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Special Communication
Health Care Reform
August 2016

Policy Framework for Covering Preventive Services Without Cost SharingSaving Lives and Saving Money?

Author Affiliations
  • 1Department of Bioethics, Clinical Center, National Institutes of Health, Bethesda, Maryland
  • 2Institute for Clinical and Economic Review, Boston, Massachusetts
JAMA Intern Med. 2016;176(8):1185-1189. doi:10.1001/jamainternmed.2016.3052

The US Affordable Care Act mandates that private insurers cover a list of preventive services without cost sharing. The list is determined by 4 expert committees that evaluate the overall health effect of preventive services. We analyzed the process by which the expert committees develop their recommendations. Each committee uses different criteria to evaluate preventive services and none of the committees consider cost systematically. We propose that the existing committees adopt consistent evidence review methodologies and expand the scope of preventive services reviewed and that a separate advisory committee be established to integrate economic considerations into the final selection of free preventive services. The comprehensive framework and associated criteria are intended to help policy makers in the future develop a more evidence-based, consistent, and ethically sound approach.