Medical and pharmacy coverage decision making at the population level

Penny E. Mohr, Sean R. Tunis

Research output: Contribution to journalArticlepeer-review


Medicare is one of the largest health care payers in the United States. As a result, its decisions about coverage have profound implications for patient access to care. In this commentary, the authors describe how Medicare used evidence on heterogeneity of treatment effects to make populationbased decisions on health care coverage for implantable cardiac defibrillators. This case is discussed in the context of the rapidly expanding availability of comparative effectiveness research. While there is a potential tension between population-based and patient-centered decision making, the expanded diversity of populations and settings included in comparative effectiveness research can provide useful information for making more discerning and informed policy and clinical decisions.

Original languageEnglish (US)
Pages (from-to)547-554
Number of pages8
JournalJournal of Managed Care Pharmacy
Issue number6
StatePublished - 2014
Externally publishedYes

ASJC Scopus subject areas

  • Pharmaceutical Science
  • Health Policy
  • Pharmacy
  • Medicine(all)


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