New Drug Treatments Drive Increased Utilization Review
This article highlights an initiative to create an evidence-based approach to evaluating the myriad of new medical devices and drugs that are hitting the market, and which are difficult for health care payers to track and evaluate for coverage. This makes good sense. With the exponential growth in new drug therapies, it's getting harder for payers to stay on top of what should be covered and what should not at the macro level. This is particularly important in light of the cost of many new drug regimens, and the need to control over-utilization. At the micro level, it means that more payers (including PBMs) are seeking outside help from IROs in order to make medically necessity determinations, develop drug formularies, and to handle member appeals when specific drugs or devices are denied.
FDA news Drug Daily Bulletin April 14, 2008 | Vol. 5 No. 73
A bill establishing a comparative-effectiveness research institute is scheduled for introduction in the Senate this week, congressional staffers say.
The Comparative Effectiveness Research Act of 2008, sponsored by Sens. Kent Conrad (D-N.D.) and Max Baucus (D-Mont.), would establish an institute to evaluate the effectiveness of different drugs and medical devices that exist for the same treatment.
The creation of such an organization was the subject of a public meeting held last week by the Medicare Payment Advisory Commission (MedPAC), an independent agency that advises Congress on issues affecting Medicare. The group supports a comparative-effectiveness program and recommends that Congress establish an independent entity to sponsor and disseminate such information. The entity would conduct prospective, head-to-head clinical trials of competing products as well as clinical reviews.
