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.
Webinar: Understanding Shifting Insurance Coverage Impacts
Join Avalere’s panel of market access and policy experts to learn about the shifting insurance coverage landscape and how these trends impact manufacturers, payers, policymakers, and providers.
Ruth Liu and Myra Simon Join Avalere Health
They bring nearly 40 years combined healthcare experience to the firm, with expertise in the health insurance sector.
Impacts of Part D Redesign Vary by Therapeutic Area
New Avalere analysis finds that 3 proposals to redesign the Part D benefit—H.R.19/S.3129, Prescription Drug Price Reduction Act (PDPRA), and Elijah Cummings Lower Drug Costs Now Act (H.R.3)—would increase 2023 mandatory manufacturer discounts by 80%, 81%, and 283%, respectively, with significant variation across therapeutic areas.
MA Enrollment in Plans with Extra Benefits for Chronically Ill Tripled in 2021
Over 3 million Medicare Advantage (MA) beneficiaries are enrolled in plans providing additional supplemental benefits to individuals with chronic illnesses, compared to just over 1 million in 2020.
What to Watch for in MA and Part D Contracting for the 2022 Plan Year
Recent regulatory action released in the final days of the Trump administration related to Medicare Advantage (MA) and Part D could significantly impact plan and manufacturer calendar year (CY) 2022 contracting strategies and stakeholder advocacy priorities.
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).
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.
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).
COVID-19 Pandemic May Reduce MA Risk Scores and Payments
The COVID-19 pandemic has created significant challenges for all Americans, particularly for its most vulnerable populations, including the elderly and people with disabilities in Medicare. The Centers for Medicare & Medicaid Services (CMS) recently reported that 21% of fee-for-service (FFS) Medicare enrollees have stated they are forgoing non-COVID-19 related care due to the pandemic. Avalere conducted analyses to determine if a similar decrease in utilization is occurring in Medicare Advantage (MA) and assess the potential impact of deferred care on MA enrollees and plans.
Fewer Highly Rated MA Plans in 2021 than in 2020
On October 8, the Centers for Medicare & Medicaid Services (CMS) published their 2021 Star Ratings for Medicare Advantage (MA-PDs) and standalone Prescription Drug Plans (PDPs) on Medicare Plan Finder.
SCOTUS Overturn of the ACA May Invalidate Biosimilar Pathway
The 351(k) biosimilars pathway was legally established under the Biologics Price Competition and Innovation Act (BPCIA) provision of the Patient Protection and Affordable Care Act (ACA) of 2010. Since the passage of the ACA, 28 biosimilars have been approved by the Food & Drug Administration (FDA) along with the promulgation of policy that also applies to all biologics, including the creation of a suffix within the nonproprietary name of these products. Additionally, substantial case law has been made with respect to intellectual property pertaining to biologics. With the legality of the ACA currently under scrutiny, the future of BPCIA and biosimilars is uncertain.
Healthcare Implications of the 2020 Election Results
The 2020 presidential election will have significant implications for the US healthcare system and Americans’ healthcare options.
States Mitigate Potential Coverage Losses Ahead of ACA SCOTUS Ruling
With the US Supreme Court (SCOTUS) set to hear arguments starting November 10 in California v. Texas and the swearing in of Justice Amy Coney Barrett on October 26, questions remain regarding the future of the Affordable Care Act (ACA) and its impact on laws passed in at least 18 states creating coverage protections for essential health benefits (EHB) and coverage of pre-existing conditions.
Video: 2020 Election with Avalere: COVID-19 Stakeholder Impacts
Tune into our seventh video of the Avalere Health Essential Voice: Election 2020 series. As election day approaches, our experts share their thoughts on how the COVID surge has changed the campaigns’ closing arguments, the current outlook on a COVID relief package, and how the election results will affect individual stakeholders.
Interview: 2020 Election with Avalere: COVID-19 Stakeholder Impacts
Tune into our seventh episode of the Avalere Health Essential Voice: Election 2020 series. As election day approaches, our experts share their thoughts on how the COVID surge has changed the campaigns’ closing arguments, the current outlook on a COVID relief package, and how the election results will affect individual stakeholders.
Webinar: 2020 Election with Avalere: What’s at Stake for Healthcare Post-Election?
Avalere experts discussed how the 2020 election is influencing the future of healthcare.
Video: 2020 Election with Avalere: How Are Public Healthcare Programs Expanding?
Tune into our sixth video of the Avalere Health Essential Voice: 2020 Election series. In this segment, our experts discuss how we might see public healthcare programs expand under each candidate and what it might mean for future legislation.
Interview: 2020 Election with Avalere: How Are Public Healthcare Programs Expanding?
Tune into our sixth episode of the Avalere Health Essential Voice: 2020 Election series. In this segment, our experts discuss how we might see public healthcare programs expand under each candidate and what it might mean for future legislation.
MA Enrollees Can Access COVID-19 Supplemental Benefits in 2021
Medicare Advantage (MA) plans continue expanding coverage of supplemental benefits, including services related to the pandemic.
Interview: State Medicaid RFP Response Considerations and Watch Outs
Tune into another episode of Start Your Day with Avalere. In this segment, our health plan experts delve into the key actions, considerations, and watch outs of a successful Medicaid procurement, or re-procurement, response from both the state and health plan perspectives.