Reality Check

MMIT Reality Check on Chronic Lymphocytic Leukemia (4Q2022)

A review of market access for chronic lymphocytic leukemia treatments shows that under the pharmacy benefit, about 51% of the lives under commercial formularies are covered with utilization management restrictions. Around 33% 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 (Nov 2022)

A review of market access for hepatocellular carcinoma treatments shows that under the pharmacy benefit, about 17% of the lives under commercial formularies are covered with utilization management restrictions. About 37% 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 (Oct 2022)

A review of market access for psoriasis treatments shows that under the pharmacy benefit, about 70% of the lives under commercial formularies are covered with utilization management restrictions. Around 12% 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 Hemophilia A (Factor VIII) (October 2022)

A review of market access for hemophilia A (factor VIII) treatments shows that under the pharmacy benefit, about 37% of the lives under commercial formularies are covered with utilization management restrictions. Around 19% 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 (October 2022)

A review of market access for diffuse large B-cell lymphoma treatments shows that under the pharmacy benefit, about 42% of the lives under commercial formularies are covered with utilization management restrictions. Around 31% 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 (October 2022)

A review of market access for multiple myeloma treatments shows that under the pharmacy benefit, about 49% of the lives under commercial formularies are covered with utilization management restrictions. Around 27% of the lives under Medicare formularies are not covered for at least one of the drugs.

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MMIT Reality Check on Sickle Cell Disease (September 2022)

A review of market access for sickle cell disease treatments shows that under the pharmacy benefit, about 44% of the lives under commercial formularies are covered with utilization management restrictions. Around 37% of the lives under Medicare formularies are not covered for at least one of the drugs.

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MMIT Reality Check on Schizophrenia (September 2022)

A review of market access for schizophrenia treatments shows that under the pharmacy benefit, about 26% of the lives under commercial formularies are covered with utilization management restrictions. Around 17% of the lives under Medicare formularies are not covered for at least one of the drugs.

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MMIT Reality Check on Acute Migraine (September 2022)

A review of market access for acute migraine treatments shows that under the pharmacy benefit, about 47% of the lives under commercial formularies are covered with utilization management restrictions. Around 49% 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 Breast Cancer HR+/HER2- (September 2022)

A review of market access for treatments of adults with hormone receptor-positive (HR+), human epidermal growth factor receptor 2-negative (HER2-) shows that under the pharmacy benefit, about 44% of the lives under commercial formularies are covered with utilization management restrictions. Around 33% of the lives under Medicare formularies are not covered for at least one of the drugs.

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