New Technology Policy

New technologies and new applications of existing technologies are evaluated and approved for coverage when they provide a demonstrable benefit for a particular illness or disease; are scientifically proven to be safe and efficacious; and there is no equally effective or less costly alternative.

Emerging and innovative technologies are monitored by the Plan through review of trend reports from technology assessment bodies; government publications; medical journals; and information provided by providers and professional societies.

A systematic process for evaluating a new technology or new application of an existing technology is proactively initiated when sufficient scientific information is available.

Plan-developed standards guide the evaluation process to assure appropriate coverage determinations. New technology must minimally meet the following guidelines to be approved for coverage.

• Technology must improve health outcomes. The beneficial effects must outweigh any harmful effects on health outcomes. It must improve the length of life, ability to function or quality of life.
• Technology must be as beneficial as any established alternative. It should improve the net health outcome as much, or more than established alternatives.
• Application of technology must be appropriate, in keeping with good medical standards, and useful outside of investigational settings.
• Technology must meet government approval to market by appropriate regulatory agency as applicable.
• Criteria must be supported with information provided by well-conducted investigations published in peer-reviewed journals. The scientific evidence must document conclusions which are based on established medical facts.
• Opinions and evaluations of professional organizations, panels or technology assessment bodies are evaluated based on the scientific quality of the supporting evidence.

A core committee of Plan Medical Directors and high level physician specialists, practitioners and/or pharmacists evaluate and recommend coverage for new technologies. Their decisions are based on information provided by professional assessment and policy development organizations, as well as other medical experts.