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.
Medicare Drug Price Negotiation Guidance: Avalere Experts Respond
Guidance adds clarity on drug selection, maximum fair price application (MFP), evidence submission, and manufacturer engagement, but leaves questions on determining MFP.
Manufacturers’ Opportunities in Digital Therapeutics
Digital therapeutics is the fastest growing field in digital health, offering promising benefits for patient outcomes and healthcare system efficiencies.
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.
After Roe, Growing Fertility Industry Faces Risks at State Level
Despite market growth, fertility services may be affected by the overturning of Roe v. Wade. The extent and nature of impact will vary by state.
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.
States Set 2023 Legislative Priorities Amid New Federal Landscape
Most states will begin new legislative sessions in 2023. Drug pricing, patient affordability, and coverage protection will be priorities in many states.
Biden Orders HHS to Test Medicare, Medicaid Drug Pricing Models
President Biden’s executive order directs HHS to identify CMMI model options that could lower drug costs and promote access for Medicare and Medicaid enrollees.
Taking Inventory: Investment Opportunities in Value-Based Care
Avalere analyzes opportunities for investment in the growing $350-billion market for population-level VBC in Medicare.
340B Reimbursement Proposal Could Reduce Payments for 80% of Hospitals
To assess how changes in OPPS payment for reimbursement of drugs under the 340B program would affect hospital reimbursement and Medicare Part B beneficiary cost sharing, Avalere estimated the impact of increasing reimbursement for 340B drugs in Medicare Part B to ASP + 6%. The analysis finds that most hospitals would see overall payment decreases, while payments would be subject to higher cost sharing.
Medicare Advantage, Part II: Influencing CMS Policy
Tune into the second episode in our video series focused on Medicare Advantage. In this segment, Avalere experts and former Center for Medicaid and Medicare (CMS) employees Sean Creighton and Tom Kornfield discuss their thoughts on the best ways for health plans to influence CMS decision making, including timing of engagement and critical messaging elements.
Medicare Advantage, Part I: The Future of MA
Tune into the first episode in our video series focused on Medicare Advantage. In this segment, Avalere experts and former Centers for Medicare & Medicaid Services (CMS) employees, Sean Creighton and Tom Kornfield, discuss the outlook for Medicare Advantage, factors that will influence growth of the program, and a behind-the-scenes look at CMS policymaking considerations.
Political Realities Require Trade-Offs from Democrats on Skinny BBBA
As Democrats seek consensus on a "skinny BBBA," concerns over inflation and deficit reduction will place greater emphasis on "pay-for" targets to advance healthcare priorities.
The Evolving Cell & Gene Therapy Market
Join Avalere’s panel of market access and policy experts for a discussion on the growing cell and gene therapy (CGT) pipeline, an in-depth look at the unique opportunities and challenges these novel therapies present, and an overview of the many hurdles stakeholders need to navigate for success.
White-Bagging Legislation Gains Popularity in State Legislatures
In recent years, payers and pharmacy benefit managers (PBMs) have been interested in implementing strategies that may reduce overall costs, such as the use of white bagging. However, provider and patient groups have raised concerns that these tactics may create access to care, cost, and safety issues. Legislation seeking to regulate this practice is on the rise in many state legislatures.
MQii Roundtable Proceedings / Malnutrition and Health Equity
Successful initiatives to address malnutrition and food insecurity through quality measurement and community partnerships are improving malnutrition care across the country and addressing health equity.
Global Malnutrition Composite Score Included in IPPS Proposed Rule
The proposed inclusion of the Global Malnutrition Composite Score in the Hospital Inpatient Quality Reporting Program will enable hospitals and their patients to benefit from identifying and addressing malnutrition. The measure’s use facilitates high-quality and comprehensive nutrition care that begins in the inpatient setting and continues across transitions of care.
Looming Deadlines Could Trigger Congressional Action on Healthcare
Congressional Democrats have indicated interest in a slimmed-down BBBA alternative that could pass the Senate. Pending deadlines and the expiration of ARPA subsidies may create impetus for Democrats to act on legislative health care priorities in 2022.
57% of Generic Drugs Are Not on 2022 Part D Generic Tiers
An updated Avalere analysis examines Medicare Part D plan tier placement of generic prescription drugs, finding that over time their percentage on generic tiers has declined from 65% in 2016 to 43% in 2022.
Treating Depression Reduces Medicare Costs; Provider Challenges Remain
A recent Avalere analysis of Medicare Fee-for-Service (FFS) data illustrates that treating major depressive disorder (MDD) in Medicare-eligible beneficiaries results in a 4% reduction in total cost compared to untreated patients, highlighting the importance of incentivizing adequate provider supply and payment in the geriatric psychiatry market.