AJMC October 18, 2024
Key Takeaways
- Utilization management practices, including prior authorization, significantly impact patient access to specialty drugs, with variations across health plans.
- Legislative actions, such as step therapy limitations and “gold carding,” aim to balance cost management with patient access to specialty medications.
- Value-based and outcome-based contracts align spending with clinical outcomes, but face challenges like finding appropriate outcome measures and addressing off-label use.
- Stakeholders emphasize the need for reform in utilization management, focusing on transparency, continuity of care, and provider input flexibility.
Industry experts explore the trends, variations, and implications of utilization management practices in specialty drug coverage.
The landscape of specialty drug coverage is complex and ever-evolving, with health care providers and payers facing a range of challenges....
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