US COMMERCIAL HEALTH PLANS CITE INTERNATIONAL HEALTH TECHNOLOGY ASSESSMENTS IN THEIR SPECIALTY DRUG COVERAGE DECISIONS WITH DIFFERENT FREQUENCIES
Author(s)
Shah V1, Chambers J2, Panzer A2, Margaretos N2
1University of Manchester, London, UK, 2Tufts Medical Center, Boston, MA, USA
Presentation Documents
OBJECTIVES : Unlike most high-income countries, the US lacks a centralized health technology assessment (HTA) agency, and historically HTA has played a relatively limited role in US health care. While health plans perform their own assessments when developing coverage policies for medical technologies, it is unclear how often they rely on externally developed health technology assessments when formulating their decisions. In this study we examine the frequency that the largest commercial health plans cite HTAs produced by US and ex-US organizations in their specialty drug coverage decisions. METHODS : We used the Tufts Medical Center Specialty Drug Evidence and Coverage (SPEC) Database to determine the frequency that 17 of the largest US commercial health plans cite assessments produced by US and ex-US HTA agencies in their specialty drug coverage decisions. We compared the frequency that plans cited HTAs, relative to other evidence categories, in their coverage decisions. We also examined the frequency that plans cited HTAs produced by agencies outside of the US. RESULTS : We found that HTAs comprised a larger percentage of the evidence cited by some plans than others, ranging from less than 1% to 18% of cited evidence. Health plans cited HTAs produced by organizations located in 12 countries. The majority of cited HTAs were performed by organizations in countries other than the US (74% vs 26%). 51% performed by European HTA organizations, including the National Institute for Health and Care Excellence, and 20% by the Canadian Agency for Drugs and Technologies in Health. CONCLUSIONS : US commercial health plans cite HTAs in their specialty drug coverage decisions with different frequencies. Study findings suggest a demand among US commercial health plans for information produced by HTA agencies, including information from HTA organizations based outside the US, although this demand varied across plans.
Conference/Value in Health Info
2019-05, ISPOR 2019, New Orleans, LA, USA
Value in Health, Volume 22, Issue S1 (2019 May)
Acceptance Code
RE4
Topic
Health Policy & Regulatory
Topic Subcategory
Reimbursement & Access Policy
Disease
No Specific Disease