- Center on Health Equity & Access
- Clinical
- Health Care Cost
- Health Care Delivery
- Insurance
- Policy
- Technology
- Value-Based Care
Segment 3 - Justifying Costs: A Request for More Evidence
Payers are often hesitant to cover more expensive, newly approved therapies. Many want to base their formulary decisions on evidence, which in many cases is limited. Richard Joseph, MD, describes this as “a difficult dilemma,” adding that “Trying to get an evidence for each scenario is a really challenging thing.”
Collecting evidence can be costly and may not provide more insight into justifying a therapy’s use, and cost, than a provider’s expert opinion. Still, care and coverage are often dictated by an individual’s form of insurance. Ideally, as data on new therapies and their costs accumulate, coverage and reimbursement considerations will align more and more closely with the evidence
Watch our related Peer Exchange, Oncology Stakeholder Summit 2014: Evidence-Based Decisions to Improve Quality and Regulate Costs
Exploring Racial, Ethnic Disparities in Cancer Care Prior Authorization Decisions
October 24th 2024On this episode of Managed Care Cast, we're talking with the author of a study published in the October 2024 issue of The American Journal of Managed Care® that explored prior authorization decisions in cancer care by race and ethnicity for commercially insured patients.
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