Reality Check

A review of market access for psoriatic arthritis treatments shows that under the pharmacy benefit, about 73% 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 acute lymphoblastic leukemia treatments shows that under the pharmacy benefit, about 39% 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.

A review of market access for hemophilia A or B with inhibitors treatments shows that under the pharmacy benefit, about 40% of the lives under commercial formularies are covered with utilization management restrictions. Around 20% of the lives under health exchange formularies are not covered for at least one of the drugs.

A review of market access for type 2 diabetes (SGLT2 and combo) treatments shows that under the pharmacy benefit, about 43% of the lives under commercial formularies are covered with utilization management restrictions. Around 22% of the lives under Medicare formularies are not covered for at least one of the drugs.

A review of market access for urothelial/bladder cancer shows that under the pharmacy benefit, about 39% of the lives under commercial formularies are covered with utilization management restrictions. Around 60% of the lives under Medicare formularies are not covered for at least one of the drugs.

A review of market access for treatments of chemotherapy-induced nausea and vomiting shows that under the pharmacy benefit, about 27% of the lives under commercial formularies are covered with utilization management restrictions. Around 55% of the lives under Medicare formularies are not covered for at least one of the drugs.

A review of market access for hereditary angioedema treatments shows that under the pharmacy benefit, about 60% of the lives under commercial formularies are covered with utilization management restrictions. Around 34% of the lives under Medicare formularies are not covered for at least one of the drugs.

A review of market access for melanoma treatments shows that under the pharmacy benefit, about 59% of the lives under commercial formularies are covered with utilization management restrictions. Around 30% of the lives under Medicare formularies are not covered for at least one of the drugs.

A review of market access for cervical cancer treatments shows that under the pharmacy benefit, about 33% of the lives under commercial formularies are covered with utilization management restrictions. Around 65% of the lives under Medicare formularies are not covered for at least one of the drugs.

A review of market access for atopic dermatitis treatments shows that under the pharmacy benefit, about 43% of the lives under commercial formularies are covered with utilization management restrictions. Around 25% of the lives under health exchange formularies are not covered for at least one of the drugs.