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.
2024: An Era of Innovation and Disruption in Kidney Care
A dynamic regulatory landscape, technological advancements, and investments in R&D offer new opportunities and challenges in kidney care.
Redefining D-SNP Look-Alikes Would Impact Enrollment
If CMS lowers the dual-eligible enrollment threshold it uses to define D-SNP look-alikes, the demographics in look-alike plan enrollment will likely change.
Part D Risk Adjustment Will Have New Importance Under IRA
Analysis of data in the CMS VRDC shows that MA-PD utilization has steadily increased in therapeutic areas likely to have large increases in plan liability under Part D redesign.
Video: How Policies Shape the Rare Disease Treatment Landscape
In this installment of our 2024 Trends Influencing Rare Disease series, Avalere experts explore policies shaping rare disease drug development and access.
Proposed Revisions to Part D Risk Adjustment Model in 2025
Due to increasing the portion of plan payments subject to risk adjustments in 2025, CMS proposed aligning the risk adjustment model with Part D redesign.
Webinar: Decoding the CY 2025 Advance Notice
Join Avalere’s healthcare policy experts as they dissect the Advance Notice of Methodological Changes for CY 2025 for Medicare Advantage (MA) Capitation Rates and Part C and Part D Payment Policies and discuss the future trajectory of Medicare Advantage (MA) in Part D and potential outcomes, headwinds, and tailwinds for health plans.
Assessment of Proposals to Address Drug Shortages
Drug shortages have consequences for a broad range of stakeholders, and policy proposals vary in their ability to address negative impacts.
Video: Impacts of Inflation Reduction Act on Patient Behavior and Affordability
Avalere experts are joined by Kevin L. Hagan, President of the PAN Foundation, to discuss their findings on the impacts of the Inflation Reduction Act’s Part D benefit redesign on patient utilization and affordability.
Proposed Changes to Best Price Could Shift Market Dynamics for Stakeholders
The MDRP proposed rule's Best Price "stacking' provision has direct and indirect impacts on Medicaid rebate liability across drug classes.
States May Consider 340B Legislative Proposals in 2024
In preparation for the 2024 state legislative sessions, stakeholders should consider how states will continue to shape the 340B policy landscape.
IRA Reforms Will Impact Patient Adherence and Affordability
With increased patient utilization and plan formulary responses to Part D redesign, many patients may still face affordability challenges under the IRA.
Medicare HI Trust Fund Solvency Assuming MA Utilization
The Hospital Insurance Trust Fund would remain solvent until 2048 if FFS utilization levels were similar to Medicare Advantage utilization levels.
ESRD Enrollment in MA Now Exceeds 30% of Dialysis Patients
New analysis finds that just over 40,000 Medicare FFS patients with end-stage renal disease (ESRD) elected to enroll in Medicare Advantage during the 2021 open enrollment period—the first time all ESRD patients had access to an MA plan. This enrollment shift increased the proportion of ESRD patients enrolled in MA from 23% to 30%.
CBO Considers Cost of Increasing Anti-Obesity Medication Use
Insurance coverage of anti-obesity medications is increasing, but patient access under Medicare remains uncertain.
Part D Premiums Increasing Despite Stabilization Program
While the premium stabilization program under the IRA limits the growth of the base beneficiary premium, individual plan premiums vary.
Part D Premium Increases, Market Disruption Expected in 2024
Over 8 million enrollees in standalone PDPs could see an increase of more than 25% in their premium in 2024.
SNF 3-Day Waiver Use During the COVID-19 Pandemic
Use of the 3-day waiver was stable over the course of the pandemic, though shifts in admission sources were observed.
Video: Unpacking the Implications of the Negotiated Drug List, Part 2
In Part 2 of our video series on the negotiated drug list, Avalere experts discuss topics including effectiveness measures that will inform CMS’s maximum fair price determinations, evidence generation strategies for manufacturers with products that have been selected for negotiation, or that are eligible for selection in the future, and CMS’s definition of therapeutic alternatives.
Webinar: Part D Redesign’s Impact on Plan-Manufacturer Contracting
Avalere experts discussed how IRA’s Part D redesign may affect plan behavior in Plan Year 2025 and how manufacturers should approach contracting and market access.
Physician Payment for Some Services Lags Behind Inflation
Physician reimbursement for some services under Medicare FFS has declined, while payment increased for the same services in the hospital outpatient setting.