Margaret A.WinkerMD, Senior EditorIndividualAuthorPhil B.FontanarosaMD, Senior EditorIndividualAuthor
In Reply.—We agree with Dr Berman that insurers vary substantially in the procedures they use to develop and implement policy regarding coverage for new technologies (and other treatments) and in the values they apply in making their decisions. We also agree that many insurers make serious efforts to address the 3 conditions we believe are necessary to create a public sense of legitimacy and fairness for limit-setting policies: (1) articulate the rationale behind their policies, (2) make the rationale public, and (3) provide opportunities for clinicians and members to appeal policies and specific decisions.1 However, even in the outstanding programs we were privileged to study in our research on policymaking, we and the program leaders agreed there was room for significant improvement.
Sabin JE, Daniels N. Jews and Medicine. JAMA. 1998;280(12):1052-1054. doi:10-1001/pubs.JAMA-ISSN-0098-7484-280-12-jbk0923