Policy & Clinical Strategies

We are committed to the pursuit of clinical excellence and full transparency, using the most clinically sound resources available to help develop guidelines, algorithms, and criteria for treatment (including FDA labeling, clinical trials, CMS-approved compendia, evidence-based clinical practice guidelines, published peer-reviewed literature, and input from our Expert Clinical Network of key opinion leaders) 

An example of our expertise in action: Biosimilars

We believe there is no single biosimilar strategy. It is important to evaluate the unique dynamics of each individual therapeutic class with biosimilar availability in order to maximize any potential opportunity. Our deep understanding of benefit design, federal and state regulations, clinical expertise, and the ever-expanding pipeline allows us to understand the complexities and effectively evaluate every biosimilar that comes to market. 

Since the first U.S. launch of a biosimilar in 2015, we took an approach of proactively reviewing biosimilars in the pipeline, gathering key opinion leader insight, developing utilization management practices, etc. Through additional engagement with members and providerswe have been successful in shifting market share while maintaining clinically effective quality of care for members.