Reality Check

A review of market access for treatments of primary humoral immunodeficiency (PID) disease shows that under the pharmacy benefit, about 53% of the lives under commercial formularies are covered with utilization management restrictions. Around 43% 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 51% 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 non-small cell lung cancer epidermal growth factor receptor (EGFR)-mutated treatments shows that under the pharmacy benefit, about 59% 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 HIV treatments shows that under the pharmacy benefit, about 11% 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 type 2 diabetes GLP-1 and combo treatments shows that under the pharmacy benefit, about 55% of the lives under commercial formularies are covered with utilization management restrictions. Around 26% 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 65% 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.

A review of market access for neutropenia treatments shows that under the pharmacy benefit, about 42% of the lives under commercial formularies are covered with utilization management restrictions. Around 56% 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 47% 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 30% of the lives under commercial formularies are covered with utilization management restrictions. Around 58% of the lives under Medicare formularies are not covered for at least one of the drugs.

A review of market access for epilepsy treatments shows that under the pharmacy benefit, about 35% of the lives under commercial formularies are covered with utilization management restrictions. Around 11% of the lives under Medicare formularies are not covered for at least one of the drugs.