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, Mail-Order, and Specialty Pharmacy Involvement in 340B
Sixty-nine percent of 340B contract pharmacies were associated with a PBM through vertical integration (53%) or contractual arrangement (16%).
What Will the 2024 Elections Mean for Health Policy?
With key health policy differences between presidential candidates, the 2024 elections are an inflection point for the future of US healthcare.
Webinar: Election 2024: What’s at Stake for Healthcare?
Experts from Avalere, part of Avalere Health, and guests discuss the 2024 elections, exploring the candidates’ health policy approaches and implications for stakeholders.
Avalere Welcomes Industry Veteran Ashley Flint to Policy Team
Ashley Flint brings 12 years of policy experience in the life sciences industry, with deep knowledge of prescription drug pricing, access, and reimbursement.
Contract Pharmacy Trends May Help Inform 340B Reform Debate
As federal and state policymakers debate the role of contract pharmacies (CPs) in 340B, Avalere analyzed how CP relationships inform the policy landscape.
Webinar: A Closer Look at Patient Support: Upcoming Legislative and Regulatory Changes
Avalere experts explore how potential implications of the Inflation Reduction Act (IRA)’s out-of-pocket cap, in addition to other key regulatory and policy activities shaping benefit design and patient cost-share (e.g., EHB), could impact patient commercial and foundation assistance.
Video: IRA Impacts on Market Access Strategy
Ahead of Asembia 2024, Avalere market access experts discuss the potential impacts of IRA provisions, including Part D redesign and Medicare drug price negotiation, on go-to-market and contracting strategy.
CMS’s Interpretation of “Qualifying Single-Source Drugs” in Medicare Negotiation
CMS’s definition of a “qualifying single-source drug” in the Medicare Drug Price Negotiation Program may impact manufacturers’ investment strategies.
Opportunities to Prepare for Year 2 of Medicare Negotiation
Manufacturers anticipating potential selection or therapeutic impact for 2027 Medicare negotiations should begin preparations and align internal decision-making, applying learnings from Year 1.
Video: Mitigating and Preventing Drug Shortages
Avalere experts provide insights on the dynamics and policy proposals surrounding recent drug shortages.
Video: The Evolution of Value Requirements
Ahead of Asembia 2024, Avalere experts discuss the evolution of biopharmaceutical value requirements and how organizations will need to evolve their business models accordingly.
Research Explores Health Plan Perceptions of PDABs and UPLs
Avalere assessed how health plans may view UPLs, including implementation considerations and impacts on providers and patients (e.g., plan benefit design).
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.