Part D Policy Change Lowers Max OOP Costs for Many Enrollees
Cost-sharing reductions from enhanced plans and EGWPs allow beneficiaries to reach the catastrophic phase with lower OOP spending than those in basic plans.
IPAY 2028 Guidance Finalizes Some Part B Details, Others Remain
The guidance clarifies some draft policies, adds MA encounter data to Part B drug selection, revises Part B 30DES calculations, and defers some issues to 2029.
White Paper: Provider Survey on Part B Negotiation Impacts
In a survey, providers say MDPNP may heighten financial pressures, raising concerns around provider sustainability and patient access
The New Stakeholder Economics of Part D After the IRA
The implementation of the IRA’s Part D redesign and Medicare drug price negotiation in 2026 will have varying impacts across plan types and therapeutic areas.
Adapting Economic Models for Medicare Negotiation
Manufacturers have several strategies at their disposal to adapt and leverage cost effectiveness evidence in preparation for Medicare drug price negotiation.
IRA, MFN, and Ongoing Fiduciary Pressures Creates Ripple Effect Across the Healthcare Ecosystem
IRA Medicare provisions, increased focus on price regulations including Most-Favored Nation pricing, and broad fiduciary pressures have ripple effects across the healthcare ecosystem.
Stakeholder Considerations for IPAY 2028 Guidance
Draft guidance for IPAY 2028 Medicare drug price negotiation includes the first-time inclusion of Part B drugs, refinement to MFP effectuation, and considerations around what qualifies as a single-source drug.
Stakeholder Considerations for MFP Effectuation in Part B
Several pathways exist to effectuate the MFP for Part B negotiation with benefits and drawbacks for stakeholders across the drug supply chain.
Early Enrollment Data Indicates More Beneficiaries Could Benefit from MPPP
Avalere Health’s analysis of early MPPP enrollment shows that only a small portion of beneficiaries who are likely to benefit from the program have enrolled.
Impact of MFP Effectuation on Pharmacies and Beneficiaries
A large share (30%) of beneficiaries access IPAYs 2026 or 2027 negotiated drugs through independent or franchise pharmacies.
Updated: Key Considerations for MFP Effectuation and the 340B Rebate Model
With less than a year until the first MFPs take effect, stakeholder concerns remain, especially as it relates to 340B duplicate discount risk.
White Paper: Valuing Multi-Use Drugs in Medicare Negotiation
Alternative approaches for weighting multiple uses of a product when setting maximum fair prices may better balance patient needs and development incentives.
IPAY 2027 Negotiated Drugs Expand Impact on Beneficiaries
The addition of 15 drugs selected for IPAY 2027 negotiation expand the impact maximum fair prices may have on key therapeutic areas and millions of beneficiaries.
Estimating the Spillover Impact of IRA Part B Negotiation
A survey finds that reimbursement contracts outside Medicare FFS still reflect Medicare metrics, raising questions about broader Part B negotiation effects.
CMS Announces Next 15 Drugs Selected for IRA Negotiation
The next cohort of drugs includes additional cancer and chronic disease therapies, as well as products that were therapeutic alternatives for IPAY 2026 drugs.
Three Takeaways from the CMS MFP Justifications for IPAY 2026
CMS released the rationale for the maximum fair prices under the Medicare Drug Price Negotiation Program for Year 1 drugs.
Medicare Prescription Payment Plan May Help Enrollees Facing More Coinsurance in 2025
Shifts from copays to coinsurance in Part D may increase OOP costs and make the Medicare Prescription Payment Plan more beneficial for some enrollees.
IRA Negotiation Impact on Part B Beneficiary OOP Costs
Avalere finds that between 0.03% and 0.1% of Medicare FFS beneficiaries would experience lower OOP costs for the first 10 Part B drugs likely to be negotiated.
The Medicare Prescription Payment Plan: Impact to Part D Stakeholders in 2025
Join Avalere to learn about the new Medicare Prescription Payment Plan and what it means for Part D enrollees in 2025.
Part D Patient Access 2025: Drug Formulary Changes
Join Avalere experts to learn about the changes to Part D formularies for 2025 and implications for patient access.