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: Election 2020 and Healthcare: Setting the Stage
Avalere’s 2020 Election series started with our experts covering the current state of play in the 2020 election and the role of healthcare between now and November.
Andrew E. Van Ostrand Joins Avalere Health
He brings healthcare tech, data, advocacy, and strategy experience to the firm.
8 Return-to-Work Considerations for Employers Amid COVID-19
As businesses across the country begin to reopen, navigating the COVID-19 pandemic will continually require employers to be resilient, flexible, innovative, and forward looking when it comes to returning employees safely to work sites. Among the myriad of concerns and considerations, organizational leadership will need tools that assist decision making and ensure compliance with Centers for Disease Control and Prevention (CDC) guidance.
Access to Medicare Part B Drugs Remains Challenging During COVID-19
Avalere continues to find a significant drop in utilization of key physician-administered therapies in 2020 relative to 2019.
Expanding LIS Subsidies Could Save Part D Beneficiaries Money
Avalere assessed the impacts of select policies to expand low-income subsidy (LIS) eligibility under Medicare Part D
Majority of API in US-Consumed Medicines is Produced in the US
New analysis of trade data finds that 54% of API, in dollars, used in domestically consumed medicines came from the US in 2019.
Proposed Medicaid Line Extension Definition Alters Rebate Calculation
The CMS proposes to define line extension under the MDRP to broadly include any product that has at least one ingredient in common with the original drug, even if it is a different dosage form. If finalized, this change would have significant implications on classification and rebate liability for a wide set of current and future products.
Comparison of Dually and Non-Dually Eligible Patients with ESRD
Dually eligible beneficiaries in Pennsylvania with end-stage renal disease (ESRD) are more often people of color and have higher costs compared to non-duals, but their utilization patterns are similar.
Exchanges May Add More than 1 Million New Enrollees due to COVID-19
Affordable Care Act (ACA) exchanges have seen a significant uptick in enrollment, especially from those losing employer-sponsored coverage or who were previously uninsured. However, different approaches to special enrollment periods (SEPs) leave many with limited opportunities to enroll.
Melissa Morley Joins Avalere Health
She deepens the firm’s post-acute and policy analytics capabilities, bringing nearly 15 years' worth of policy analytics experience to Avalere with a specific focus on the provider sector.
COVID-19 Impacts State Policy Priorities
After adjourning or suspending sessions due to the COVID-19 pandemic, state legislatures are reconvening with new priorities, as pandemic-related policy decisions take precedence.
Medicare FFS Risk Scores Vary Based on Eligibility and Entitlement
An analysis of CMS’s Hierarchical Condition Category (HCC) model shows that fully dual-eligible beneficiaries have the highest risk scores.
Medicaid VBP Rule May Facilitate Drug Contracts, But Questions Remain
CMS proposes to alleviate drug price reporting barriers that have hindered the adoption of innovative contracting models for prescription drugs. Stakeholders should contemplate the details and implications of CMS’ proposals—including how the changes would impact current contracting—as well as remaining areas of ambiguity.
Interview: E10, Part 2 – Get the Facts on COVID-19: Healthcare Provider Exemptions and Waivers
Tune into part 2 of our tenth episode of Avalere Health Essential Voice podcast series. In this segment, Avalere experts from the Center for Healthcare Transformation will discuss the impacts of COVID-19 on healthcare provider performance specific to exemptions and waivers.
How COVID-19 Could Reduce MA Risk Scores and Payments in 2021
Deferral of care during the COVID-19 pandemic is resulting in fewer claims and diagnoses among Medicare Advantage (MA) enrollees, which could lead to a 3%–7% reduction in 2021 risk scores and lower plan payments in 2021.
Impact of H.R.3 as Passed by the House on Federal Spending and Drug Manufacturer Revenues
Scenario analysis of varying levels of negotiation under H.R.3 (as passed in the House on December 12, 2019) finds that the bill could reduce federal spending by $850B to $1,060B and decrease manufacturer revenues by $1,275B to $1,655B for CY 2020–2029.
Impact of Protected Class Utilization Management in Medicare Part D
Health plans, including Medicare prescription drug plans, commonly apply utilization management (UM) tools to manage spending on prescription drugs.
Utilization and Spending by Medicare Beneficiaries in Employer Part D
An Avalere analysis finds that, on average, non-LIS Medicare beneficiaries in Employer Group Waiver Plans (EGWPs) have higher utilization but lower out-of-pocket (OOP) costs than non-EGWP enrollees.
Cannabidiol: A Regulatory Snapshot
The US market has seen a recent surge in cannabidiol (CBD) use and sales, despite many of these marketed CBD products being unregulated and untested for most of the claimed indications.
Behavioral Health in Medicaid May Be Unable to Meet Increased Demand
As COVID-19 forces the healthcare system to reprioritize patients and resources, providers delivering behavioral health services may be left with insufficient means to serve the population. Medicaid programs may observe increased demand for behavioral health services but may be ill-equipped to support beneficiaries.