Reality Check

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 16% 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 39% 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 31% of the lives under commercial formularies are covered with utilization management restrictions. Around 54% of the lives under Medicare formularies are not covered for at least one of the drugs.

A review of market access for treatments for adults with narcolepsy shows that under the pharmacy benefit, about 58% of the lives under commercial formularies are covered with utilization management restrictions. Around 38% 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 32% of the lives under commercial formularies are covered with utilization management restrictions. Around 18% 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 adults with anemia due to chronic kidney disease shows that under the pharmacy benefit, about 37% of the lives under commercial formularies are covered with utilization management restrictions. Around 41% of the lives under Medicare formularies are not covered for at least one of the drugs.

A review of market access for treatments for adults with growth hormone deficiency shows that under the pharmacy benefit, about 52% 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.

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 68% of the lives under commercial formularies are covered with utilization management restrictions. Around 7% 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 29% of the lives under Medicare formularies are not covered for at least one of the drugs.