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.
Video: Inside Compendia: Introduction to Clinical Drug Compendia
In the first installment of our Inside Compendia series, Avalere Health Advisory experts discuss how to engage and support life sciences companies in ways of incorporating their products into clinical compendia and guidelines.
White Paper: The Role of PBMs in the US Healthcare System
A new white paper describes the role of PBMs in the US healthcare system using evidence published in the literature to inform future discussions.
MFN EO Raises A Range of Potential Options for DTC Implementation
A DTC purchasing program could take various forms to enable patients to access MFN pricing.
What the EPIC Act Could Mean for Generics and Medicare Spend
Delaying selection of small-molecule drugs for Medicare negotiation may support the generic market by preserving competition and maximizing long-term savings for payers and the federal government.
CMS Proposes Pay Bump for CAR-T in FY 2026
The inpatient rule proposes a 17% increase for CAR-T stays and several CGTs are under review for New Technology Add-on Payments.
Trump EO Lays Out a Roadmap for Drug Pricing Action
New Executive Order on drug pricing revives earlier Trump proposals and also suggests new approaches for Medicare and states.
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.
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.
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.
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.
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.
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.
Webinar: 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.
340B Purchase Data Highlights Continued Program Growth
HRSA 2023 340B purchase data demonstrates continued program growth and that sales for the top 10 340B drugs exceeded sales for those drugs in Medicare.
Stakeholders Can Engage USP During DC 2025 Comment Period
The USP DC 2025 Draft is open for public comment until October 31, allowing stakeholders to engage with the USP even in years without an update to the MMG.