A Roadmap for Improving Medicare's Application of Coverage With Evidence Development.

Autor: Lakdawalla D; USC Schaeffer Center, University of Southern California, Los Angeles, CA, USA., Tunis S; Rubix Health, Baltimore, MD, USA., Neumann P; Center for the Evaluation of Value and Risk at the Institute for Clinical Research and Health Policy Studies, Tufts Medical Center, Boston, MA, USA., Whicher D; Mathematica, Washington, DC, USA., Zeitler E; Department of Medicine and the Dartmouth Institute, Dartmouth Geisel School of Medicine, Hanover, NH, USA., Liden B; USC Schaeffer Center, University of Southern California, Washington, DC, USA. Electronic address: bliden@usc.edu.
Jazyk: angličtina
Zdroj: Value in health : the journal of the International Society for Pharmacoeconomics and Outcomes Research [Value Health] 2024 Sep; Vol. 27 (9), pp. 1191-1195. Date of Electronic Publication: 2024 May 23.
DOI: 10.1016/j.jval.2024.05.008
Abstrakt: The Centers for Medicare and Medicaid Services' coverage with evidence development (CED) policy allows the agency to provide coverage for an item or service through a National Coverage Determination (NCD), conditional upon an agreement to collect evidence designed to address specific questions or uncertainties. The goals of this policy are to expedite beneficiary access to new items and services and to generate additional evidence on the impact of these items or services for Medicare beneficiaries. However, these goals have not been fully realized because of several issues with the way the policy has been implemented, including (1) a lack of clear criteria for when CED will be applied, (2) examples of CED data collection activities placing unnecessary burdens on clinicians and the potential for undue inducement on beneficiaries, and (3) a lack of clarity around the process and timeline for reconsidering and ending CED requirements. Additionally, there are cases in which the application of CED has failed to improve access to services for certain Medicare beneficiaries because no data collection activity was implemented in response to the CED requirement or because the NCD only allows the technology to be provided and studied in certain centers of excellence. We describe a roadmap for addressing these issues, which includes, for example, developing a framework to guide the application of coverage constraints in NCDs with CED requirements. Once these issues are addressed, the Centers for Medicare and Medicaid Services could consider expanding the use of CED to technologies that are not subject to NCDs.
Competing Interests: Author Disclosures Author disclosure forms can be accessed below in the Supplemental Material section.
(Copyright © 2024. Published by Elsevier Inc.)
Databáze: MEDLINE
Externí odkaz: