Reality Check

MMIT Reality Check on Macular Edema

A review of market access for macular edema treatments shows that under the pharmacy benefit, about 26% of the lives under commercial formularies are covered with utilization management restrictions. Around 57% of the lives under Medicare formularies are not covered for at least one of the drugs.

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MMIT Reality Check on Antiepileptic Drugs

A review of market access for antiepileptic drugs (AEDs) shows that under the pharmacy benefit, about 38% of the lives under commercial formularies are covered with utilization management restrictions. Around 13% of the lives under Medicare formularies are not covered for at least one of the drugs.

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MMIT Reality Check on Non-Small Cell Lung Cancer ALK+ or ROS1+

A review of market access for non-small cell lung cancer (ALK+ or ROS1+) treatments shows that under the pharmacy benefit, about 77% of the lives under commercial formularies are covered with utilization management restrictions. Only 2% of the lives under Medicare formularies are not covered for at least one of the drugs.

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MMIT Reality Check on Metastatic Prostate Cancer

A review of market access for metastatic prostate cancer treatments shows that under the pharmacy benefit, about 52% of the lives under commercial formularies are covered with utilization management restrictions. Around 28% of the lives under Medicare formularies are not covered for at least one of the drugs.

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MMIT Reality Check on Migraine Prevention

A review of market access for preventive migraine treatments shows that under the pharmacy benefit, about 53% of the lives under commercial formularies are covered with utilization management restrictions. Around 45% of the lives under Medicare formularies are not covered for at least one of the drugs.

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MMIT Reality Check on Breast Cancer (HR+/HER2+)

A review of market access for hormone receptor-positive/human epidermal growth factor receptor 2-positive (HR+/HER2+) breast cancer treatments shows that under the pharmacy benefit, about 40% of the lives under commercial formularies are covered with utilization management restrictions. Around 47% of the lives under Medicare formularies are not covered for at least one of the drugs.

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MMIT Reality Check on Nonmetastatic Prostate Cancer

A review of market access for nonmetastatic prostate cancer treatments shows that under the pharmacy benefit, about 53% of the lives under commercial formularies are covered with utilization management restrictions. Around 29% of the lives under Medicare formularies are not covered for at least one of the drugs.

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MMIT Reality Check on Ovarian Cancer

A review of market access for ovarian cancer treatments shows that under the pharmacy benefit, about half of the lives under commercial formularies are covered with utilization management restrictions. Around 13% of the lives under Medicare formularies are not covered for at least one of the drugs.

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MMIT Reality Check on Type 2 Diabetes (DPP4 and Combo)

A review of market access for type 2 diabetes (DPP4 and combo) treatments shows that under the pharmacy benefit, about 39% of the lives under commercial formularies are covered with utilization management restrictions. Around 21% of the lives under Medicare formularies are not covered for at least one of the drugs.

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MMIT Reality Check on Colorectal Cancer

A review of market access for colorectal cancer treatments shows that under the pharmacy benefit, about 53% of the lives under commercial formularies are covered with utilization management restrictions. Around 28% of the lives under Medicare formularies are not covered for at least one of the drugs.

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