Health plans guide their enrollees' access to specialty drugs through coverage policies. We examined a set of health plan policies to determine if they have become more or less stringent over time. We did so by comparing the consistency of policies with Food and Drug Administration (FDA) label indications. We considered coverage policies for the same 187 specialty drugs issued by 17 large US commercial health plans from 2017 through 2021. Overall, the proportion of policies that were consistent with the FDA label declined from 57.1% in 2017 to 45.1% in 2021; the proportion of policies that were more restrictive than the FDA label increased from 39.5% to 51.7%. The proportion of policies excluding drug coverage remained approximately constant (3.4% in 2017; 3.2% in 2021). Trends in coverage restrictiveness varied across plans. For 13 plans, the proportion of policies with restrictions increased over time, while for 4 plans it declined.

Download full-text PDF

Source
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC10986192PMC
http://dx.doi.org/10.1093/haschl/qxad030DOI Listing

Publication Analysis

Top Keywords

proportion policies
16
specialty drugs
12
fda label
12
health plans
8
policies
8
coverage policies
8
2021 proportion
8
plans
5
commercial coverage
4
coverage specialty
4

Similar Publications

Want AI Summaries of new PubMed Abstracts delivered to your In-box?

Enter search terms and have AI summaries delivered each week - change queries or unsubscribe any time!