Cutting coverage for experimental drugs
Case Management Weekly, September 25, 2007
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According to The Wall Street Journal, health insurers are limiting coverage of high cost specialty drugs in an effort to control healthcare expenses. Insurance officials explain that specialty drugs cost thousands of dollars for a relatively small portion of the population, and the New Jersey consulting firm, Health Strategies Group, reports these drugs accounted for one-quarter of the total drug spending in the U.S.
Insurers maintain they must control healthcare costs due to inflation, and therefore, they will only cover drugs the FDA has specifically approved as treatments or for which there is extensive clinical testing. The Journal also reports that insurers do not have leverage when it comes to negotiating the prices of specialty drugs because they often extend lives and have little competition. Many doctors, particularly oncologists, rely on the use of specialty drugs when other medications fail to treat patients.
Source: The Wall Street Journal
Other articles of interest:Drug utilization still growing, though price increases moderate
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