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.
Manufacturers Should Assess Wastage to Inform Mitigation Strategy
Manufacturers impacted by the Part B discarded drug refund policy should assess claims billing and adjudication patterns to inform mitigation strategy.
Will Part D Redesign Lower OOP Costs for HIV Care?
The IRA’s Part D redesign could lower out-of-pocket costs for people with HIV; providers can help make sure their patients are aware of these changes.
What is the Role of 340B Grantees?
Some federal grant recipients use 340B program eligibility to expand their reach and services provided to a wide range of patient populations.
Video: Unpacking the Implications of the Negotiated Drug List, Part 1
Delve into the far-reaching implications of the recently announced negotiated drug list as Avalere experts provide insights and answers to pressing questions surrounding CMS's landmark decision on Part D drug pricing and its impact on manufacturers, patients, and the future healthcare landscape.
CMS Selects First 10 Drugs for Medicare Negotiation
CMS selected 10 Part D drugs for the first year of negotiation. Stakeholders should consider engagement opportunities and evaluate broader therapeutic dynamics.
How Will the IRA Impact the Future of Biosimilars?
Multiple Inflation Reduction Act provisions impact biologics and biosimilars, but the net impact and potential consequences will vary across products.
States Turn to Drug Price Boards to Reduce Spending
State legislatures are increasingly considering prescription drug affordability boards and upper payment limits to lower state expenditures and patient costs.
Proposed Operational Updates to the Discarded Drug Refund Policy
In CY 2024 rulemaking, CMS proposes operational clarification to the discarded drug refund policy finalized last year.
How Do IRA Policies and the Enhancing Oncology Model Interact?
Manufacturers should adjust commercial and evidence generation strategies in response to the shifted incentives under the IRA and Enhancing Oncology Model.
CMS Best Price Discount Stacking Proposal May Trigger AMP Cap
Requiring manufacturers to stack all discounts provided through the supply chain could increase Medicaid rebate liability and complicate rebate dynamics.
340B Stakeholders Consider Impacts of Duplicate Discounts
Drug manufacturers, covered entities, and other 340B stakeholders have shown increased interest in 340B duplicate discounts.
State Copay Accumulator Bans Will Affect 19% of US Commercial Lives
19% of people enrolled in the US commercial insurance market will belong to a health plan that must count copay assistance toward patient cost sharing by 2024.
Key Stakeholders of the 340B Drug Discount Program
Key 340B stakeholders include the federal government, patients, pharmacies, drug manufacturers, PBMs, plans, and the 340B prime vendor.
What Is the 340B Prescription Drug Discount Program?
Section 340B of the Public Health Service Act requires significant discounts on outpatient drugs for “covered entities"—safety-net providers and programs.
Which Therapeutic Areas Are Likely to Be Affected by IRA Negotiation?
Sponsors with portfolio or pipeline assets within certain therapeutic areas can prepare for the downstream effects of price negotiation on the market.
Should Competitors of Negotiated Drugs Review Their Market Strategies?
Manufacturers of therapeutic alternatives to negotiation-eligible drugs should re-examine their commercialization strategies in response to market dynamics.
Should Competitors of Negotiated Drugs Review Their Evidence Strategy?
Manufacturers of therapeutic alternatives to negotiation-eligible drugs should examine their value and evidence strategy in response to new dynamics.
Will the IRA Change Investment in Orphan Drug Pipelines?
IRA negotiation eligibility criteria may impact orphan drug investment, affecting long-term innovation and patient access.
How Do IRA Drug Pricing Policies Interact with One Another?
Stakeholders should consider the interaction of inflation-based rebates, AMP cap removal, and Medicare price negotiation in pricing and contracting strategies.
Insights on IRA Policies and Business Impacts Presented at Asembia
Avalere’s expert presentations at the AXS23 Summit described IRA drug-pricing policies and the law’s impact on patient access and affordability.