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Formulary decisions rely more on clinical profiles than cost efficacy, ex-Aetna VP McGivney tells DIA.

Executive Summary

MANAGED CARE FORMULARY DECISIONS RELY PRIMARILY ON CLINICAL ADVANTAGE determinations between products and only secondarily on cost-effectiveness data, former Aetna VP-Clinical Coverage Policy Bill McGivney (National Comprehensive Cancer Network) maintained at the Drug Information Association's annual meeting in Montreal on June 25. "It is only when there is no clinical advantage that can be discerned that we get down to explicit considerations of cost," McGivney said. "In terms of formal, systematic application of cost-effectiveness analysis in the managed care setting, it really hasn't happened."
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