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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…
Online Tools to Synthesize Real-World Evidence of Comparative Effectiveness Research to Enhance Formulary Decision Making
This JMCP study describes and compares the features and characteristics of five tools to evaluate real-world evidence studies and adds clarity on what the tools provide.
Improving Transparency to Build Trust in Real-World Secondary Data Studies for Hypothesis Testing—Why, What, and How Recommendations and a Roadmap from the Real-World Evidence Transparency Initiative
A position paper by the RWE Transparency Initiative describes a plan for improving the transparency of the research process and making registration of real-world evidence study methods easier and…
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…
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…
Does a One Size Fits All Cost-Sharing Approach Incentivize Appropriate Medication Use?
Patients contribute to health care costs through out-of-pocket expenses, like copays and coinsurance. These cost-sharing mechanisms are intended to help payers manage costs and encourage more…
Does a One-Size-Fits-All Cost-Sharing Approach Incentivize Appropriate Medication Use? A Roundtable on the Fairness and Ethics Associated with Variable Cost Sharing
A study convened an expert roundtable of patient, payer, and employer representatives to review four case studies to understand when it would be more (or less) acceptable to require patients with the…
Got CER? Educating Pharmacists for Practice in the Future: New Tools for New Challenges
This study provides an early evaluation of the CER Collaborative's training program's impact on learners’ self-reported abilities to evaluate and incorporate comparative effectiveness research…
Standards and Guidelines for Observational Studies: Quality Is in the Eye of the Beholder
The lack of observational study standard/guideline agreement may contribute to variation in study conduct; disparities in what is considered credible research; and ultimately, what evidence is…
Developing Evidence that is Fit for Purpose: A Framework for Payer and Research Dialogue
A study published in the September 2015 issue of The American Journal of Managed Care introduces a framework developed by the National Pharmaceutical Council (NPC) and AcademyHealth that could help…
Three Perspectives on the Impact of Comparative Effectiveness Research on Decision Making
In a special supplement to the May 2012 Journal of Managed Care Pharmacy, National Pharmaceutical Council Chief Science Officer Robert W. Dubois, MD, PhD, takes a closer look at comparative…
Pharmaceutical Technology Assessment: Perspectives From Payers
The processes and evidence used in making pharmaceutical coverage decisions vary substantially among US health plan payers. These variations during the pharmaceutical technology assessment (PTA)…
Your Pharmacy Benefit: Make it Work for You!
The 16-page booklet offers advice for those with prescription drug coverage through an employer, union, or other group plans. Topics include Choose Your Plan, Use Your Plan, and More Options.