James D. Chambers, PhD

The frequency with which 7 of the largest Medicare Advantage plans impose step therapy protocols in their Part B drug coverage decisions varies substantially.

2018 was a landmark year for new drug approvals. However, patients’ access to these novel drugs varied by drug category and enrolled health plan.

Health plans restrict orphan drug coverage less often than nonorphan drug coverage. However, the frequency of restrictions varies considerably across plans.

The authors examine the largest 20 US commercial payers’ coverage policies and identify variation in how interventions are covered and the evidence reviewed in them.

The authors review empirical evaluations of drug exclusion policies to examine their impact on patients and on healthcare costs.