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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Avalere Analysis: 90% of Companies Offer Cost-Sharing Assistance to Exchange Enrollees, But Program Characteristics Vary Widely
A recently-completed Avalere Health survey finds that while 90 percent of pharmaceutical and biotech manufacturers are offering cost-sharing assistance to exchange patients, the type of support, generosity and program structure vary widely.
MedPAC Advises CMS to Make Critical Changes to its Medicare ACO Programs
On June 16, MedPAC issued a letter to CMS, advising the agency to make critical changes to its two accountable care organization (ACO) programs-the Pioneer demonstration and Medicare Shared Savings Program (MSSP).
An Opportunity for SNFs Through New Payment Models
In this week's edition of McKnight's Long-Term Care, Jeff Terkowitz wrote a guest column discussing new payment models, and the opportunities they present for SNFs.
Avalere Analysis: Average Exchange Premiums Rise Modestly in 2015 and Variation Increases
New analysis from Avalere Health finds that average proposed premiums for individual market exchange plans will increase modestly in 2015, based on initial rate filings in nine states.
Diagnostic Laboratory Industry Negotiates FDA’s Revised Standards
As the laboratory testing community continues to weather recent policy changes in both regulatory and reimbursement areas - there has been yet another development.
Washington State Rate Analysis: Carriers with Low 2014 Market Share Hold Down Premiums in 2015
A new analysis from Avalere Health finds that proposed rate increases for 2015 exchange plans in Washington state were lowest among carriers with the smallest share of the 2014 market.
New WellPoint Program Will Pay Physicians For Adhering To Oncology Pathways
On May 28 WellPoint/Anthem BlueCross BlueShield announced the launch of the WellPoint Cancer Care Quality Program - a new pay-for-adherence initiative which incentivizes physicians to follow certain evidence-based WellPoint Cancer Treatment Pathways.
Avalere Analysis: Cost-Sharing for Specialty Medicines
In a June 2014 analysis, Avalere analyzed 123 silver exchange plan formularies to evaluate tier placement.
CMS Delays Implementation of AMP-Based FULs, Originally Scheduled for July
On June 2, CMS announced that it will not finalize the Average Manufacture Price (AMP) based Federal Upper Limits (FULs) for reimbursement of multiple source drugs in Medicaid in July 2014, as expected.
CMS Announces Successful ICD-10 Testing Week
On May 30, CMS released results from the March week of ICD-10 acknowledgement testing.
Avalere Analysis: Cost-Sharing Reductions Unevenly Applied Across Services in Exchange Plans
A new analysis from Avalere Health finds that consumers in exchanges receiving federal assistance to reduce their out-of-pocket costs may experience inconsistent reductions in spending depending on the plan they choose.
Poster Presentations for Avalere at AcademyHealth
Avalere’s experts will be presenting several posters at AcademyHealth’s Annual Research Meeting in San Diego.
District Court Strikes Down 340B Orphan Drug Rule Concluding that HRSA Does Not Have Necessary Rulemaking Authority
On May 23, the U.S. District Court for the District of Columbia issued a decision striking down the 340B orphan drug rule that was finalized by the Health Services and Resources Administration (HRSA) in July 2013 and took effect Oct. 1, 2013.
Successful Value-Based Purchasing Strategies for Today’s PAC Providers
In this month's edition of McKnight's Long Term Care News & Assisted Living, Avalere's Sally Rodriguez wrote a guest blog discussing value-based payment strategies for post-acute care (PAC) providers, given the Affordable Care Act's (ACA) current focus on value over volume.
Final Medicare Advantage and Part D Rule Significantly Scales Back Proposed Policies
On May 19, CMS released the Final Rule on policy changes to the Medicare Advantage (MA) and Medicare Part D programs for Contract Year (CY) 2015.
Avalere Analysis: Low Premium Carriers Expected to Gain 2014 Market Share in Exchanges
A new analysis from Avalere Health finds that individuals choosing an exchange plan based on premiums are most likely to consider plans from Coventry (acquired by Aetna in 2013), Humana, and WellPoint in regions where they participate.
HHS Releases Exchange and Insurance Market Standards for 2015 and Beyond Final Rule, Finalizing Most Provisions as Proposed
On May 16, HHS released the final Exchange and Insurance Market Standards for 2015 and Beyond rule.
Exploring Pharmacists’ Role in a Changing Healthcare Environment
More and more, pharmacists are forging expanded roles in healthcare delivery to ensure optimal drug therapy and improve patient outcomes.
CMS Proposes to Cover TMVR under CED
On May 14, CMS released a proposed national coverage determination (NCD) for Transcatheter Mitral Valve Repair (TMVR), and proposed to cover TMVR under its Coverage with Evidence Development (CED) program.
FDA Releases Draft Guidance for Clinical Pharmacology Data to Support a Demonstration of Biosimilarity to a Reference Product
On May 13, FDA released a draft guidance describing the clinical pharmacology data needed to support a demonstration of biosimilarity to a reference product.