Avalere Health Insights Who We Help Expertise About Us Submit Connect Federal Policy As the largest, single US healthcare payer, the government plays a dominant role in shaping the healthcare marketplace. Our experts track, interpret, and model federal policies that affect insurance coverage, access, and consumer choice so you can see around the bend. Featured Content Federal Policy Video: Medicare Part D, Part V: What’s Next for CMMI? Tune into the fifth and final episode of the Avalere Health Essential Voice miniseries focused on Me... Sarah Butler Federal Policy More Medicare Advantage Plans Will Offer Non-Medical Benefits in... New analysis from Avalere finds that in 2022 more Medicare Advantage plans will offer non-medical su... Thomas Kornfield Federal Policy Video: Medicare Part D, Part IV: Budget Neutrality and Congressional... Tune into the fourth episode of the Avalere Health Essential Voice miniseries focused on Medicare Pa... Sarah Butler 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 October 22, 2021 Federal Policy Video: Medicare Part D, Part V: What’s Next for CMMI? Tune into the fifth and final episode of the Avalere Health Essential Voice miniseries focused on Medicare Part D. In this segment, our experts discuss the Center for Medicare & Medicaid Innovation (CMMI) and its strategic direction for the coming year, particularly as it relates to the Part D program. Sarah Butler Ryan Urgo October 22, 2021 Federal Policy Podcast: Medicare Part D, Part V: What’s Next for CMMI? Tune into the fifth and final episode of the Avalere Health Essential Voice miniseries focused on Medicare Part D. In this segment, our experts discuss the Center for Medicare & Medicaid Innovation (CMMI) and its strategic direction for the coming year, particularly as it relates to the Part D program. Sarah Butler Ryan Urgo October 19, 2021 Federal Policy More Medicare Advantage Plans Will Offer Non-Medical Benefits in 2022 New analysis from Avalere finds that in 2022 more Medicare Advantage plans will offer non-medical supplemental benefits, such as meals, nutrition, transportation, and in-home support services, at a $0 premium. Thomas Kornfield Alessandra Fix Robin Duddy-Tenbrunsel Shruthi Donthi Brooke Fruman October 15, 2021 Federal Policy Video: Medicare Part D, Part IV: Budget Neutrality and Congressional Scoring Tune into the fourth episode of the Avalere Health Essential Voice miniseries focused on Medicare Part D. In this segment, our experts discuss key elements of the legislative process, including pay-fors, budget neutrality, and congressional scoring. Sarah Butler Ryan Urgo October 15, 2021 Federal Policy Podcast: Medicare Part D, Part IV: Budget Neutrality and Congressional Scoring Tune into the fourth episode of the Avalere Health Essential Voice miniseries focused on Medicare Part D. In this segment, our experts discuss key elements of the legislative process, including pay-fors, budget neutrality, and congressional scoring. Sarah Butler Ryan Urgo October 15, 2021 Federal Policy The Impact of ARPA Exchange Subsidies on Consumers Ages 50–64 Consumers ages 50–64 could see higher exchange premiums starting in 2023 without extension of ARPA subsidies. Massey Whorley Myra Simon Richard Hamilton October 7, 2021 Federal Policy Video: Medicare Part D, Part III: Impact of Policy Changes on Market Access Tune into the third episode of the Avalere Health Essential Voice miniseries focused on Medicare Part D. In this segment, our experts discuss policy changes currently under consideration and how stakeholders can prepare for the potential market access impacts. Ryan Urgo October 7, 2021 Federal Policy Podcast: Medicare Part D, Part III: Impact of Policy Changes on Market Access Tune into the third episode of the Avalere Health Essential Voice miniseries focused on Medicare Part D. In this segment, our experts discuss policy changes currently under consideration and how stakeholders can prepare for the potential market access impacts. Ryan Urgo October 5, 2021 Federal Policy Understanding the Seasonality of Part D Expenditures Under the OCM In the OCM, a total cost-of-care model, episode-level Part D expenditures include the amount the government pays for low income cost-sharing subsidy and reinsurance for beneficiaries who reach the catastrophic portion of the benefit once they have accumulated sufficient OOP costs. The latter leads to a seasonality effect in how Part D payments are captured in OCM episodes, which may have implications for how trends in OCM performance are assessed over time and how the OCM benchmark price is constructed. Shalini Parekh Madison Davidson Brook Getachew Lance Grady September 30, 2021 Federal Policy Video: Medicare Part D, Part II: Understanding Plan Decision-Making Tune into the second episode of the Avalere Health Essential Voice miniseries focused on Medicare Part D. In this segment, our Policy and Market Access experts discuss how health plans make decisions, particularly formulary decisions, in Part D, and how specific markets influence those decisions. Ryan Urgo September 30, 2021 Federal Policy Podcast: Medicare Part D, Part II: Understanding Plan Decision-Making Tune into the second episode of the Avalere Health Essential Voice miniseries focused on Medicare Part D. In this segment, our Policy and Market Access experts discuss how health plans make decisions, particularly formulary decisions, in Part D, and how specific markets influence those decisions. Ryan Urgo September 23, 2021 Federal Policy Podcast: Medicare Part D, Part I: Key Trends and Pressures Tune into the first episode of the Avalere Health Essential Voice miniseries focused on Medicare Part D. In this segment, our Policy and Market Access experts discuss Part D trends and pressures in the currently evolving drug pricing environment. Ryan Urgo September 23, 2021 Federal Policy Video: Medicare Part D, Part I: Key Trends and Pressures Tune into the first episode of the Avalere Health Essential Voice miniseries focused on Medicare Part D. In this segment, our Policy and Market Access experts discuss Part D trends and pressures in the currently evolving drug pricing environment. Ryan Urgo September 16, 2021 Federal Policy Part D Redesign Would Reduce OOP Costs Across Non-LIS Beneficiaries New Avalere analysis finds Part D redesign via PDPRA would reduce average OOP costs by 23% for non-LIS beneficiaries, especially for certain drug classes and beneficiary groups by race and reason for entitlement. Daniel Nam Rebecca Yip Shruthi Donthi September 14, 2021 Federal Policy Podcast: What’s Next for Health Policy on Capitol Hill? Tune into another episode of Avalere Health Essential Voice. In this segment, Avalere policy expert Matt Kazan discusses what he expects to see from a legislative perspective this fall on Capitol Hill. Elizabeth Carpenter Matt Kazan September 14, 2021 Federal Policy Video: What’s Next for Health Policy on Capitol Hill? Tune into another episode of Avalere Health Essential Voice. In this segment, Avalere policy expert Matt Kazan discusses what he expects to see from a legislative perspective this fall on Capitol Hill. Elizabeth Carpenter Matt Kazan September 10, 2021 Federal Policy Most Significant Healthcare Legislation Since ACA Possible this Fall As Congress considers the bipartisan infrastructure package and budget reconciliation agenda, the coming months are likely to include debate on what could be the most significant federal healthcare legislation in over a decade. Additionally, the Biden administration is expected to release several important healthcare rules this fall, including the details necessary to implement the new law banning surprise billing and regulations to protect and strengthen Medicaid and the Affordable Care Act (ACA). Anjali Chhatre Matt Kazan Myra Simon August 16, 2021 Federal Policy Ryan Urgo Joins Avalere Health as Managing Director Seasoned health policy professional brings significant expertise in federal legislation, drug pricing policy, delivery system reform, and federal and state programs that affect insurance coverage. Kelly Brantley June 29, 2021 Federal Policy Higher Gap Discount Payments for Employer Part D Plans Avalere’s analysis shows differences in payments between employer and non-employer Part D plans. Thomas Kornfield Shruthi Donthi Kelly Brantley June 29, 2021 Federal Policy 4 Reasons to Watch PCORI’s Evolving Role in Healthcare Decision-Making The Patient Centered Outcomes Research Institute (PCORI) recently announced an open comment period for a new set of proposed national priorities to inform its research agenda. Avalere analysis finds that from March 2019 to September 2020, PCORI directed roughly $259 million to comparative effectiveness research (CER) awards with an increasing share of new projects focused on drugs. 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