Reality Check

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.

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.

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.

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.

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...