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.
Featured Content
Premium Content
Premium Content
New COVID-19 Treatment Add-On Increases Payment Relative to NTAP
Avalere analysis finds hospitals would receive higher additional payments from Medicare through the New COVID-19 Treatment Add-on Payment (NCTAP) compared to the New Technology Add-on Payment (NTAP).
MFN Model Would Have Had a Major Impact on Certain Providers
New Avalere analysis finds that the the Most Favored Nation (MFN) Model would have a significant negative impact on Medicare providers that furnish Part B drugs—especially in oncology and rheumatology—and those in rural areas.
IoT: Opportunities and Use Cases for Life Sciences Organizations
Internet of Things (IoT) is a catch-all term that refers to any device that can connect to a network (including the Internet) and communicate with other devices.
Clearing the Path: Through the Pandemic and Beyond
Healthcare stakeholders face a unique set of challenges and opportunities in 2021 as we continue to respond to the COVID-19 pandemic and prepare for the political changes inherent in a new presidential administration. As we take stock of the historic events of 2020, it is important to look ahead toward the new era already coming into view.
10 Key Healthcare Implications of the GA Senate Runoff Elections
The outcome of Georgia’s runoff election—resulting in a Democratic majority in the Senate—combined with the existing Democratic majority in the House and incoming Biden administration, significantly changes the policy outlook for 2021.
Reducing Maternal Mortality Among Women of Color
Women of color are disproportionately affected by pregnancy-related death in the US, which has a higher maternal mortality rate than 10 other developed nations worldwide.
Investing in Health Disparities: A Framework for Accelerating Action
In response to the COVID-19 public health emergency and recent social events highlighting systemic inequities, life sciences companies have issued bold statements reaffirming their commitment to diversity, inclusion, and health equity.
Opportunities for Advancing Health Justice in the COVID-19 Era
The COVID-19 pandemic has disproportionately impacted communities of color since the first cases were identified in the United States.
Avalere and RWJF Select Grantees to Advance Health Equity
Grantees will evaluate models for transforming health systems to promote health equity for Medicaid populations.
Strengthening Patient Access for Type 2 Diabetes Preventive Services
Type 2 diabetes (T2D) rates have grown substantially over the years and have placed a significant burden on the US healthcare system. While prevention efforts continue to advance, including the availability of screening tools and early prevention therapies, systemic disparities still preclude equitable access to preventive services. These will need to be addressed as a key component of strengthening patient access to preventive care and lowering the incidence of disease.
Medicare Covers More Part B Therapies for Breast Cancer than NHS England
Avalere analysis found that in 2017 and 2018, more than half (56%) of Medicare patients with breast cancer taking a medicine covered by Medicare Part B received a therapy that was not routinely covered by England’s National Health Service (NHS) or its Cancer Drug Fund (CDF).
Most Favored Nation Rule’s Impact on Medicare Beneficiaries OOP Costs
New Avalere analysis finds that most Medicare fee-for-service (FFS) beneficiaries would not see a substantial reduction in their out-of-pocket (OOP) costs as a result of the Most Favored Nation (MFN) model.
Improving the Public Health Impact of Pediatric Prevention Innovations
As the pipeline of novel vaccines expands, so does the pipeline for other “vaccine-like” products.
Avalere Statement on Trump Administration Drug Pricing Reforms
Earlier today, the Trump Administration released long-anticipated drug pricing reforms, including rules related to a Most Favored Nation (MFN) approach for drugs administered by providers in Medicare and rebate reform for the Medicare Part D program. Both rules represent fundamental shifts in our current system and have significant implications for manufacturers, health plans, pharmacies, providers, and patients.
Liquid Biopsies: What You Need to Know
Liquid biopsies test blood samples for circulating tumor DNA (tumor derived cell-free DNA), circulating tumor cells, cell-free tumor DNA, proteins, metabolites, exosomes, messenger RNA, and microRNAs. The promise of liquid biopsies is a new modality that screens for cancer in ways that complement and, in some cases, improve existing tests, and allow testing for early detection, cancer diagnosis, and monitoring of minimum residual disease and recurrence, without the need for invasive biopsies.
Cell and Gene Therapy Pipeline Patient Affordability Opportunities
With a number of cell and gene therapies (CGTs) expected to obtain Food & Drug Administration (FDA) approval in the next 3 years, stakeholders must consider the unique patient access and affordability barriers that may limit patient ability to receive these novel treatments. Stakeholders should explore affordability solutions that can optimize access, or they risk excluding patients from obtaining potentially life-saving treatments.
CMS Takes Steps to Expand Access to COVID-19 Antibody Treatment
The Centers for Medicare & Medicaid Services (CMS) released coding and payment instructions associated with the first physician-administered outpatient COVID-19 therapeutic. The release specifies that during the public health emergency (PHE), Medicare will cover and pay for these infusions in the same way it does for COVID-19 vaccines.
Medicaid Programs Seek New Approaches for Cell and Gene Therapies
State Medicaid programs are likely to face significant budget impacts from emerging cell and gene therapies and may seek to implement a variety of strategies to manage utilization and address provider reimbursement and financing challenges.
Accelerating Evidence-Based Nutrition Practice
On November 3, the Journal of the Academy of Nutrition and Dietetics published an article entitled “Implementation Science in Evidence-Based Nutrition Practice: Considerations for the Registered Dietitian Nutritionist,” co-authored by Christina Badaracco.
Payer Experiences with COVID-19
New Avalere research featuring payer views of COVID-19 finds a heightened concern about the clinical effectiveness of related future vaccines and therapeutics, a substantial reduction in preventive services due to the COVID-19 public health emergency, and a significant uptick in telehealth adoption.