Reality Check

MMIT Reality Check on Rheumatoid Arthritis

A review of market access for rheumatoid arthritis treatments shows that under the pharmacy benefit, about 63% 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.

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MMIT Reality Check on Neutropenia

A review of market access for neutropenia treatments shows that under the pharmacy benefit, about 45% 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.

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MMIT Reality Check on Multiple Sclerosis

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 46% of the lives under Medicare formularies are not covered for at least one of the drugs.

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MMIT Reality Check on Macular Edema

A review of market access for macular edema treatments shows that under the pharmacy benefit, about 26% of the lives under commercial formularies are covered with utilization management restrictions. Around 57% of the lives under Medicare formularies are not covered for at least one of the drugs.

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MMIT Reality Check on Antiepileptic Drugs

A review of market access for antiepileptic drugs (AEDs) shows that under the pharmacy benefit, about 38% of the lives under commercial formularies are covered with utilization management restrictions. Around 13% of the lives under Medicare formularies are not covered for at least one of the drugs.

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MMIT Reality Check on Non-Small Cell Lung Cancer ALK+ or ROS1+

A review of market access for non-small cell lung cancer (ALK+ or ROS1+) treatments shows that under the pharmacy benefit, about 77% of the lives under commercial formularies are covered with utilization management restrictions. Only 2% of the lives under Medicare formularies are not covered for at least one of the drugs.

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MMIT Reality Check on IBS-C (Oct 2020)

According to our recent payer coverage analysis for the treatment of irritable bowel syndrome with constipation (IBS-C), combined with news from key healthcare influencers, market access is shifting in this drug lan...
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