Drug Pricing and Affordability
Keep up with our comprehensive coverage of administrative and legislative activity and what it means for industry, plans, providers, and patients.
Navigating the Medicare Prescription Payment Plan: What It Means for Part D Plan Sponsors
The MPPP introduces new considerations for Part D plans’ financial risk, operations, and enrollee engagement.
Navigating the Medicare Prescription Payment Plan: What It Means for Manufacturers
The MPPP will help improve Part D patient affordability, prompting manufacturers to reassess existing patient assistance programs and educational efforts.
Navigating the Medicare Prescription Payment Plan: What It Means for Patients and Patient Groups
The MPPP is a new payment option for Part D beneficiaries in 2025; patient groups will play a key role in supporting education and outreach on the program.
IRA Negotiations May Affect Millions of Medicare Beneficiaries
Maximum fair prices for the first 10 selected drugs may shift therapeutic dynamics and have direct and indirect impact to millions of beneficiaries.
Commercial Spillover Impact of Part B Negotiations on Physicians
Physicians could lose at least $25 billion in add-on payments for 10 Part B drugs expected to be negotiated by CMS, with oncology products accounting for at least $12 billion.
Navigating the Medicare Prescription Payment Plan: What It Means for Stakeholders
The Medicare Prescription Payment Plan will change how Medicare beneficiaries manage their Part D out-of-pocket costs, with implications across stakeholders.
Manufacturer Learnings from the First Round of Negotiated MFPs
Avalere experts share initial impressions of the publicly released negotiated MFPs for the first round of selected drugs, highlighting implications to industry.
Implications of Self-Administered Drug List Determinations on Access
SAD list placement will inform the channel that providers and patients use to access a therapy.
Drug Pricing Transparency Expands Under Several Policies
Transparency disclosures could provide significant insight into pricing and rebating activities.
White Paper: Infusion Care and White-Bagging Requirements
Avalere surveyed providers on the administrative and economic costs of white-bagging requirements on infusion centers.
Can Comprehensive 340B Reform Generate Federal Savings?
Stakeholders are debating potential reforms to the 340B program, with specific policies directly or indirectly impacting federal spending.
Trends in Generic Tiering in Medicare Part D, 2011–2021
From 2011 to 2021, there was an increase in higher formulary tiering, patient out-of-pocket spending, and negotiated price for a cohort of generics.
Upper Payment Limits on Drugs Could Alter Patient Access
State approaches to PDABs and UPLs vary, but all approaches could impact patient access and affordability.
Over Half of Generic Drugs Are Not on Part D Generic Tiers
In recent years, Medicare Part D plan tier placement of generic prescription drugs has declined, from 64.5% in 2016 to 43.8% in 2024.
States Will Prioritize Drug Affordability and Access in 2024
States will commence legislative sessions at the beginning of January. Drug pricing, including payment limits and reference pricing, as well as improved access will be key priorities.
IRA Negotiation Creates Ripple Effects Across Drug Markets
Medicare negotiation has ripple effects across therapeutic markets, requiring manufacturers to reassess strategies to stay ahead of the changing drug landscape.
IRA Drug Price Negotiation Impact on Cardiovascular Drugs
A new Avalere white paper raises important considerations on potential added lifecycle pressures for sponsors of cardiovascular disease products.
How Will 340B Discounts Interact with Negotiated Drugs’ MFP?
The IRA requires covered entities to pay the lesser of a drug’s 340B ceiling price and MFP, presenting operational complications for manufacturers and providers.
Court Ruling Will Limit Accumulators
A district court’s decision to strike down the 2021 NBPP is the latest policy update on the use of copay adjustment programs, but questions persist.
How Can Manufacturers Help Shape Medicare Negotiations?
Manufacturers should reevaluate CMS engagement strategies as soon as possible to maximize the opportunity to influence the IPAY 2026 Medicare negotiations.