In 2018, CMS proposed to revise its Risk Adjustment Data Validation (RADV) methodology to exclude the FFS Adjuster in its payment recoupment calculations. New analysis from Avalere finds that the payment impact associated with fee-for-service (FFS) Medicare coding discrepancies would be greater for certain subgroups of beneficiaries (e.g., dual-eligible, those with certain common and potentially serious health conditions) enrolled in the MA program.

• Robin Duddy-Tenbrunsel
• Sean Creighton
• Colin OLaughlin

Avalere analysis finds that a larger proportion of beneficiaries taking a Part D cancer therapy reached catastrophic compared to all Part D enrollees.

• Kelly Brantley
• Tiernan Meyer
• Mitchell Cole
• Kylie Stengel

The Center for American Progress (CAP) commissioned Avalere to evaluate ‘Medicare Extra’ as a package of reform polices implemented and phased in over time across the US healthcare system.

• Neil Rosacker
• Chris Sloan
• Richard Kane
• Mitchell Cole
• Colin OLaughlin

Avalere was recently commissioned to project how policy proposals related to biosimilars would impact government spending and patient costs, including modeling and scoring analyses created for 3 proposals publicly released by the Biosimilars Forum in May 2019.

• Sarah Alwardt
• Chris Sloan
• Elizabeth Carpenter

New Avalere analysis finds that shifting Part B-covered rheumatoid arthritis (RA) drugs to Part D benefit would increase the share of prescriptions occurring in the catastrophic phase for impacted beneficiaries by more than 5 times.

• Megan West (Olsen)
• Joanna Young
• Mitchell Cole

While the Department of Health & Human Services (HHS) did not intend for proposed changes to Anti-Kickback Statute (AKS) regulations to impact commercial market drug negotiations, some state laws may indirectly lead to commercial market implications.

• Lisa Murphy
• Katie Patton
• Nick Diamond
• Chad Brooker