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.
PBM Delinking: Policy Considerations
Legislation aimed at changing how PBMs operate, including “delinking” bills, could have unforeseen consequences for drug prices, contracting and competition.
Recent Part D Final Policies Leave Open Areas for Future Action
After the release of the CY 2026 MA and Part D final rules, CMS may take further action on several key policy areas, including anti-obesity medications and premium stabilization.
Video: Unpacking the Final CY2026 CMS Part C and D Rule and Rate Announcement
Avalere Health Advisory experts explore how the Trump Administration approached Medicare Advantage and Medicare Part D policies proposed by the Biden Administration, ranging from anti-obesity medication coverage to plan payment increases
Update: Health Plans’ Perceptions of PDABs and UPLs
In interviews and a survey, health plans communicate concerns with UPLs’ potential impact on patient access, pharmacists, providers, and their own financial positions.
MA and Part D Enrollment Growth Slows in 2025
Year-over-year enrollment growth in MA and Part D slowed in 2025. Although, enrollment in chronic condition special needs plans experienced significant growth.
Updated: Key Considerations for MFP Effectuation and the 340B Rebate Model
With less than a year until the first MFPs take effect, stakeholder concerns remain, especially as it relates to 340B duplicate discount risk.
Video: Unpacking CMS RADV: The Selection Process and Planning for the Future
Avalere experts discuss the CMS Medicare Advantage (MA) Risk Adjustment Data Validation (RADV) audit process and provide insight on how health plans can proactively plan and prepare for these audits.
Vaccine Policy and Access Under New HHS Leadership
Policy actions in the first days of the Trump administration raise questions about the future role of key vaccine advisory committees.
Rare Disease Advisory Councils: Opportunities for Engagement
Stakeholders should seek to engage with RDACs to develop a better understanding of rare disease care access, treatment, and populations in different states.
What the Election Results Mean for Health Policy in the Year Ahead
A second Trump administration and Republican Congress will mark a shift in healthcare policy priorities in 2025 on both legislative and regulatory fronts.
Webinar: Part D Patient Access 2025: Drug Formulary Changes
Join Avalere experts to learn about the changes to Part D formularies for 2025 and implications for patient access.
Webinar: Part D Patient Access 2025: Plan Options and Premiums
Avalere experts will examine changes in Part D plan options and premiums for 2025 and will explore how these shifts may affect patient costs and choice.
Webinar: 2026 Part D Plan and Manufacturer Contracting Strategies
Join our webinar to learn how Part D redesign and drug price negotiation will shape the Plan Year 2026 market, and what this means for manufacturers and plans.
Video: Kidney Care Agenda: Fall 2024
Ahead of the American Society of Nephrology Kidney Week, Avalere experts dive into the key regulatory and legislative developments related to kidney disease that expect to see action in the remaining weeks of 2024.
Webinar: Part D Patient Access 2025: Preparing for Benefit Changes
Join Avalere for an overview of how the Medicare Part D benefit will be changing in 2025 under the Inflation Reduction Act.
Number of Part D Plan Choices Declines for 2025
The number of PDP and MA-PD options are declining by 26% and 7%, respectively, in 2025.
VP Debate Highlights Healthcare Policy Differences
During the debate, VP candidates outlined their views on healthcare topics such as the ACA, drug pricing, manufacturing, reproductive rights, and mental health.
IRA Inflation Rebate Impact on Part B Beneficiary OOP Costs
Avalere finds that between 0.1% and 0.2% of Medicare FFS beneficiaries would experience lower OOP costs for the Part B drugs subject to Q3 2024 inflation rebates.
Potential Impacts of IPAY 2026 Maximum Fair Prices on Health Plan Formulary Negotiations
With the release of the IPAY 2026 MFPs, health plans should analyze the impact to formularies and identify opportunities for contracting changes.
Health Policy in the 2024 Election: Avalere and Outside Experts Weigh In
With the election fast approaching, former HHS Secretary Alex Azar, Dan Mendelson, and Avalere experts discussed implications for healthcare stakeholders.