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Trends that Matter for Health Exchange Coverage

Posted by Matt Breese on May 25, 2016

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The following infographics highlight how Health Exchange health plans cover treatments in trending therapeutic areas. Typically, HIX formularies implement reimbursement controls that appear as a hybrid of commercial and medicare coverage.

HIV: For HIV treatments in the market, a payer pharmacy benefit analysis across channels shows that health exchange formularies are the most restrictive to these drugs. Click on the image to view more.


Hepatitis C: An analysis of payer pharmacy benefit coverage for formularies associated with health exchanges reveals that roughly 50% of lives are restricted by a prior authorization or step therapy. Click on the image to view more.



Immune Globulin: Coverage by channel shows that health exchange formularies designate IVIG products as "not covered" the most, as compared to commercial and medicare. Click on the image to view more.


PCSK9: A review of market access for the relatively new PCSK9 class of treatments shows the variation in coverage across channels. Health exchange formularies mirror commercial formularies closely, featuring only about 10% of lives with unrestricted access. Click on the image to view more.


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Topics: Industry Trends, Provider, Payer