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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Avalere Resource: Coverage and Coding Regulatory Calendar
Avalere’s new CY 2025–2026 Coding and Regulatory Calendar supports life sciences firms’ strategic planning for critical coding deadlines, timelines, and regulatory updates.
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.
Impact of J-Code Naming Conventions on 505(b)(2) Drugs
Manufacturers have noted challenges arising from 505(b)(2) code descriptors, prompting CMS to consider proposed updates
Avalere Announces Practice Directors for Policy, Operations
Milena Sullivan will lead Avalere’s Policy Practice, and Erica Eisenhart is promoted to Operations Practice Director.
Highlights From The 2024 InformaConnect Congress
Two Avalere experts captured information presented at a recent conference and published their perspectives in Pharmaceutical Commerce.
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.
Vaccine Policy and Access Under New HHS Leadership
Policy actions in the first days of the Trump administration raise questions about the future role of key vaccine advisory committees.
Health Plans 2030: Unlocking Value through Data & Technology Advancements
With increasingly sophisticated data and technology available, plans should strategize about how to integrate both across the enterprise to drive higher value.
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.
USP DC 2025 Updates and Strategic Engagement Opportunities
USP’s updated Drug Classification for plans outside of the Medicare Part D market reflects revisions and newly approved products through October 2024.
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.
Newborn Screening: Landscape and Rare Disease Developments
Novel approaches to newborn screening of rare diseases could shape the future of federal and state screening guidelines.
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.
Updated Resource: State Statute Oncology Drug Coverage Report
A detailed Avalere report offers insights into state-specific statutes guiding commercial payer coverage for off-label use of oncology drugs/biologics.
Evidence Generation and Access at the San Antonio Breast Cancer Symposium
At a breast cancer symposium, Avalere oncology advisory experts connected with colleagues to discuss early detection, precision medicine, and clinical trials.
RxHCC Model May Not Accurately Predict Costs for Certain TAs
Avalere analysis finds that the Part D risk adjustment model likely underpredicts expenditures for some high-cost conditions.
Study: 57 Percent of Covered Generic Drugs Not on Part D Generic Tiers in 2025
Over time, the percentage of generic prescription drugs placed on Medicare Part D generic tiers has declined, from 65% in 2016 to 43% in 2025.
Rare Disease Advisory Councils: Opportunities for Engagement
Stakeholders should seek to engage with RDACs to develop a better understanding of rare disease care access, treatment, and populations in different states.
Avalere White Paper: Value-Based Care and Orthotics and Prosthetics
A white paper explores ways in which VBC payment models can benefit from incorporating allied health domains, such as Orthotics and Prosthetics.