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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White Paper: 50-State Comparison of Medicaid Adult Vaccine Provider Reimbursement
A new analysis reaffirms 2024 and 2021 findings that first identified variability in Medicaid physician office and pharmacy vaccine reimbursement policies.
Part D Policy Change Lowers Max OOP Costs for Many Enrollees
Cost-sharing reductions from enhanced plans and EGWPs allow beneficiaries to reach the catastrophic phase with lower OOP spending than those in basic plans.
Uniting US and Global Pricing Teams in a Post-MFN World
Increasing interplay between US and ex-US drug pricing requires manufacturers to shift to a truly globalized model to future-proof their access strategies.
IPAY 2028 Guidance Finalizes Some Part B Details, Others Remain
The guidance clarifies some draft policies, adds MA encounter data to Part B drug selection, revises Part B 30DES calculations, and defers some issues to 2029.
From Concept to Practice: Driving Collaboration in Rare Diseases Across Asia-Pacific
In this first installment of our APAC rare disease series, we introduce the topic of multi-stakeholder collaboration and present a corresponding framework.
Part D Choices Continue to Shrink with Fewer PDPs in 2026
The Part D market will contract even further in 2026, with a 22% decrease in standalone PDP options and a 9% decrease in non-SNP MA-PDs.
Key Health Policy Actions to Watch for the Rest of 2025
Policy initiatives announced in early 2025 are now at an inflection point as they converge with regulatory cycles and are set to drive significant activity.
What Do Risk Adjustment Model Updates Mean for Part D Plans?
CMS’s post-IRA updates to the RxHCC risk adjustment model have varying effects on plan loss ratios across therapeutic areas.
ICD-10 C&M Committee 2025 Fall Meeting: Proposed ICD-10-CM Code Revisions
On September 9-10, NCHS discussed proposals for 300+ new ICD-10-CM codes designed to improve accuracy, address emerging health issues, and strengthen disease reporting.
Access Challenges for Medicare Part D-Covered Vaccines
Differences in Medicare Part B and D coverage can impede access to vaccines, as demonstrated through 2020–2022 administration data of the herpes zoster vaccine.
CMS Continues to Refine Value-Based Care Approach for Kidney Care
The kidney care policy landscape is undergoing important changes, given shifts in the Trump administration’s priorities and a reassessment of existing kidney care models.
Health Plans 2030: Responding to OBBBA Medicaid Provisions
The OBBBA brings sweeping Medicaid changes, reshaping eligibility, funding, and access, impacting millions of enrollees, providers, and health plans.
Policy Changes to Expect for Medicare Advantage in 2027
In the CY 2027 Medicare Advantage policymaking cycle, the Trump administration is expected to propose changes to payments, oversight, and Star Ratings.
The Role of Payer Mix in Access Strategies for Complex Therapeutic Areas
With IRA, MFN, and OBBBA pressures, manufacturers must assess coverage shifts, demographics, and payer mix to refine channel strategy and improve patient access.
Implications of PBM-Pharmacy Co-ownership Legislation
Avalere Health examines how new federal and state efforts to oversee PBM-pharmacy ownership may affect stakeholders systemwide.
Part D Trends in LTC Show Growth in Home and Community-Based Care
From 2018 to 2022, Medicare Part D facility-based long-term care pharmacy spending and beneficiary use increased across nearly all patient residence types.
White Paper: Provider Survey on Part B Negotiation Impacts
In a survey, providers say MDPNP may heighten financial pressures, raising concerns around provider sustainability and patient access
New CAR-T Policies Affect Access, Reimbursement
Medicare CAR-T payment will increase in FY 2026, improving hospital reimbursement; CMS will consider shifting to market-based rate-setting in future rulemaking.
340B Rebate Guidance Poses Risks and Rewards for Stakeholders
HRSA’s new 340B rebate pilot for negotiated drugs in 2026 introduces reporting and payment rules, introducing both transparency and new risks for stakeholders.
The Evolving Role of Global Value Communication
As national reimbursement is no longer the only priority for global teams, value communication materials may evolve to enable meaningful, timely patient access.