Reality Check

A review of market access for non-small cell lung cancer epidermal growth factor receptor (EGFR)-mutated treatments shows that under the pharmacy benefit, about 55% 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.

A review of market access for Crohn’s disease treatments shows that under the pharmacy benefit, about 53% of the lives under commercial formularies are covered with utilization management restrictions. Around 48% of the lives under Medicare formularies are not covered for at least one of the drugs.

A review of market access for HIV treatments shows that under the pharmacy benefit, about 11% of the lives under commercial formularies are covered with utilization management restrictions. Around 14% of the lives under Medicare formularies are not covered for at least one of the drugs.

A review of market access for type 2 diabetes (GLP-1 and combo) treatments shows that under the pharmacy benefit, about 47% of the lives under commercial formularies are covered with utilization management restrictions. Around 12% of the lives under Medicare formularies are not covered for at least one of the drugs.

A review of market access for rheumatoid arthritis treatments shows that under the pharmacy benefit, about 63% of the lives under commercial formularies are covered with utilization management restrictions. Around 40% of the lives under Medicare formularies are not covered for at least one of the drugs.

A review of market access for neutropenia 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.

A review of market access for multiple sclerosis treatments shows that under the pharmacy benefit, about 62% of the lives under commercial formularies are covered with utilization management restrictions. Around 46% of the lives under Medicare formularies are not covered for at least one of the drugs.

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.

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.

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.