Related Experiment Videos
Growth hormone coverage policy and implementation: a four-year experience
1Harvard Pilgrim Health Care, Braintree, MA 02184, USA. katzh@warren.med.harvard.edu
HMO Practice
|May 7, 1997
Summary
Implementing a growth hormone (GH) review policy significantly reduced costs and improved equitable access to GH treatment. This approach offers a model for managing high-cost pharmaceuticals and advanced technologies.
Area of Science:
- Health economics
- Pharmaceutical policy
- Endocrinology
Background:
- Annual growth hormone (GH) expenditures in the US approach $400 million.
- Controversy exists regarding GH treatment indications and insurance coverage.
- Variability in GH access necessitates a structured policy approach.
Purpose of the Study:
- To describe the 4-year experience of the Harvard Pilgrim Health Care (HPHC) Growth Hormone Review Committee.
- To evaluate the impact of a policy limiting GH access to evidence-based indications.
- To assess cost reductions and equity in GH treatment coverage decisions.
Main Methods:
- Development of a policy and implementation plan in 1992 by HPHC.
- Establishment of a Growth Hormone Review Committee for case-by-case review.
- Analysis of prescribing costs and savings from 1992-1995.
Main Results:
- Significant cost reductions, with estimated savings exceeding $1 million over 4 years.
- Growth hormone prescribing costs decreased from 13.4% to 4.4% of total drug costs.
- A more rational and equitable approach to GH treatment coverage decisions was achieved.
Conclusions:
- The HPHC GH policy led to substantial cost savings and improved equity.
- Caution is advised regarding expanded GH access due to potential side effects.
- The policy framework may be applicable to managing other high-cost pharmaceuticals and technologies.