Health plan formularies lowered barriers to fair access to some drugs, analysis finds

Most of the formularies run by some of the largest health plans in the U.S. generally provide “fair access” to 18 treatments for a handful of serious diseases, although transparent coverage information is often lacking for some medicines, a new analysis has found.

Almost uniformly, the 19 formularies made the medicines available fairly when judged on three criteria: eligibility based on clinical data, restrictions placed on prescribers, and step therapy, which requires patients to try other medicines before an insurer will approve a prescription. The formularies are run by health plans, pharmacy benefit managers, and the U.S. Department of Veterans Affairs.

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