Newly Final CMS Policy May Help Plans When Evidence For Coverage Is Lacking

Abstract

THE EMERGENCE OF A BIOLOGIC THERAPY OFTEN PRESENTS INSURERS WITH A DILEMMA: how to establish coverage policies when evidence of effectiveness and published guidelines could be years away? Medicare's new policy may provide some guidance, but its application is controversial.

The time when health plans could “sit back and wait for evidence to accrue [and] ponder it” is gone, Steven Pearson, MD, senior fellow for America’s Health Insurance Plans, says of the rapid emergence of biologic therapies. PHOTOGRAPH BY ROB CRANDALL