Reality Check

MMIT Reality Check on Non-Small Cell Lung Cancer ALK+ or ROS1+ (1Q2023)

A review of market access for non-small cell lung cancer ALK+ or ROS1+ treatments shows that under the pharmacy benefit, about 72% of the lives under commercial formularies are covered with utilization management restrictions. Only 4% of the lives under Medicare formularies have access to at least one of the drugs without utilization management restrictions.

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MMIT Reality Check on Metastatic Prostate Cancer (1Q2023)

A review of market access for metastatic prostate cancer treatments shows that under the pharmacy benefit, about 50% 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.

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MMIT Reality Check on Migraine Prevention (4Q2022)

A review of market access for preventive migraine treatments shows that under the pharmacy benefit, about 50% of the lives under commercial formularies are covered with utilization management restrictions. Around 15% of the lives under Medicare formularies are not covered for at least one of the drugs.

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MMIT Reality Check on Breast Cancer (HR+/HER2+) (4Q2022)

A review of market access for hormone receptor-positive/human epidermal growth factor receptor 2-positive (HR+/HER2+) breast cancer treatments shows that under the pharmacy benefit, about 39% of the lives under commercial formularies are covered with utilization management restrictions. Around 59% of the lives under Medicare formularies are not covered for at least one of the drugs.

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MMIT Reality Check on Nonmetastatic Prostate Cancer (4Q2022)

A review of market access for nonmetastatic prostate cancer treatments shows that under the pharmacy benefit, about 51% of the lives under commercial formularies are covered with utilization management restrictions. Around 36% of the lives under Medicare formularies are not covered for at least one of the drugs.

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MMIT Reality Check on Ovarian Cancer (4Q2022)

A review of market access for ovarian cancer treatments shows that under the pharmacy benefit, about 46% of the lives under commercial formularies are covered with utilization management restrictions. Around 20% of the lives under Medicare formularies are not covered for at least one of the drugs.

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MMIT Reality Check on Follicular Lymphoma (4Q2022)

A review of market access for follicular lymphoma 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 Colorectal Cancer (4Q2022)

A review of market access for colorectal cancer treatments shows that under the pharmacy benefit, about 50% 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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MMIT Reality Check on Cystic Fibrosis (4Q2022)

A review of market access for cystic fibrosis treatments shows that under the pharmacy benefit, about 63% of the lives under commercial formularies are covered with utilization management restrictions. Around 20% of the lives under Medicare formularies are not covered for at least one of the drugs.

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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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