Reality Check

MMIT Reality Check on Colorectal Cancer (4Q2023)

A review of market access for colorectal cancer treatments shows that under the pharmacy benefit, about 51% of the lives under commercial formularies are covered with utilization management restrictions. Around 41% of the lives under Medicare formularies are not covered for at least one of the drugs.

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MMIT Reality Check on Cystic Fibrosis (4Q2023)

A review of market access for cystic fibrosis treatments shows that under the pharmacy benefit, about 63% 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 Chronic Lymphocytic Leukemia (4Q2023)

A review of market access for chronic lymphocytic leukemia treatments shows that under the pharmacy benefit, about 54% 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 Hepatocellular Carcinoma (4Q2023)

A review of market access for hepatocellular carcinoma treatments shows that under the pharmacy benefit, about 54% of the lives under commercial formularies are covered with utilization management restrictions. About 46% of the lives under Medicare formularies are not covered for at least one of the drugs.

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MMIT Reality Check on Psoriasis (4Q2023)

A review of market access for psoriasis treatments shows that under the pharmacy benefit, about 63% of the lives under commercial formularies are covered with utilization management restrictions. Around 38% of the lives under Medicare formularies are not covered for at least one of the drugs.

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MMIT Reality Check on Hemophilia A (Factor VIII) (4Q2023)

A review of market access for hemophilia A (factor VIII) treatments shows that under the pharmacy benefit, about 43% of the lives under commercial formularies are covered with utilization management restrictions. Around 23% of the lives under health exchange formularies are not covered for at least one of the drugs.

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MMIT Reality Check on Diffuse Large B-Cell Lymphoma (4Q2023)

A review of market access for diffuse large B-cell lymphoma treatments shows that under the pharmacy benefit, about 43% of the lives under commercial formularies are covered with utilization management restrictions. Around 50% of the lives under Medicare formularies are not covered for at least one of the drugs.

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MMIT Reality Check on Multiple Myeloma (4Q2023)

A review of market access for multiple myeloma treatments shows that under the pharmacy benefit, about 45% of the lives under commercial formularies are covered with utilization management restrictions. Around 42% of the lives under Medicare formularies are not covered for at least one of the drugs.

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MMIT Reality Check on Spinal Muscular Atrophy (3Q2023)

A review of market access for spinal muscular atrophy treatments shows that under the pharmacy benefit, about 39% of the lives under commercial formularies are covered with utilization management restrictions. Around 24% of the lives under health exchange formularies are not covered for at least one of the drugs.

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MMIT Reality Check on Schizophrenia (3Q2023)

A review of market access for schizophrenia treatments shows that under the pharmacy benefit, about 27% of the lives under commercial formularies are covered with utilization management restrictions. Around 10% of the lives under Medicare formularies are not covered for at least one of the drugs.

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