Reports from Tufts Medical Center Highlight Recent Findings in Health and Society (Variation In Use and Content of Prescription Drug Step Therapy Protocols, Within and Across Health Plans): Health and Medicine – Health and Society

2022 JAN 04 (NewsRx) -- By a News Reporter-Staff News Editor at Insurance Daily News -- New research on Health and Medicine - Health and Society is the subject of a report. According to news reporting from Boston, Massachusetts, by NewsRx journalists, research stated, “Insurers limit the use of certain prescription drugs by requiring step therapy-that is, by allowing access only after alternatives have been tried and have failed. Using data from seventeen of the largest US commercial health plans, we examined step therapy protocols that determined patients’ eligibility for specialty drugs and identified ten diseases that are often subject to that requirement.”

Financial support for this research came from Genentech.

The news correspondents obtained a quote from the research from Tufts Medical Center, “Overall, plans applied step therapy in 38.9 percent of drug coverage policies, with varying frequency across plans (20.6-57.5 percent). Of the protocols for the ten diseases, 34.0 percent were consistent with corresponding clinical guidelines, 55.6 percent were more stringent, and 6.1 percent were less stringent. Trials of alternatives not included in the clinical guidelines were required in 4.2 percent of protocols, and the consistency of protocols varied within and across plans. These findings raise questions about potentially overly restrictive step therapy protocols, as well as concerns that variability across health plans makes protocols onerous for patients and practitioners alike.”

According to the news reporters, the research concluded: “The findings thus suggest the need for state and federal legislative initiatives to help ensure appropriate prescription drug use.”

This research has been peer-reviewed.

For more information on this research see: Variation In Use and Content of Prescription Drug Step Therapy Protocols, Within and Across Health Plans. Health Affairs, 2021;40(11):1749-1757. Health Affairs can be contacted at: Project Hope, 7500 Old Georgetown Rd, Ste 600, Bethesda, MD 20814-6133, USA.

Our news journalists report that additional information may be obtained by contacting James D. Chambers, Tufts Medical Center, Center for the Evaluation of Value and Risk in Health, Boston, MA 02111, United States. Additional authors for this research include Kelly L. Lenahan, Donald E. Nichols and Rebecca M. Gertler.

The direct object identifier (DOI) for that additional information is: https://doi.org/10.1377/hlthaff.2021.00822. This DOI is a link to an online electronic document that is either free or for purchase, and can be your direct source for a journal article and its citation.

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