Reality Check

MMIT Reality Check on Heterozygous Familial Hypercholesterolemia

A review of market access for treatments of adults with heterozygous familial hypercholesterolemia (HeFH) shows that under the pharmacy benefit, about 65% 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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© 2024 MMIT

MMIT Reality Check on Immune Globulin (PID)

A review of market access for treatments of primary humoral immunodeficiency (PID) disease shows that under the pharmacy benefit, about 49% of the lives under commercial formularies are covered with utilization management restrictions. Around 25% of the lives under Medicare formularies are not covered for at least one of the drugs.

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© 2024 MMIT

MMIT Reality Check on Non-Small Cell Lung Cancer EGFR-Mutated

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.

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© 2024 MMIT

MMIT Reality Check on Crohn’s Disease

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.

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© 2024 MMIT

MMIT Reality Check on HIV

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.

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© 2024 MMIT

MMIT Reality Check on Type 2 Diabetes (GLP-1 and Combo)

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.

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© 2024 MMIT

MMIT Reality Check on Rheumatoid Arthritis

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.

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© 2024 MMIT

MMIT Reality Check on Neutropenia

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.

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© 2024 MMIT

MMIT Reality Check on Multiple Sclerosis

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.

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© 2024 MMIT

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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© 2024 MMIT