Managing Heterogeneity in Prescription Drug Coverage Policies

AUTHORS: J. Russell Teagarden

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SUMMARY:

Necessity and fairness require that health plans limit the products and services they cover. The basis for these decisions refers to population averages and related population parameters. However, individuals vary and may not be accurately represented by the parameters used to establish coverage policies. Health plans, therefore, are obligated to anticipate and manage heterogeneity among their member groups. This commentary offers considerations for managing heterogeneity in prescription drug benefits.

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