by Jinghong Chen
All COPD medications are covered under the pharmacy benefit with some limitations, most frequently prior authorizations and quantity limits. Four medications — Brovana, Lonhala Magnair Starter, Perforomist and Yupelri — are covered under the medical benefit. For most of the drugs on the market, more than half of covered lives are under the preferred tier/preferred with prior authorization or step therapy and covered tier/covered with PA/ST. Payer pharmacy benefit formularies require ST for 16% of the covered lives and PA for 26% of the lives. The graphics below show how COPD medications are covered among commercial health plans, health exchange programs and Medicare and Medicaid programs, and their utilization management restrictions.
NOTE: Under the pharmacy benefit, the numbers of total covered lives under commercial, health exchange, Medicare and Medicaid formularies are 108.9 million, 10.2 million, 33.2 million and 62.0 million, respectively. Under the medical benefit, the numbers of total covered lives under commercial, health exchange, Medicare and Medicaid formularies are 184.9 million, 10.2 million, 44.5 million and 62.0 million, respectively.
SOURCE: Managed Markets Insight & Technology, LLC database as of May 2019.