The obscure advisory committees at the heart of the U.S. drug pricing debate

According to the CDC, 1.1 million Americans lost health insurance coverage in 2018.

About 30.4 million Americans did not have health insurance in 2018, up from 29.3 million in 2017, according to the CDC’s National Health Interview Survey.  That means about 1.1 million more Americans lost insurance coverage last year.

Efforts by the Trump administration and Congress to challenge and loosen requirements of the Affordable Care Act probably played a role in some going without coverage, analysts said.

A small group of external medical experts who quietly advise U.S. health insurers on new drugs.

These relatively unknown expert committees have been involved in drug coverage decisions for decades. Their identities are kept secret due to federal regulations aimed at preventing pharmaceutical industry interference. The committees make their decisions based on a drug’s clinical value, independent of cost, pharmacy benefit managers say. But their power has grown more recently with the consolidation of most of the U.S. pharmacy benefits business under OptumRx, CVS and Express Scripts. Taken together, their three advisory committees now guide drug coverage for more than 90 million Americans.

P&T committees also hold sway over record numbers of novel and expensive medicines introduced into the U.S. market each year, more often with less evidence of effectiveness or safety than in the past.

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