Healthcare Economist March 10, 2025
That is the question asked in a new paper by Enright, et al. (2025). The authors use the Tufts Medical Center Specialty Drug Evidence and Coverage (SPEC) database current as of August 2023. This database contains publicly available specialty pharmacy coverage decisions as issued by 18 large US commercial health plans, which—collectively—cover 200m people (i.e., 70% of US commercially insured lives). The authors used 13,128 coverage decisions in the SPEC database across for 425 drugs, corresponding to 919 drug-indication pairs.
The authors categorized the evidence cited in the coverage policy decisions into 7 categories:
- Clinical or treatment guidelines,
- Systematic review and/or meta-analyses,
- Randomized controlled trials (RCTs)
- Other clinical studies,
- Real-world evidence (ie, studies related to the effectiveness
of an intervention...
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