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.
Video: Congressional Debate Over PBM Legislation
Avalere experts discuss Congress’ ongoing consideration of pharmacy benefit manager (PBM) legislation.
How Does the IRA Affect Providers’ and Pharmacies’ Strategies?
Providers and pharmacies are two critical stakeholders that should prepare their own IRA strategies to adequately react to a changing landscape.
Oxygen a Large and Growing Share of Medicare DME Spending
Oxygen expenditures as a share of total Medicare DME expenditures grew from 8.5% in 2018 to 9.8% in 2021, with significant variation across states.
First 2023 HCPCS Meeting Focuses on Non-Drug Products
CMS recently convened stakeholders for a public HCPCS meeting to discuss billing, coding, and reimbursement of non-drugs and non-biological products.
Plan Finder Will Play a Key Role in Part D Redesign
Interviews show the importance of Medicare Plan Finder as a resource and generated ideas to incorporate IRA reforms and improve user experience.
How Will the IRA’s Part D Changes Affect Plan Strategies?
Plans preparing MA-PD and PDP bids for Plan Year 2025 should consider how Part D redesign will affect enrollee costs, plan payment, and market dynamics.
Alternative Funding Programs Present Stakeholder Challenges
Increased use of alternative funding programs has introduced new access challenges for patients, plans, and manufacturers for specialty therapies.
US Supreme Court Will Hear Case Affecting Agency Power
The Supreme Court is expected to hear oral arguments in Loper Bright Enterprises v. Raimondo, which challenges Chevron deference.
Braidwood Ruling’s Impact on Preventive Service Access
168 million individuals could lose access to $0 preventive services, creating pressure for healthcare stakeholders to address access and equity concerns.
PBM Reform on Top of Congress’s Healthcare Agenda
Avalere Policy Edge survey of bipartisan health policy experts suggests that PBM oversight and reform legislation will pass during this Congress.
Video: IRA Impacts on Evidence and Strategy
Ahead of the Asembia and ISPOR 2023 conferences, Avalere experts discuss the increasing importance of value and evidence strategies as part of Inflation Reduction Act (IRA) implementation planning.
Avalere Health Welcomes Lisa Joldersma as Strategic Advisor
As a strategic advisor to the Policy Practice, Lisa Joldersma adds deep expertise in Medicare, commercial and employer-based insurance, and state policy issues.
How Will the IRA Impact Product Launch Prices?
IRA inflation rebates and drug price negotiation will impact drug launch prices in Medicare, with spillover effects in the Medicaid and commercial markets.
Video: IRA Impacts on Patient Access
Ahead of Asembia 2023, Avalere experts discuss how the IRA and other regulatory changes will impact patient access and affordability.
How Should Manufacturers Adjust Their Pipeline Strategies to the IRA?
In response to IRA provisions, life sciences companies should reevaluate their pipeline investment and development strategies.
What Evidence Is Needed for Medicare Drug Price Negotiation?
As CMS clarifies evidence requirements for drug price negotiations, manufacturers should prepare their strategies for asset development and on-market products.
Medicaid Redeterminations Will Increase Use of Patient Support
Medicaid redeterminations will bring changes to individual prescription drug access. Manufacturers should consider the impact on patient support programs.
Biden’s 2024 Budget: New Drug Pricing and Coverage Policies
The Biden administration’s budget outlines a healthcare policy agenda focused on drug pricing, coverage reform, infectious diseases, and biomedical research.
IRA Question of the Week: How Will the Law Impact Plans and PBMs?
Part D redesign and OOP smoothing shift financial liability from beneficiaries to plans, incentivizing utilization and formulary management.
IRA Question of the Week: How Does the Law Impact Patients?
The IRA will reduce out-of-pocket drug costs (especially in Medicare Part D), increase the availability of marketplace plans, and expand access to vaccines.