The following infographics highlight how health plans leverage utilization management policies, specifically step therapies, in trending therapeutic areas. Payers implement step therapies to control costs and restrict reimbursement for specific drugs. A clinical review of these utilization management strategies reveals the complexity of these policies in some treatment areas:
Multiple Sclerosis: A review of the MS market basket reveals that over 60% of step therapies only require a single step through another branded drug. Click on the image to view more.
Immunology: A review of pharmacy benefit coverage in the immunology market basket, specifically Rheumatoid Arthritis treatments, shows how restricted U.S. lives are. Only 40% of lives go unrestricted by a step therapy policy. Click on the image to view more.
Dermatology: Acne: Dermatology treatments face restricted reimbursement across many geographic areas. Around one-fifth of pharmacy benefit lives are restricted by some form of a step therapy. Click on the image to view more.
Respiratory: Pharmaceuticals indicated for asthma or COPD face complex step therapies from payers. When a step therapy does exist, you can expect that it will require a drug to step through two or more treatments around half of the time. Click on the image to view more.
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