The frequency with which 7 of the largest Medicare Advantage plans impose step therapy protocols in their Part B drug coverage decisions varies substantially.
Study Results from Tufts Medical Center in the Area of Managed Care and Specialty Pharmacy Reported (Specialty Drug Coverage Varies Between Health Plans Medical and Pharmacy Benefit Policies): Drugs and Therapies - Managed Care and Specialty Pharmacy - Insurance News insurancenewsnet.com - get the latest breaking news, showbiz & celebrity photos, sport news & rumours, viral videos and top stories from insurancenewsnet.com Daily Mail and Mail on Sunday newspapers.
A study assessing factors that may determine a commercial health plan’s likelihood of covering a biosimilar found that biosimilars that are cancer therapies, used to treat children, indicated for highly prevalent conditions, or only competing against the originator were more likely to have coverage restrictions.
Coverage restrictions on biosimilars were observed in highly prevalent diseases but were less likely in biosimilars that generate an annual list price savings of more than $15,000 per patient.