Updated Analysis Finds Sustained Drop in Routine Vaccines Through 2020
In 2020, the COVID-19 pandemic resulted in nationwide lockdowns and restrictions with a well-documented impact on utilization of routine healthcare services.
Unprecedented Mid-Year Plan Changes Could Impact Patient Access
While access to insurance has increased for millions, mid-year plan switching can have unforeseen consequences for patients.
Coverage of COVID-19 mAbs Presents Opportunities for Stakeholders
In November 2020, the Food and Drug Administration (FDA) granted Emergency Use Authorization (EUA) to COVID-19 monoclonal antibodies for treatment of mild-to-moderate COVID-19 infection.
CMS Introduces Changes to CAR-T Reimbursement in IPPS Proposed Rule
Policy proposals for Medicare’s CAR-T inpatient reimbursement build on policies finalized in last year’s rulemaking. Looking ahead, stakeholders will continue to weigh the appropriateness of payment.
Medicare Expansion Could Have a Mixed Impact on Premiums
New Avalere analysis finds that lowering the Medicare eligibility age from 65 to 60 could expand access to Medicare coverage for an additional 24.5 million individuals, but Medicare premiums may be less affordable in some cases than subsidized exchange coverage.
Accurate COVID-19 Testing to Protect the Military and Support Schools
The US continues to face challenges with managing COVID-19 (SARS-CoV-2) while reopening communities. Accurate COVID-19 diagnostic testing is an effective tool in minimizing the risk of transmission.
Avalere Statement on US Support of TRIPS Waiver for COVID Vaccines
On May 5, the Biden administration announced its support for waiving World Trade Organization (WTO) intellectual property regulations with respect to COVID-19 vaccines, in an effort to increase supply and worldwide access to the vaccines.
Looking Ahead: The Evolving Oncology Landscape
Avalere experts examined the changing oncology landscape amid the COVID-19 pandemic.
Removing Low-Risk Cancers Has Variable Impact on OCM Performance
An Avalere analysis found that the impact of removing low-risk/low-intensity episodes from the Oncology Care Model (OCM) reconciliation process would not have a notable impact for most practices. Among practices where performance would change, however, performance would improve for most practices if enrolled in 1-sided risk but worsen for most practices if enrolled in alternative 2-sided risk.
Advancements in Cell Therapies Require New Patient Support Solutions
Manufacturers seeking Food & Drug Administration (FDA) approval for cell therapies will need to assess the financial and logistical burden on patients and develop novel solutions to help alleviate these challenges.
PACHA Highlights Need to Address HIV PrEP Coverage Disparities
On March 8–9, the Presidential Advisory Council on HIV/AIDS (PACHA) discussed avenues to achieving equitable access to HIV prevention products for at-risk populations as well as next steps in revising the National Strategic Plan to End the HIV Epidemic.
2021 State Drug Pricing Legislation: The Evolution Beyond Transparency
The majority of state legislatures are currently in session, and many states are taking steps to address prescription drug spending and prices through a range of legislative proposals. While states have historically focused on price transparency, state policymakers are now moving beyond those measures to more directly control prescription drug prices through reference pricing, affordability review boards setting upper payment limits, and other price control mechanisms.
OCM, OCF, and the Future of Cancer Care: 5 Things to Look Out For
As the Oncology Care Model (OCM) approaches its conclusion, stakeholders are anxiously awaiting the details of the Center for Medicare & Medicaid Innovation's (CMMI’s) next oncology episodic payment model, Oncology Care First (OCF).
Measuring Scope of COVID-19 Relief Coverage Expansion Provisions
Avalere analysis finds that Congress's healthcare reforms under the COVID-19 relief bill could expand exchange coverage subsidies for up to 18.3 million individuals.
Senior Health and Well-Being During COVID-19
Tune into another episode in the Avalere Health Essential Voice podcast series focused on COVID-19. In this segment, Richard Ashworth, President and CEO of Tivity Health, joins us to discuss survey findings around COVID-19 and the senior population, with key takeaways related to vaccination acceptance and hesitancy.
Patient Support Programs and Rare Disease
Tune into the second segment of the Avalere Health Essential Voice series focused on disease education. In this segment, experts from our Market Access practice discuss rare disease patient support programs and the need for stakeholder partnerships to address many of the barriers patients and their caregivers face.
Patient Support Programs and Rare Disease
Tune into the second segment of the Avalere Health Essential Voice podcast series focused on disease education. In this segment, experts from our Market Access practice discuss rare disease patient support programs and the need for stakeholder partnerships to address many of the barriers patients and their caregivers face.
Incorporating Clinical Factors Could Improve OCM Cost Prediction
An Avalere analysis found that among high-risk breast cancer episodes, those in later stages of the disease had higher episode expenditures relative to their benchmarks compared to those in earlier stages.
Copay Accumulator and Maximizers: Evolving Policy Landscape
Implementation of copay accumulator and maximizer programs continues to increase; recent policy provisions finalized through federal rulemaking and state-level legislation have created new uncertainty for the future of these programs and the stakeholders they affect.
Understanding Shifting Insurance Coverage Impacts
Join Avalere’s panel of market access and policy experts to learn about the shifting insurance coverage landscape and how these trends impact manufacturers, payers, policymakers, and providers.