Insights & Analysis
There’s one constant in healthcare: change. Count on us to break down the trends so you can stay up to date. Follow our take on each piece of this deep, intertwined, and often perplexing industry to find opportunities and practical approaches to move healthcare forward.
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Analysis of CMMI Model Costs, Quality Performance, and Transparency
Avalere Health assessed 18 CMMI models for their performance on financial and quality measures as well as the transparency of their development and implementation.
New Analysis Finds Top-Performing ACOs Across Models Focus on Patients with Complex Needs
With ACO REACH sunsetting in 2026 amid ongoing stakeholder interest in identifying successful value-based care models, findings highlight the critical future role of High Needs ACOs.
New Resource: Commercial Payers’ Use of Oncology Compendia
Avalere’s dashboard provides insights into commercial payer trends for use of clinical drug compendia for off label coverage decisions in oncology.
Expiration of Enhanced Tax Credits Would Impact 18M Americans
If the ACA marketplace enhanced premium tax credits are made permanent, nearly 5 million people ages 50–64 will be eligible to receive premium subsidies in 2026.
Update: Health Plans’ Perceptions of PDABs and UPLs
In interviews and a survey, health plans communicate concerns with UPLs’ potential impact on patient access, pharmacists, providers, and their own financial positions.
Navigating the Evolving World of Drug Compounding
Drug compounding regulation has evolved due to recent industry trends, emphasizing the need to understand its optimal role in healthcare delivery.
National Kidney Month: Setting the Stage for 2025 Changes
Political changes, transplant system reforms, research advancements, and expanded CKD indications create opportunities and challenges in the kidney care space.
Disease Registries Offer Solutions in Rare Disease
Disease registries can provide high-quality data and may serve as an additional resource when developing medical interventions for rare and ultra-rare diseases.
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.
Telehealth in Medicare: Shifts Before and After COVID-19
Pandemic-era telehealth flexibilities in Medicare will expire in April 2025, potentially limiting primary care access for beneficiaries.
MA and Part D Enrollment Growth Slows in 2025
Year-over-year enrollment growth in MA and Part D slowed in 2025. Although, enrollment in chronic condition special needs plans experienced significant growth.
State Copay Accumulator Bans Now Affect 16% of Commercial Lives
Over 16% of people enrolled in the US commercial insurance market belong to a health plan that must count copay assistance toward patient cost sharing.
Stakeholders Can Influence Patient-Centered Value Research During Public Comment Period
Life sciences companies, payers, and advocates can weigh in on patient-centered value assessments in a new public comment opportunity.
Part D Prior Authorization Policies May Include Step Therapy
Analysis of Part D plans including step therapy in prior authorization and the frequency of step therapy criteria that include steps beyond the drugs’ FDA labels.
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.
Opportunities to Move the Needle on US Behavioral Healthcare in 2025
Behavioral health is at a turning point in 2025, with newly implemented policies, groundbreaking treatments, and novel regulatory and financial dynamics.
White Paper: The Medicaid Drug Rebate Program and Considerations for Generic Markets
This paper details five AMP increase scenarios that could lead to a generic manufacturer being subject to inflation rebates in situations where the generic manufacturer is not taking a price increase beyond the inflation rate.
eBook: Rare Disease Biotechnology Landscape
In an eBook, Avalere Health experts describe the policy, market access, and evidence landscape of rare disease in the United States and globally.
Part D Coverage of MS Drugs Declined in 2025
Overall coverage of MS drugs among Part D plans declined by six percentage points, from 49% of the time across all plans and drugs analyzed in 2024 to 43% in 2025.
Impacts of 340B on State Medicaid Programs and Patient OOP Costs
The 340B program may create unintended consequences for state Medicaid budgets and patients who may not see direct benefits from the program.