A study published in the July issue of Health Affairs reveals highly-variable coverage and reimbursement decisions for specialty treatments. The study reportedly found only 15.9 percent of coverage policies for specialty therapies across the largest commercial health plans are consistent.
Furthermore, the study, which was conducted by the National Pharmaceutical Council (NPC) and the Center for the Evaluation of Value and Risk in Health, Tufts Medical Center, found less than half of all coverage decisions are hold consistent across most health plans.
“Beyond approval from the FDA health plans determine whether or not new treatments will be covered,” Tuft Medical Center’s James Chambers, the study’s lead author, said. “We found that even if a drug was covered, many treatments had multiple restrictions prior to patients being able to access these medications.”
To read more about the study on NPC’s website, click here.