This is the question asked in a new paper, which is done by Enryit, et al. (2025). The author uses Tufts Medical Center Specialty Drug Evidence and Coverage (Spec) database present by August 2023. The database includes publicly available pharmacy coverage decisions issued by 18 large American commercial health schemes, which a -Coldley -Cover 200 meters (ie,, 70%, US for more than 70% of the US for more than 70% of the US). The authors used 13,128 coverage decisions in the imagination database for 425 drugs to suit 919 drug-indication pairs.
The authors classified the evidence quoted in coverage policy decisions into 7 categories:
- Clinical or treatment guidelines,
- Systematic reviews and/or meta-analysis,
- Random controlled test (RCT)
- Other clinical studies,
- Evidence of real world (ie, studies related to the effectiveness of intervention made in a real -world setting),,
- Health Technology Assessment (HTA),
- Economic valuation
Overall, clinical evidence (eg, clinical guidelines, RCT) was most often quoted relative to HTA and other economic evidence.
Nevertheless, most American commercial payments (78.8%) considered the cost effective analysis (CEA) in their evaluation.
The most quoted HTA body evidence came from UK (30.7%), ICER (17.7%) in the US, and Canadian Drugs Agency (CDA) (CDA) (13.4%).
The writers convey their findings in this way:
Unlike other countries, where HTA bodies often play a determination role in the reach of the patient for drugs, American payers are not bound by such bodies, define the role of HTA in US decision making … Although the decision of coverage quotes HTA compared to other types of evidence, shows our untop the untop of HTA, mentioning American Commercial Health Plannings, in this way the HTA mentions the HTA, in which the HTA mentions the HTA on the Spirit. Can consider.
Why do commercial payers want HTA evidence?
HTAS, which are often released around the time of approval of a treatment, provide timely information for coverage decisions, especially for complex remedies and orphan drugs, for which the evidence available in the beginning may be limited (eg, relying on those studies that are not randomly or are small sample sizes … Although our own sample may be addressed. There may be a shortage of resources to do so.
You can read the entire study here.
