Formulary guidance and transparency from P&T to point of care

Trends that Matter for Commercial, Health Exchange & Medicare Market Access

Posted by Matt Breese on Jul 28, 2016

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The following infographics highlight payer-controlled commercial, health exchange and medicare formulary market access across trending therapeutic areas. To learn more about key findings and trends in these therapeutic areas, please click on the images to visit MMIT's 3-page "Reality Checks" for each class:

Antipsychotics: This category includes treatments indicated for schizophrenia, bipolar disorder and major depressive disorder. While payer-controlled Medicare Part D formularies lack coverage for the greatest percentage of lives, health exchange formularies restrict the greatest percentage with PA or step therapy policies. Click on the image to view more.



Asthma & COPD: An analysis of payer pharmacy benefit coverage for respiratory drugs reveals less differentiation across major coverage channels than other highly managed classes. However, trends reveal that Medicare Part D and health exchange formulary restrictions increase at a steady pace. Click on the image to view more.




Dermatology: Acne: A review of payer-controlled pharmacy benefit coverage for dermatology products shows the high percentage of restricted lives in the Medicare Part D space, specifically. Just under three-quarters of U.S. are not covered entirely by medicare formularies. Click on the image to view more.



Hepatitis C: For Hepatitis C treatments, medicare and health exchange formularies are the most restricted. However, commercial formularies still implement a high degree of PA or step therapy policies to restrict access. Click on the image to view more.



Detoxification Agents: For detoxification agent market access, the following graph shows that commercial, medicare and health exchange formularies share roughly the same percentage of U.S. lives (one-third) that are restricted by prior authorizations or step therapies. Click on the image to view more.


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Topics: Specialty, Industry Trends, Market Access, Payer