Little Consistency In Evidence Cited By Commercial Plans For Specialty Drug Coverage

James D Chambers; Ari D Panzer; Elle F Pope; Jennifer S Graff; Peter J Neumann

doi:10.1377/hlthaff.2019.00201

Little Consistency In Evidence Cited By Commercial Plans For Specialty Drug Coverage

Health Aff (Millwood). 2019 Nov;38(11):1882-1886. doi: 10.1377/hlthaff.2019.00201.

Authors

James D Chambers¹, Ari D Panzer², Elle F Pope³, Jennifer S Graff⁴, Peter J Neumann⁵

Affiliations

¹ James D. Chambers ( jchambers@tuftsmedicalcenter. org ) is an investigator in the Center for the Evaluation of Value and Risk in Health, Tufts Medical Center, and an associate professor of medicine in the School of Medicine, Tufts University, both in Boston, Massachusetts.
² Ari D. Panzer is a research assistant in the Center for the Evaluation of Value and Risk in Health, Tufts Medical Center.
³ Elle F. Pope is a graduate student at the University of Maryland School of Public Health, in College Park. She was a research associate in the Center for the Evaluation of Value and Risk in Health, Tufts Medical Center, when the majority of this research was conducted.
⁴ Jennifer S. Graff is vice president of comparative effectiveness research at the National Pharmaceutical Council, in Washington, D.C.
⁵ Peter J. Neumann is director of the Center for the Evaluation of Value and Risk in Health, Tufts Medical Center, and a professor of medicine in the School of Medicine, Tufts University.

PMID: 31682500
DOI: 10.1377/hlthaff.2019.00201

Abstract

We found wide variation in the evidence that US commercial health plans reported reviewing in their specialty drug coverage policies. There was little consistency in the numbers or types of studies cited by health plans. On average, only 15 percent of health plans' coverage policies cited the same study evaluating a specific drug for a specific indication.

Keywords: Access to care; Clinical research; Drug coverage; Evidence-based medicine; Formularies; Health policy; Pharmaceuticals; Specialty drugs; private health insurance.

Publication types

Research Support, Non-U.S. Gov't

MeSH terms

Drug Costs*
Insurance Coverage / economics*
Insurance, Pharmaceutical Services*
Organizational Policy*
Research
United States