Rising Drug Costs Drives the Growth of Pharmacy Benefit Managers Exclusion Lists: Are Exclusion Decisions Value-Based?

ABSTRACT:

Objective

We examine whether drugs' excluded versus recommended status on pharmacy benefit manager exclusion lists corresponds to evidence from cost-effectiveness analyses, lack of evidence, or rebates.

Data sources

To find cost-effectiveness data for drugs on 2016 exclusion lists of CVS Caremark and Express Scripts, we searched the Tufts Cost-Effectiveness Analysis Registry and the peer-reviewed literature.

Study design

For each excluded and recommended drug, we compared the mean cost-per-QALY, and we calculated the difference between the numbers of excluded and recommended drugs for which we could find no cost-effectiveness evidence.

Data collection

As keywords in our searches, we used the brand and generic drug name and "cost-effectiveness" and "cost-per-qua

SUBMITTER: Cohen JP 

PROVIDER: S-EPMC6056588 | biostudies-literature | 2018 Aug

REPOSITORIES: biostudies-literature