A recent study by the National Pharmaceutical Council (NPC) and Center for the Evaluation and Risk in Health at Tufts Medical Center found “significant variation” in how health plans use evidence in coverage decisions.
The study evaluated 1,562 policies from the 17 largest health plans in the U.S.
“Once we observed the inconsistency of coverage policies for specialty medicines, we wanted to explore what might be driving those variations,” NPC Vice President for Comparative Effectiveness Research Jennifer Graff said in a statement. “While we expected some variation in the evidence that plans report reviewing, the extent of variation in the volume, composition, and consistency of the cited evidence is notable and may be a key factor behind the inconsistent coverage that patients encounter.”
To read more, click here.