Showing 27 Results
Commercial coverage of specialty drugs, 2017–2021
New study examines the role of NIH and industry in bringing new treatments into clinical settings.
Impact of Shared Decision-Making and Patient Decision Aids on Health Care Cost and Utilization in the US: A Systematic Review
Shared decision-making and patient decision aids may reduce costs or improve utilization but not consistently across settings and diseases, according to a new systemic literature review by…
Characterizing Health Plan Evidence Review Practices
The study finds that some plans updated the evidence in their coverage policies for specialty medicines more often than others, and the type of evidence plans cited in their coverage policies…
Predictors of Adherence to Oral Anticancer Medications: An Analysis of 2010-2018 U.S. Nationwide Claims
Low-income Medicare patients who face high out-of-pocket costs are less likely to remain adherent to oral anticancer medications. This research shows the need for strategies to address adherence and…
Impact of Real-Time Benefit Tools on Patients’ Access to Medications: A Retrospective Cohort Study
Study finds the use of Real-Time Prescription Benefit Tools results in higher fill rates and lower cancellation rates.
Health Care Spending Effectiveness: Estimates Suggest that Spending Improved U.S. Health from 1996 to 2016
This research assessed the effectiveness of U.S. health care spending by comparing changes in health outcomes and found that, overall, innovations in health care are creating more cost-effective care…
Specialty Drug and Healthcare Utilization Vary by Wage Level in Employer-Sponsored Health Plans
This research shows that low-wage employees are less likely use autoimmune medicines than employees who earn more despite a higher prevalence of autoimmune conditions in low-wage employees. These…
Health Care Spending Guiding Principles
NPC established a set of principles to assess health care spending estimates and policies to ensure alignment with the goals of patient-centered care.
The Patient’s Medication Access Journey: A Conceptual Framework Focused Beyond Adherence
The Pharmacy Quality Alliance, with support from NPC, developed a framework that defines a patient’s medication access journey and characterizes barriers frequently encountered while seeking…
Limited Role of Patient Input in Specialty Drug Coverage Policies
A new study in JMCP found that patient input is rarely sought for coverage policies – although plans had processes to engage physicians and medical societies when developing coverage policies, no…
Affordability Is About More Than Drug Prices
A research survey from NPC and Xcenda found that potential government involvement in drug pricing would be unlikely to increase patient affordability.
The Dollar or Disease Burden: Caps on Healthcare Spending May Save Money, but at What “Cost” to Patients?
This study assessed the potential effects of budget caps design on disease burden and cost savings to help budget decision makers understand which budget cap features minimize impact to patient…
Stakeholders Find Step Therapy Should Be Evidence-Based, Flexible and Transparent: Assessing Appropriateness Using a Consensus Approach
Stakeholders disagree on when step therapy is appropriate, but agree on a set of criteria about how to develop, implement, communicate, safeguard and evaluate step therapy protocols.
Little Consistency in Evidence Cited by Commercial Health Plans for Specialty Drug Coverage
Evidence cited by payers in coverage decisions for specialty medicines varies significantly, with health plans only citing the same study in 15% of health plan coverage policies for a given drug and…
What's Been the Bang for the Buck? Cost-Effectiveness of Health Care Spending Across Selected Conditions in the US
This study was designed to assess whether increased medical intervention spending on prevalent chronic conditions has been a good investment over time.
Prioritizing Health Care Spending: Engaging Employees in Health Care Benefit Design
A case study shows that employees who are who are meaningfully engaged in deliberating and designing their health care benefits may have a more positive view of their coverage options.
Study of U.S. Commercial Health Plans Shows Widespread Variation in Coverage and Reimbursement for Specialty Medicines
Research published in Health Affairs shows that insurance coverage and reimbursement for specialty medications varies substantially, finding that only 15.9% of drug coverage policies were consistent…
Financial Impact of HSA-HDHP Reform to Improve Access to Chronic Disease Management Medications
According to an issue brief from VBID Health, providing pre-deductible coverage for medicines used to treat common chronic conditions could lower out-of-pocket costs and increase medication adherence…
A Comparison of Coverage Restrictions for Biopharmaceuticals and Medical Procedures
Payer evaluation and coverage of pharmaceuticals and medical procedures may differ independent of their clinical benefit. Therapy access depends on factor other than cost and clinical benefit,…
Toward Better Value
There is a disconnect between the important role employers believe their pharmacy benefit managers (PBMs) play in helping to manage prescription drug benefits and employers’ perceptions of the…