Federal and State Policy
As the largest US healthcare payer, the federal government plays a dominant role in shaping the healthcare marketplace, while states take center stage when it comes to developing novel policy approaches. Our experts track, interpret, and model policies that affect insurance coverage, access, and consumer choice so you can see around the bend.
High-Intensity Prostate Cancer Costs Consistently Below OCM Benchmark
An Avalere analysis found differences in the performance of low- and high-intensity prostate cancer episodes in the Oncology Care Model (OCM). High-intensity prostate cancer episode expenditures were consistently below the benchmark price while low-intensity episode expenditures were similar to the benchmark price. This finding is likely driven by the Centers for Medicare & Medicaid Services (CMS) methodology used to calculate benchmark prices but may also indicate participant success in controlling costs for these episodes.
BBBA Negotiation for Part B Drugs Raises Operational Questions
Congress would operationalize Medicare negotiation for Part B drugs as outlined in the Build Back Better Act (BBBA) by cutting drug reimbursement to providers, which raises 4 potential downstream implications
Video: HIV/AIDS Prevention and Treatment, Part II
Tune into another episode of Avalere Health Essential Voice. In this segment, we welcome leaders from the National Alliance of State & Territorial AIDS Directors (NASTAD) to discuss how HIV state policies have changed in light of advancements in prevention and treatment, and the key to ending the HIV and viral hepatitis epidemics in the US.
Interview: HIV/AIDS Prevention and Treatment, Part II
Tune into another episode of Avalere Health Essential Voice. In this segment, we welcome leaders from the National Alliance of State & Territorial AIDS Directors (NASTAD) to discuss how HIV state policies have changed in light of advancements in prevention and treatment, and the key to ending the HIV and viral hepatitis epidemics in the US.
Jessica Alessio Brings Revenue Cycle Expertise to Avalere Health
New hire brings years of access, reimbursement, and revenue-cycle experience, strengthening Avalere's Market Access practice.
Home Care Services Reduce Medicare Spending for 30 Chronic Conditions
An Avalere analysis determined that Medicare Fee-for-Service (FFS) patients who received personal care services experienced a decrease in Medicare expenditures over time when compared to a statistically comparable control group comprising patients who did not receive the same level of personalized care. The reduction in spend was specific to a subset of chronic conditions that were targeted operationally for intervention and case management.
Video: World AIDS Day: HIV/AIDS Prevention and Treatment
Tune into another episode of Avalere Health Essential Voice. In this segment, we welcome Carl Schmid, Executive Director at the HIV + Hepatitis Policy Institute, to discuss how HIV prevention and treatment policy influence broader health policy issues as we commemorate World AIDS Day on December 1.
Interview: World AIDS Day: HIV/AIDS Prevention and Treatment
Tune into another episode of Avalere Health Essential Voice. In this segment, we welcome Carl Schmid, Executive Director at the HIV + Hepatitis Policy Institute, to discuss how HIV prevention and treatment policy influence broader health policy issues as we commemorate World AIDS Day on December 1.
Part D Redesign Impact on Manufacturer Discounts in Protected Classes
New Avalere analysis finds that 3 proposals to redesign the Part D benefit would lead to larger increases in mandatory manufacturer discounts on brand drugs within the Part D “6 protected classes” compared to brand Part D drugs overall. Mandatory manufacturer discounts within the protected classes would increase by 661%, 301%, and 409% across the 3 proposals evaluated, compared to 153%, 63%, and 64% for Part D drugs overall.
Exchange Operational Models for 2022
In plan year (PY) 2022, most states continue to rely on the federal government for some or all exchange operational functions. However, 3 states have transitioned to state-based exchanges (SBEs).
Video: Medicare Part D, Part V: What’s Next for CMMI?
Tune into the fifth and final episode of the Avalere Health Essential Voice miniseries focused on Medicare Part D. In this segment, our experts discuss the Center for Medicare & Medicaid Innovation (CMMI) and its strategic direction for the coming year, particularly as it relates to the Part D program.
Interview: Medicare Part D, Part V: What’s Next for CMMI?
Tune into the fifth and final episode of the Avalere Health Essential Voice miniseries focused on Medicare Part D. In this segment, our experts discuss the Center for Medicare & Medicaid Innovation (CMMI) and its strategic direction for the coming year, particularly as it relates to the Part D program.
Video: Medicare Part D, Part IV: Budget Neutrality and Congressional Scoring
Tune into the fourth episode of the Avalere Health Essential Voice miniseries focused on Medicare Part D. In this segment, our experts discuss key elements of the legislative process, including pay-fors, budget neutrality, and congressional scoring.
Interview: Medicare Part D, Part IV: Budget Neutrality and Congressional Scoring
Tune into the fourth episode of the Avalere Health Essential Voice miniseries focused on Medicare Part D. In this segment, our experts discuss key elements of the legislative process, including pay-fors, budget neutrality, and congressional scoring.
The Impact of ARPA Exchange Subsidies on Consumers Ages 50–64
Consumers ages 50–64 could see higher exchange premiums starting in 2023 without extension of ARPA subsidies.
Video: Medicare Part D, Part III: Impact of Policy Changes on Market Access
Tune into the third episode of the Avalere Health Essential Voice miniseries focused on Medicare Part D. In this segment, our experts discuss policy changes currently under consideration and how stakeholders can prepare for the potential market access impacts.
Interview: Medicare Part D, Part III: Impact of Policy Changes on Market Access
Tune into the third episode of the Avalere Health Essential Voice miniseries focused on Medicare Part D. In this segment, our experts discuss policy changes currently under consideration and how stakeholders can prepare for the potential market access impacts.
Understanding the Seasonality of Part D Expenditures Under the OCM
In the OCM, a total cost-of-care model, episode-level Part D expenditures include the amount the government pays for low income cost-sharing subsidy and reinsurance for beneficiaries who reach the catastrophic portion of the benefit once they have accumulated sufficient OOP costs. The latter leads to a seasonality effect in how Part D payments are captured in OCM episodes, which may have implications for how trends in OCM performance are assessed over time and how the OCM benchmark price is constructed.
Video: Medicare Part D, Part II: Understanding Plan Decision-Making
Tune into the second episode of the Avalere Health Essential Voice miniseries focused on Medicare Part D. In this segment, our Policy and Market Access experts discuss how health plans make decisions, particularly formulary decisions, in Part D, and how specific markets influence those decisions.
Interview: Medicare Part D, Part II: Understanding Plan Decision-Making
Tune into the second episode of the Avalere Health Essential Voice miniseries focused on Medicare Part D. In this segment, our Policy and Market Access experts discuss how health plans make decisions, particularly formulary decisions, in Part D, and how specific markets influence those decisions.