Cornerstones of ‘fair’ drug coverage: appropriate cost sharing and utilization management policies for pharmaceuticals

Summary

Ethical tension between maximizing the freedom of patients and clinicians to tailor care for the individual and the need to make healthcare affordable lies at the heart of health insurance programs.

This White Paper, authored by individuals affiliated with the Institute for Clinical and Economic Review (MA, USA) and the Office of Health Economics (London, UK), focuses on three areas over which there is the most controversy about how to judge whether drug coverage is appropriate: cost-sharing provisions, clinical eligibility criteria, and economic-step therapy and required switching.