Segment 3 - Justifying Costs: A Request for More Evidence

Payers are often hesitant to cover more expensive, newly approved therapies. Many want to base their formulary decisions on evidence, which in many cases is limited. Richard Joseph, MD, describes this as “a difficult dilemma,” adding that “Trying to get an evidence for each scenario is a really challenging thing.”

Collecting evidence can be costly and may not provide more insight into justifying a therapy’s use, and cost, than a provider’s expert opinion. Still, care and coverage are often dictated by an individual’s form of insurance. Ideally, as data on new therapies and their costs accumulate, coverage and reimbursement considerations will align more and more closely with the evidence

Watch our related Peer Exchange, Oncology Stakeholder Summit 2014: Evidence-Based Decisions to Improve Quality and Regulate Costs