Specialty drug coverage and reimbursement is highly variable across 17 of the country’s largest health insurers, according to a study published in Health Affairs, with only 15.9 percent of policies consistent across commercial plans.
The study was conducted by the National Pharmaceutical Council and the Center for Evaluation of Value and Risk in Health at Tufts Medical Center.
Researchers analyzed payers’ specialty drug coverage decisions in a bid to see variations in payers’s specialty drug coverage decisions and consistency with Food and Drug Administration-approved indications.
Less than half of the coverage decisions made, according to a Specialty Pharmacy Times report, were consistent across a majority of the health care plans.
“Variation in coverage may substantially influence patient access to specialty medicines,” National Pharmaceutical Council Vice President of Comparative Effectiveness Research Jennifer Grtaff, the study’s author, said in a statement. “For patients switching between insurers or employers, differences in plans’ coverage decisions may result in care disruptions.”
To read the full report on Specialty Pharmacy Times, click here.