Specialty drug coverage varies between health plans’ medical and pharmacy benefit policies

Health plans can cover drugs under their medical and/or pharmacy benefits. When plans have medical and pharmacy policies for the same drug, they are the same most of the time. However, 14% of the time, a plan’s medical and pharmacy policies for the same drug are different, usually because of differe...

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Bibliographic Details
Published in:Journal of managed care & specialty pharmacy 2023-06, Vol.29 (6), p.607-613
Main Authors: Levine, A. Alex, Panzer, Ari D, Kauf, Teresa L, O’Sullivan, Amy K, Strand, Lauren, Chambers, James D
Format: Article
Language:English
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Summary:Health plans can cover drugs under their medical and/or pharmacy benefits. When plans have medical and pharmacy policies for the same drug, they are the same most of the time. However, 14% of the time, a plan’s medical and pharmacy policies for the same drug are different, usually because of different treatments that patients must try before getting the drug. Inconsistent coverage policies may hinder patients’ access to specialty drugs.
ISSN:2376-0540
2376-1032
DOI:10.18553/jmcp.2023.29.6.607