Insurers' strategies for managing the use and cost of biopharmaceuticals

Abstract

This paper examines strategies under development by health insurers to manage biopharmaceuticals, as their use spreads beyond rare diseases and academic sub-specialists to common conditions and community-based practices. Emphasis is placed on medical management (formulary placement and prior authorization), network design (physician contracting and drug distribution), and benefit design (coinsurance and annual payment limits). Contemporary initiatives are modest in ambition but potentially lay the foundation for a framework that balances access to innovation with affordability in this dynamic industry.