contributions and proactively address the impacts of climate change on health outcomes, health equity, and healthcare costs.