Use of clinical outcome assessments in specialty drug coverage policies

COA inclusion varied across plans, with most using them to limit access. ClinROs were the most frequently used COA type, underscoring the pivotal role of providers on behalf of patients and health plans in shaping treatment access decisions. Plans used PROs relatively infrequently, with some including PROs in their policies more than others, suggesting a missed opportunity to consistently incorporate patients' voices to complement the assessment of treatment outcomes when determining coverage. Future research should explore the rationale behind COA use and its implications for treatment access.