Balancing Evidence and Need: Variation in US Commercial Payer Coverage of Esketamine.

Purpose: Variations in US commercial health plan coverage policies affect how patients access medications. Plans may vary in treatment access criteria, line of therapy, and prescriber requirements. In this study, we examined coverage of esketamine hydrochloride (Spravato) for major depressive disorder (MDD) and treatment-resistant depression (TRD) to answer the following question: how do US commercial health plans cover esketamine, and how do they guide prompt patient access to the drug?

Methods: We used information from the Tufts Medical Center Specialty Drug Evidence and Coverage database, which includes coverage policies issued by 18 large commercial health plans in the United States.

Using decision analysis to better evaluate pediatric clinical guidelines.

Although systematic and explicit, existing evidentiary criteria for clinical guidelines tend to use study design as a surrogate for evidence quality. Moreover, they do not independently characterize evidence quality and net benefits and do not systematically evaluate research needs. Decision analysis, which quantifies the range of potential net benefits based on whatever evidence is available, can augment traditional frameworks.