Patients' access to 2018 FDA-approved drugs 1 year post approval.
| Autor: | Panzer AD; Center for the Evaluation of Value and Risk in Health, Institute for Clinical Research and Health Policy Studies, Tufts Medical Center, 800 Washington St #63, Boston, MA 02111. Email: apanzer@tuftsmedicalcenter.org., Margaretos NM, Bridger N, Osani MC, Lai RC, Chambers JD |
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| Jazyk: | angličtina |
| Zdroj: | The American journal of managed care [Am J Manag Care] 2022 Apr 01; Vol. 28 (4), pp. e153-e156. Date of Electronic Publication: 2022 Apr 01. |
| DOI: | 10.37765/ajmc.2022.88869 |
| Abstrakt: | Objectives: To examine US commercial health plans' adoption of 2018 FDA-approved drugs. Study Design: Database analysis. Methods: We identified novel drugs that the FDA approved in 2018 and categorized them as follows: cancer treatment, orphan drug, included in an expedited review program, and biosimilar. Using a data set of 17 large health plans' drug coverage policies and formularies, we examined coverage 1 year following FDA approval. Results: The FDA approved 66 drugs in 2018 (5 were not yet marketed 1 year following approval). For 60 of 61 drugs, some plans issued coverage policies whereas other plans included the drug in their formularies. Plans imposed restrictions (eg, step therapy) in 37% (275/742) of coverage policies. Plans covered biosimilars, orphan drugs, and cancer treatments more generously than drugs not in those categories (P < .05). Plans imposed restrictions in their policies with different frequencies (range, 7%-52%). Plans imposed utilization management (UM) in 82% (3837/4697) of formulary entries. Of those entries, plans required prior authorizations in 98%, included drugs on the highest patient co-payment tier in 70%, and imposed step therapy in 3%. Plans most often placed orphan drugs and cancer treatments on the highest cost-sharing formulary tiers (68% and 64% of the time, respectively). Plans imposed UM in their formularies with different frequencies (range, 62%-100% of entries). Conclusions: Health plans imposed fewer coverage restrictions on cancer treatments, orphan drugs, and biosimilars than on drugs not in those categories. Some plans covered 2018 FDA-approved drugs more generously than others, which has implications for patients' access to innovative therapies. |
| Databáze: | MEDLINE |
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