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.
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.
IRA Question of the Week: When Will the IRA Be Implemented?
The first Insight in this series explores timing for Medicare negotiation, inflation rebates, and Part D benefit redesign changes and details to be defined.
Orphan Drug Development Amid Regulatory Uncertainty
Policies within the IRA and at the FDA in response to recent litigation could influence commercialization decisions for orphan drugs and may need to be clarified by policymakers.
Risk Adjustment Under Part D Benefit Redesign
With higher plan liability under Part D benefit redesign, risk adjustment could play a larger role in how plans set formulary design and contracting strategies.
Video: IRA Policy Changes: Planning for Life Sciences
The Inflation Reduction Act (IRA) brings some of the biggest changes affecting the pharmaceutical industry in the last decade. Avalere expert Megan West discusses how these shifts will impact pharmaceutical organizations and how Avalere can support in developing strategies to mitigate risk and identify opportunities across the product lifecycle.
CMS Engagement Opportunities in Discarded Drug Refund Implementation
Manufacturers should assess liability to drug waste refunds and engage with CMS as it considers an increased applicable percentage for specific product types.
Proposed MA Plan Payment Changes May Impact Premiums and Benefits
Due to changes proposed in the CY 2024 Advance Notice, enrollees in Medicare Advantage could have higher premiums and fewer benefits in 2024 than 2023.
Video: Medicare Advantage and Part D Advance Notice: Proposed Payment Changes
Avalere expert Sean Creighton explains key policy changes proposed in the Advance Notice for Medicare Advantage and Part D Payment for Plan Year 2024.
MA RADV Policy Changes Raise Questions for Plans
Policy changes included in the final MA RADV rule will substantially affect the MA program, plan benefit design, and operations.
2024 Advance Notice Would Substantially Alter Risk Adjustment Model
Proposed technical changes to the MA risk adjustment model would have major implications if finalized.
Video: Plan and Beneficiary Responses to IRA Policies
Avalere expert Rebecca Yip discussed plan and beneficiary responses to IRA policies during our 2023 Outlook webinar.
5 Ways the IRA Will Impact Healthcare Investors in 2023 and Beyond
The IRA’s drug price negotiation policies, extended marketplace subsidies, and Part D redesign will impact investors’ current portfolios and investment strategy in the future.
More Medicare Advantage Plans Will Offer Non-Medical Benefits in 2022
New analysis from Avalere finds that in 2022 more Medicare Advantage plans will offer non-medical supplemental benefits, such as meals, nutrition, transportation, and in-home support services, at a $0 premium.
Some Enrollees May Face Affordability Challenges Under Part D Redesign
An Avalere analysis finds that about 800,000 beneficiaries in 2024 and 200,000 in 2025 will have OOP costs that exceed 10% of their annual income.
What to Expect in the Final Medicare Advantage RADV Rule
CMS is expected to publish a final MA RADV rule by February 1. Policy changes could have a substantial impact on 2024 bids, plan benefit design, and operations.
340B Drug Payment Increase Would Reduce Most Hospitals’ Part B Pay
Avalere analysis shows that a CMS policy to increase payment for 340B drugs, compared to alternative approaches, will result in lower payment to most hospitals.
Avalere Health Announces Addition of Kelsey Lang to Policy Practice
The veteran health policy professional brings expertise in coverage, access, and reimbursement and experience working with providers, plans, and manufacturers.
Video: Innovative Partnerships in Medicare
In this video, Manoj Pawar, Chief Medical Officer of Mutual of Omaha, joins Avalere experts to discuss their recent partnership on a project that sought to identify innovative ways to use data to inform payer/provider partnerships in the Medicare program.
Video: 2022 Midterm Elections Recap: What’s Next for Healthcare Policy?
Join Avalere experts Elizabeth Carpenter and Matt Kazan for a discussion on the 2022 midterm election results and what to watch for future healthcare legislation.