Avalere Health Insights Who We Help Expertise About Us Submit Connect Drug Pricing Keep up with our comprehensive coverage of administrative and legislative activity and what it means for industry, plans, providers, and patients. Featured Content Drug Pricing Part B Drug Negotiation Under BBBA Would Reduce Payments... New Avalere analysis finds that the latest version of Medicare negotiation in the Build Back Better ... Milena Sullivan Drug Pricing Some Part D Beneficiaries May Pay Full Price for... Avalere analysis finds that when generics in Part D are placed on the preferred brand tier some pati... Alessandra Fix Drug Pricing Series of Changes to Drug Pricing Metrics Will Interact... The intersection of upcoming changes to drug pricing metrics will require new methods of calculating... Amelia Nell Sort by Topic 2020 Election Alternative Payment Models COVID-19 Intel Center Drug Pricing FDA Regulatory Pathways Federal Policy Healthcare Industry Outlook Quality Improvement Real-World Data Social Determinants of Health State Policy Vaccines / Preventive Services Value Assessments Value-Based Care November 18, 2021 Drug Pricing Part B Drug Negotiation Under BBBA Would Reduce Payments to Providers New Avalere analysis finds that the latest version of Medicare negotiation in the Build Back Better Act (BBBA) would lead to a 40% cut on average for Medicare providers that furnish the Part B drugs that are likely to be initially targeted for negotiation. Milena Sullivan Amanda Tripp Kent McKinney Ekemini Isaiah Blair Burnett Reed Diskey Audrey Yang Luke Frazier July 20, 2021 Drug Pricing Some Part D Beneficiaries May Pay Full Price for Certain Generic Drugs Avalere analysis finds that when generics in Part D are placed on the preferred brand tier some patients pay the full cost for their drugs. Alessandra Fix Ellyn Frohberg Shruthi Donthi Daniel Nam Massey Whorley July 13, 2021 Drug Pricing Series of Changes to Drug Pricing Metrics Will Interact in Coming Years The intersection of upcoming changes to drug pricing metrics will require new methods of calculating and reporting government pricing with implications for net pricing and contracting strategies. Amelia Nell Nicole Meyerson Alan He Elizabet Shvets Megan Olsen Margaret Scott Lance Grady May 5, 2021 Drug Pricing Podcast: Cell and Gene Therapy in Oncology, Part I Tune into another episode in the Avalere Health Essential Voice podcast series focused on disease education. In this segment, the first of several discussing cell and gene therapies, experts from our Policy and Market Access practices highlight many of the challenges surrounding these therapies from both the patient and payer perspective. Kolton Gustafson Jay Jackson Megan Olsen May 5, 2021 Drug Pricing Video: Cell and Gene Therapy in Oncology, Part I Tune into another episode in the Avalere Health Essential Voice podcast series focused on disease education. In this segment, the first of several discussing cell and gene therapies, experts from our Policy and Market Access practices highlight many of the challenges surrounding these therapies from both the patient and payer perspective. Kolton Gustafson Jay Jackson Megan Olsen April 26, 2021 Drug Pricing Pending ASP Changes Impact Payments & May Shape Future FDA Filings Beginning July 1, 2021, average sales price (ASP) calculations for Part B drugs with an additional non-covered self-administered formulation could alter Medicare reimbursement. Blair Burnett Zachary Zalewski Kelly L. George Ekemini Isaiah Michael Kearney Milena Sullivan Lance Grady April 15, 2021 Drug Pricing Advancements in Cell Therapies Require New Patient Support Solutions Manufacturers seeking Food & Drug Administration (FDA) approval for cell therapies will need to assess the financial and logistical burden on patients and develop novel solutions to help alleviate these challenges. Brigit Kyei-Baffour James Coffelt Michael Kearney Merrill Harmison Jay Jackson Megan Olsen Lance Grady April 2, 2021 Drug Pricing 2021 State Drug Pricing Legislation: The Evolution Beyond Transparency The majority of state legislatures are currently in session, and many states are taking steps to address prescription drug spending and prices through a range of legislative proposals. While states have historically focused on price transparency, state policymakers are now moving beyond those measures to more directly control prescription drug prices through reference pricing, affordability review boards setting upper payment limits, and other price control mechanisms. Megan Olsen Katie Patton Mitchell Finkel Kate Sikora Ellyn Frohberg March 31, 2021 Drug Pricing Majority of Part D Spending Is on Brand Drugs in Classes with Generics With Congress likely to consider a second reconciliation bill in the near future that may include various drug-pricing and Medicare Part D reform policies as spending offsets, an updated Avalere analysis examines spending across classes with various availability of brand and generic drugs. Ellyn Frohberg Joanna Young Shruthi Donthi Rebecca Yip Kylie Stengel March 26, 2021 Drug Pricing Three Considerations for 2021 Drug Pricing Reform Outlook A second reconciliation package could include significant drug pricing reforms as a means to pay for permanent coverage expansion and other top priorities. Matt Kazan Milena Sullivan Amelia Nell Brook Getachew March 11, 2021 Drug Pricing Generic Drug Placement on Part D Generic Tiers Declines Again in 2021 A new analysis from Avalere finds that in 2021, Medicare Part D plans place generic prescription drugs on generic tiers 45% of the time, a decrease from 64% in 2016. Alessandra Fix Ellyn Frohberg Chris Sloan Shruthi Donthi January 21, 2021 Drug Pricing MFN Model Would Have Had a Major Impact on Certain Providers New Avalere analysis finds that the the Most Favored Nation (MFN) Model would have a significant negative impact on Medicare providers that furnish Part B drugs—especially in oncology and rheumatology—and those in rural areas. Milena Sullivan Ekemini Isaiah Luke Frazier Blair Burnett Massey Whorley Mitchell Cole December 7, 2020 Drug Pricing Podcast: Most Favored Nation Model Stakeholder Considerations Tune into another episode of Start Your Day with Avalere. In this segment, experts from Avalere’s Policy practice discuss the Most Favored Nation (MFN) drug pricing model, how it works, and the implications for stakeholders. Massey Whorley Chris Sloan December 3, 2020 Drug Pricing Most Favored Nation Rule’s Impact on Medicare Beneficiaries OOP Costs New Avalere analysis finds that most Medicare fee-for-service (FFS) beneficiaries would not see a substantial reduction in their out-of-pocket (OOP) costs as a result of the Most Favored Nation (MFN) model. Milena Sullivan Mitchell Cole Blair Burnett November 20, 2020 Drug Pricing Avalere Statement on Trump Administration Drug Pricing Reforms Earlier today, the Trump Administration released long-anticipated drug pricing reforms, including rules related to a Most Favored Nation (MFN) approach for drugs administered by providers in Medicare and rebate reform for the Medicare Part D program. Both rules represent fundamental shifts in our current system and have significant implications for manufacturers, health plans, pharmacies, providers, and patients. Lance Grady Milena Sullivan Omar Hafez Miryam Frieder Matt Kazan November 11, 2020 Drug Pricing Medicaid Programs Seek New Approaches for Cell and Gene Therapies State Medicaid programs are likely to face significant budget impacts from emerging cell and gene therapies and may seek to implement a variety of strategies to manage utilization and address provider reimbursement and financing challenges. Amelia Nell Kylie Stengel Megan Olsen Jay Jackson Margaret Scott September 17, 2020 Drug Pricing “Most Favored Nation” EO Creates New Questions on International Prices On September 13, the Trump Administration released the much-anticipated “Most Favored Nation” (MFN) Executive Order (EO), calling for models that would cap the price Medicare pays for select Part B and D drugs. The President’s EO underscores the administration’s continued focus on reducing prescription drug price disparities between the US and other developed countries. Milena Sullivan Ekemini Isaiah Chris Sloan Massey Whorley Miryam Frieder Luke Frazier September 10, 2020 Drug Pricing CMS Finalizes New Reimbursement Method for CAR-T Treatments Policy changes to Medicare’s CAR-T inpatient reimbursement set a precedent for high-cost durable treatments. Looking ahead, questions and concerns remain for pipeline cell and gene therapies that have high up-front costs. Kolton Gustafson Jay Jackson Megan Olsen Abby Moorman August 6, 2020 Drug Pricing EOs Direct Drug Pricing Action, Raise Additional Questions The administration’s 4 drug pricing EOs direct agency action across a host of policy areas, including Part D rebates, Part B reimbursement and pricing, 340B drug discounts, and drug importation. Next steps and a timeline for agency action will vary by EO dependent on the specific policies to be advanced or finalized. In the interim, stakeholders should explore outstanding questions and contemplate near- and longer-term policy scenarios. Megan Olsen Milena Sullivan Chris Sloan Kylie Stengel Ekemini Isaiah July 27, 2020 Drug Pricing Avalere Statement on Prescription Drug Pricing Executive Orders On July 24, the administration released 3 executive orders (EO) and announced the planned publication of a fourth EO, all focused on prescription drug pricing. The EOs reflect a combination of familiar policy goals (e.g., rebate reform, importation, international pricing) and a new 340B initiative, and in combination could have substantial implications for healthcare stakeholders and pharmaceutical markets if implemented. Elizabeth Carpenter Chris Sloan Chad Brooker Miryam Frieder Lance Grady Page 1 Page 2 Page 3 Next Avalere Health An Inovalon Company 1201 New York Avenue NW Suite 1000 Washington, DC 20005 Phone 202.207.1300 Fax 202.467.4455 info@avalere.com Contact Careers Privacy Policy Terms of Use Twitter LinkedIn Avalere is a healthcare consulting firm dedicated to improving healthcare. Our life sciences, plan, and provider clients count on us to help them anticipate and adapt to the latest industry trends. © 2021 - Avalere Health We'll assume you're ok with this, but you can opt-out if you wish.Accept