Reality Check

A review of market access for treatments for adults with narcolepsy shows that under the pharmacy benefit, about 55% 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.

A review of market access for hemophilia B (factor IX) treatments shows that under the pharmacy benefit, about 28% of the lives under commercial formularies are covered with utilization management restrictions. Around 21% of the lives under health exchange formularies are not covered for at least one of the drugs.

A review of market access for treatments for people with anemia due to chronic kidney disease shows that under the pharmacy benefit, about 20% of the lives under commercial formularies are covered with utilization management restrictions. Around 40% of the lives under health exchange formularies are not covered for at least one of the drugs.

A review of market access for treatments for people with growth hormone deficiency shows that under the pharmacy benefit, about 49% 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.

A review of market access for seizure emergency treatments shows that under the pharmacy benefit, about 35% of the lives under commercial formularies are covered with utilization management restrictions. Around 17% of the lives under health exchange formularies are not covered for at least one of the drugs.

A review of market access for treatments of adults with acute myeloid leukemia (AML) shows that under the pharmacy benefit, about 64% of the lives under commercial formularies are covered with utilization management restrictions. Around 18% of the lives under Medicare formularies are not covered for at least one of the drugs.

A review of market access for treatments of adults with chronic obstructive pulmonary disease (COPD) shows that under the pharmacy benefit, about 13% 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 treatments of adults with heterozygous familial hypercholesterolemia (HeFH) shows that under the pharmacy benefit, about 63% 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 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.