Availability of Cost-effectiveness Studies for Drugs With High Medicare Part D Expenditures

Payers worldwide have implemented Cost-Effectiveness Analysis (CEA) requirements for reimbursed prescription drugs since the 1980s. It has remained a steadfast and efficient tool in comparing clinical value and allocating scarce resources.

This new article via JAMA explores the availability of CEA for drug coverage decisions-making in the United States.

Researchers found that almost half of expensive drugs covered under the U.S. Medicare Part D program lacked cost-effectiveness data.

In this cross-sectional study examining 250 drugs with the greatest Medicare Part D spending in 2016, cost-effectiveness analyses were unavailable for 46%. These products represent nearly $50 billion or a third of Medicare Part D costs in 2016. For the other half that did have studies, many did not "meet minimum quality standards."

This lack of cost-effective data in combination with its growing application to real-word decision-making poses a serious threat for access to today’s innovative treatments.