Exploring Payer Coverage Decisions Following FDA Novel Drug Approvals

In 2018, the FDA approved a record 66 novel drugs. Among them were cancer treatments, orphan drugs for rare diseases, drugs under expedited review, and biosimilars. However, access to each of these drugs for patients covered by different health plans was not uniform. On this episode of Managed Care Cast, we speak with Ari D. Panzer, BS, a master of public policy candidate at Duke University, and lead author of “Patients’ Access to 2018 FDA-Approved Drugs 1 Year Post Approval,” which was published in the April issue of The American Journal of Managed Care®. He delves into why it’s important to ensure patients receive optimal treatment and maximize their outcomes, understanding why health plans vary in their coverage decisions despite having access to the same evidence, and the difficulty of striking the right balance between drug access, cost, and coverage to ensure patients can get the drug therapies they require when appropriate.