Former USPSTF chairs say that guidelines should inform -- not determine -- coverage

Former USPSTF chairs say that guidelines should inform - not determine - coverage

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Former chairs of the U.S. Preventive Services Task Force (USPSTF), Virginia A. Moyer, MD, MPH, Michael LeFevre, MD, MSPH, and Ned Calonge, MD, MPH, say that it may be time for USPSTF guidelines to inform - not determine - insurance coverage. The authors present Mylan's attempt to lobby the USPSTF to develop guidelines on its EpiPen as an example of the pitfalls of linking recommendations to coverage. Their commentary is published in Annals of Internal Medicine.

Under the Affordable Care Act, insurers must cover without copay interventions that receive grade A or B recommendation from the USPSTF. The USPSTF is an independent, volunteer panel of 16 national experts in prevention and evidence-based medicine whose mission is to improve the health of all Americans by making evidence-based recommendations on screening, counseling, and preventive medications. The USPSTF uses rigorous assessments of conflict of interest to ensure unbiased decisions about preventive services. The panel does not consider costs or coverage when making recommendations, only the scientific assessment of benefits and harms. According to the authors, Mylan's attempt to influence the panel violates the integrity of its process. They say that the American public is best served by an independent scientific process free from advocacy and political pressure. If the only way to assure such independence is to sever the direct linkage to coverage, then it may be time to consider that option.

Note: Dr. Moyer can be reached directly via email at vmoyer@abpeds.org. Dr. LeFevre can be reached through Ann Huber at huberal@health.missouri.edu, and Dr. Calonge can be reached through Julian Kesner at Julian@coloradotrust.org.

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