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Trends that Matter for Restricted Therapeutic Areas

Posted by Matt Breese on Feb 17, 2016

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The following infographics highlight specific therapeutic area where pharmacy benefit or medical benefit coverage is restricted. These graphs portray restricted market access, in the form of prior authorizations, step therapies or not-covered statuses, based on U.S. payer-controlled lives:

PCSK9 Inhibitors: For the newly launched cholesterol treatments, Medicare Part D formularies are particularly restrictive, with a lack of payer coverage for many U.S. lives. Click on the image to view more.



Dermatology: Branded dermatology drugs face a great deal of payer restrictions in the current market access landscape. An analysis of PA policies for acne treatments reveals that 88% are restrictive compared to the FDA-approved label. Click on the image to view more.



Antipsychotics: A review of payer-controlled pharmacy benefit lives shows that oral drugs face a PA or step therapy for roughly 1/3 of lives, while injectable agents face a restriction for around 1/4 of lives. Click on the image to view more.



Diabetes: Utilization management from top payers shows that a step therapy regimen is required for an average of 40% of pharmacy lives, varying by product grouping. Click on the image to view more.


Respiratory: A market access analysis of Asthma and COPD treatments reveals that payer-controlled managed medicaid formularies restrict over half of U.S. covered lives. Click on the image to view more.


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Topics: Specialty, Industry Trends, Market Access