New Drugs: To Cover or Not to Cover...That is the Question
Posted: Sep 15 2015

The good news in prescription healthcare is that there are a lot of new medications entering the market that are having a positive impact in treating disease. A great example of this is Sovaldi, hyped in the news because it can cure Hepatitis C, but it comes with a very hefty price tag. Because of cost, it is critical to make sure you have the right clinical criteria in place for approval. Not all patients need it and may never need it in their lifetime. Because of cost, it is important to know when all the clinical criteria is in place to approve the medication. It’s about getting the right medication to the right patient at the right time!


Like Harvoni, many of the new drugs in the 2015 and 2016 pipeline are expensive. Some are orphan drugs (impacting less than 200,000 people) and specialty drugs (requiring special administration or distribution). The small population, distribution and route of administration for these drives up cost.

Others, like some of the new cholesterol drugs, such as the PCSK9 inhibitors, that have been introduced (Praluent, Sanofi, etc) are entering a very competitive marketplace with several lower cost alternatives that work very well in treating cholesterol.

Typically, there is a lot of excitement and enthusiasm from prescribers and patients when new drugs are released. For this reason, it is important to have a thorough evaluation criteria established prior to approval so you aren’t approving medications that have alternatives that work just as well, only at a much higher price. MedTrak controls this through our 90 Day Drug Review Policy for all new drugs. This policy makes sure that we have the appropriate clinical criteria in place before approving these medications and incurring unexpected costs to your plan. To see our policy, click here.

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