Private plans are more complex and opaque than public plans. Much information on the private plan process and coverage decisions is often considered proprietary by the plans.

Their broader goal is customer satisfaction, achieved by providing access to medications for plan members and sponsors an employee benefit.

Plans make coverage decisions based on advice from insurers, pharmacy benefit managers (PBM’s) and benefit advisors, and typically do not rely on public HTA assessments as these assessments are done internally. Most plans are managed which means that there are more steps required for product reimbursement.