Payers OK-ish with orphan drug prices
New data suggests payers are not generally not balking at the high price of orphan medications. The Wall Street Journal reports that a survey of 34 insurers found that what was described as “robust” clinical effectiveness data and what is already on the market (or not) are key in a payer's decision to cover an orphan drug, and the percentage of insurers who expect to change their access rules is shrinking.
The Journal notes that last year 30% of payers expected stricter policies by 2016, compared to just 17% who now expect a change to go into effect in two years.
Data from CB Partners shows that payer coverage still includes patient participation. The healthcare consultancy has found co-insurance has jumped from 15% to 28% over the last 10 years, and that insurers have increased its use of prior authorization requirements.