Market access

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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New Drugs for Asthma, Kidney Disease, HIV Are On the Horizon

A new biologic for severe asthma, a drug for anemia related to chronic kidney disease (CKD) and a long acting pre-exposure prophylaxis (PrEP) for HIV-1 are among the first-in-class therapies featured in OptumRx’s Q1 2022 Drug Pipeline Insights Report. In addition to these new drugs, the PBM also calls attention to the likelihood of more COVID-19 vaccines and treatments receiving full approval and additional uses in 2022.

Tezepelumab (brand name Tezspire) was approved by the FDA for maintenance treatment of severe asthma in December 2021. Many biologics for severe asthma are already on the market, but these drugs target asthma subtypes determined by baseline blood eosinophil counts, according to the OptumRx report. On the other hand, tezepelumab, developed by AstraZeneca and AmGen Inc., has been developed with a broader indication.

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 Metastatic Prostate Cancer

A review of market access for metastatic prostate cancer treatments shows that under the pharmacy benefit, about 52% of the lives under commercial formularies are covered with utilization management restrictions. Around 28% 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

A review of market access for preventive migraine treatments shows that under the pharmacy benefit, about 53% 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 Breast Cancer (HR+/HER2+)

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 40% 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.

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MMIT Reality Check on Nonmetastatic Prostate Cancer

A review of market access for nonmetastatic prostate cancer treatments shows that under the pharmacy benefit, about 53% 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.

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MMIT Reality Check on Ovarian Cancer

A review of market access for ovarian cancer treatments shows that under the pharmacy benefit, about half 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 Type 2 Diabetes (DPP4 and Combo)

A review of market access for type 2 diabetes (DPP4 and combo) treatments shows that under the pharmacy benefit, about 39% of the lives under commercial formularies are covered with utilization management restrictions. Around 21% 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

A review of market access for colorectal cancer treatments shows that under the pharmacy benefit, about 53% of the lives under commercial formularies are covered with utilization management restrictions. Around 28% of the lives under Medicare formularies are not covered for at least one of the drugs.

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