Examining Variation in Orphan Drug Coverage Among Commercial Plans

This month’s issue of The American Journal of Managed Care^® took a look at differences in coverage of orphan and nonorphan drugs to get insight into variation in orphan drug coverage across the largest commercial plans in the United States. The study, Variation in US Private Health Plans’ Coverage of Orphan Drugs, analyzed a data set of private health plan coverage decisions for specialty drugs in 3 ways and found that health plans restrict access to orphan drugs about one-third of the time and that restrictions vary across plans.

To get more insight into the findings, and the reasons behind these trends, we sat down with James Chambers, PhD, associate professor of medicine at Tufts Medical Center Institute for Clinical Research and Health Policy Studies.

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