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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Enhancing Manufacturer Partnerships in an Evolving Specialty Landscape
Recent developments in the specialty pharmaceutical marketplace merit distinct attention from manufacturers.
2020 Implementation of Rebate Rule Could Create Uncertainties for Part D Plans
On April 5, CMS issued guidance announcing a voluntary, 2-year demonstration that would modify the Part D risk corridors if the proposed rule to revise the Anti-Kickback Statute safe harbors is effective for 2020.
Issue of Part D Cost Sharing for Preventive Services Arises at Senate Drug Pricing Hearing
An April 9 hearing before the Senate Finance Committee entitled “Drug Pricing in America: A Prescription for Change” included discussion related to cost-sharing for preventive services in the Medicare Part D.
CMS Announces 5 New Advanced Primary Care Payment Models
The CMS announced the new CMS Primary Cares Initiative, comprising 5 new payment models under 2 programs, which will test the impact of providing considerable financial incentives and flexibility to primary care practices and organizations in exchange for significant provider risk.
Bringing Real Innovation to Medicare
The Centers for Medicare & Medicaid Services (CMS) is currently reviewing a new payment rule, which could impact coverage of innovative procedures like transcatheter aortic valve replacement for the treatment of severe aortic stenosis.
CMS Grants Flexibility to Counter Drug Manufacturers’ Coupons
The Centers for Medicare & Medicaid Services released the final Notice of Benefit and Payment Parameters (NBPP) for the 2020 plan year. This annual rule, released today, updates guidance and regulations related to exchanges as well as the broader individual, small group, and large group insurance markets.
A Review of the New Medicare App: The Role of Patient Engagement and Digital Health
The Centers for Medicare & Medicaid Services (CMS) is embracing digital health and virtual care in many ways.
Avalere Commentary on HIV Prevention Policy Featured in Health Affairs Blog
On April 9, Avalere policy experts published a piece in the Health Affairs blog about the administration’s recently launched “Ending the HIV Epidemic: A Plan for America” initiative.
Comparing the Effectiveness of New Versus Established Multiple Sclerosis Therapies in the Managed Medicaid Population
Avalere experts recently presented their research, “Comparison of Healthcare Utilization Among Managed Medicaid Individuals Diagnosed with Multiple Sclerosis Treated with Emergent vs. Established Disease-Modifying Therapy in the US.”
US Healthcare Spending Projected to Grow 5.5% Annually Through 2027
Healthcare spending is expected to represent 19.4% of US GDP in 2027.
Avalere Research and Expertise to be Featured at AMCP and ISPOR Conferences
In the coming months, Avalere experts will be presenting new data and research at major conferences, featuring insights derived from Inovalon’s Medical Outcomes Research for Effectiveness and Economics Registry (MORE2 Registry®).
Understanding the Combined Effects of Drug-Pricing Reforms
The interaction of recently announced drug pricing reforms will have differential implications for stakeholders.
Vaccine Exemptions and the Federal Government’s Role
With the number of measles cases rising across the country, FDA Commissioner Scott Gottlieb raised the prospect of federal intervention over exemptions to state-level immunization school-entry requirements. While not specifying what role the federal government would play, Gottlieb stated, “You could mandate certain rules about what is and isn’t permissible when it comes to allowing people to have exemptions.”
FDA Reform: It’s Time to Act, But Not as an Independent Agency
As former federal officials, Dan Troy, David Beier, and I share our perspectives on the call by former FDA officials representing both political parties to make the FDA an independent agency separate from its parent, HHS.
Avalere Supports Development of the 2019 ACC/AHA Guideline on the Primary Prevention of Cardiovascular Disease
Avalere served as the document manager for the 2019 American College of Cardiology (ACC)/American Heart Association (AHA) Guideline on the Primary Prevention of Cardiovascular Disease, released on March 17 at the ACC.19 Scientific Session. This guideline includes practical and concise evidence-based guidance for clinicians on the primary prevention of cardiovascular disease (CVD).
CMS Methodology for Calculating Payment Errors May Result in Underpayments to Health Plans
In February 2012, the Centers for Medicare & Medicaid Services (CMS) announced a final payment error calculation methodology for its contract-level Risk-Adjustment Data Validation (RADV) audits of Medicare Advantage (MA) plans.
Top 4 Steps to Ensure Operational Readiness for RAPS to EDS Transition
As CMS continues to transition from the Risk Adjustment Processing System (RAPS) to the Encounter Data System (EDS) for Medicare Advantage (MA) risk score calculation, plans must evaluate operations and close gaps to minimize the impact of risk score differences using this claims data source.
Everyone Has a Job to Do in Reducing Costs
Today continues a steady diet of healthcare cost hearings with committees on both sides of Capitol Hill digging into the issue.
Effect of Potential Policy Change to Part D Generic Tiering on Patient Cost Sharing and Part D Plan Costs
In a new analysis, Avalere examines the implications of CMS’ potential new requirement that Part D plans place generics only on generic tiers.
Medicare Reimbursement of Virtual Care Delivery and Remote Monitoring
Beginning in 2019, CMS will reimburse for 5 codes relating to virtual care delivery and remote monitoring