When a new drug enters the U.S. drug market, there can be enthusiasm among prescribers and patients to begin prescribing and using the new therapy option. MedTrakRx recognizes the appeal of alternative or new therapy options, particularly if the option is saving members hundreds or thousands of dollars. However, our New Drug to Market Policy ensures that we are maintaining the integrity of the medications that we cover.
This policy’s product evaluation includes:
- Review of the approved product labeling and relevant literature
- Assessment of the medication’s appropriate place in therapy
- Analysis of the price of the medication relative to other treatment modalities for the labeled indications
New to market products and new variations of products already in the marketplace are excluded from benefit coverage until they have been evaluated, deemed clinically appropriate, considered cost effective, and assessed for places in therapy. In order to allow adequate time for the Clinical Care Center to perform a full evaluation, it is MedTrakRx’s policy that new drug entities not be eligible for benefit coverage for a period of 90 days after market entry. Requests for coverage made prior to 90 days after market entry will be declined. However, exceptions are made on a case-by-case basis after taking into consideration the medication, clinical justification, and specific characteristics of the member for whom it is being requested.
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