Characterizing health plan evidence review practices

Clinical and economic evidence should guide health plans’ drug coverage policies. We reviewed the citations of clinical and economic evidence plans included in their drug coverage policies between August 2017 and August 2019. When plans revised their drug coverage criteria, they also tended to updat...

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Bibliographic Details
Published in:Journal of managed care & specialty pharmacy 2022-09, Vol.28 (9), p.1053-1058
Main Authors: Panzer, Ari D, Enright, Daniel E, Graff, Jen, Chambers, James D
Format: Article
Language:English
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Research Brief
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Summary:Clinical and economic evidence should guide health plans’ drug coverage policies. We reviewed the citations of clinical and economic evidence plans included in their drug coverage policies between August 2017 and August 2019. When plans revised their drug coverage criteria, they also tended to update the cited evidence. This finding suggests, albeit indirectly, that clinical and economic evidence informs plans’ decisions, and that plans may adjust their drug coverage criteria in response to new evidence.
ISSN:2376-0540
2376-1032
DOI:10.18553/jmcp.2022.28.9.1053