Federal and state policy

Avalere Health helped a pharmaceutical client assess how Inflation Reduction Act-driven Part D reforms would affect net plan liability for five target drugs relative to competitors across major Part D sponsors and plan types. Using Part D claims data, we modeled pre- and post-IRA stakeholder costs under various maximum fair price scenarios and mapped out strategic responses. The analysis informed the client’s Part D plan engagement, contracting strategy, and pricing and policy considerations needed to thrive in a post-IRA world.

A client sought Avalere Health’s assistance in estimating the effects of rolling back or altering Medicaid expansion in states that expanded Medicaid eligibility under the ACA. Utilizing CMS enrollment data and the American Community Survey, we enabled the client to quantify the number of individuals who would likely lose Medicaid coverage if states revert to pre-Affordable Care Act coverage levels and developing an interactive dashboard to view findings.

A biotech client sought to understand potential challenges to commercializing both mono and combination therapy regimens, and the associated impacts on average sales price and Medicaid Best Price. Avalere Health provided a landscape assessment of reimbursement dynamics, a model of how combination and indication-specific regimens might be utilized by a patient, and an assessment of potential strategies and key considerations for optimal commercialization of a combination therapy.