Use of Health Technology Assessments in Specialty Drug Coverage Decisions by US Commercial Health Plans
Overview
Affiliations
Background: Health technology assessment (HTA) involves a formal review of the clinical, economic, and societal implications of health technologies. Internationally, HTA supports decisions regarding access to novel therapeutics. However, the role of HTA in the decision-making processes of US-based health care payers remains unclear.
Objective: To assess how frequently US commercial health plans reference HTAs in their specialty drug coverage policies.
Methods: Using the Tufts Medical Center Specialty Drug Evidence and Coverage database, we reviewed the evidence cited in the publicly available specialty drug coverage policies of 17 US commercial health plans. We assessed the frequency of HTA citations and characterized them by (1) country of origin, (2) publishing organization, (3) whether it addressed a treatment's cost-effectiveness, (4) disease category addressed, and (5) whether it assessed orphan or nonorphan treatments.
Results: HTAs accounted for 450 of the 14,033 citations in our analysis (3.2%), with the frequency of HTA citations varying across health plans (0.1% to 7.4% of cited evidence). Ex-US HTAs were cited more frequently than US-based HTAs (65.3%). However, a single health plan accounted for the majority of HTA citations (57.1%) and ex-US citations (76.2%). Most cited HTAs included cost-effectiveness assessments (78.7%). The 3 disease categories for which plans most often cited HTAs were neurological disorders (24.8%), musculoskeletal disorders (21.5%), and cancers (14.6%). Health plans cited HTAs for nonorphan drugs more often than for orphan drugs (59.4%).
Conclusions: HTAs represented a small portion of the evidence cited by health plans in specialty drug coverage decisions, with significant variation in citation frequency across plans. Plans cited both US and ex-US HTAs, and most cited HTAs included a cost-effectiveness assessment. These findings suggest that health plans may consider the information provided by HTAs when formulating coverage policies.