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

 

Reality Check on Cystic Fibrosis

Market access for cystic fibrosis treatments reveals differences in payer coverage across each major channel, as well as specific trends in the drug landscape.  

To help make sense of this new research, MMIT's team of experts has analyzed the data for you and summarized the key findings:

  • Payer Insights: Under the pharmacy benefit, almost 62% of the lives under commercial formularies are covered with utilization management restrictions
  • Class Trends: In September 2020, the FDA expanded the label of Vertex Pharmaceuticals Inc.'s Kalydeco (ivacaftor) for use in children ages 4 months to less than 6 months old with cystic fibrosis who have at least one mutation in their cystic fibrosis transmembrane conductance regulator (CFTR) gene that is responsive to Kalydeco based on clinical and/or in vitro assay data 
  • Key Findings: Good formulary coverage exists for most products in this class. The majority of prior authorization is defined by diagnosis; few policies will require a step through a preferred generic agent

What can pharma do to curb this trend and overcome these challenges?

Get the data behind this change and how it could impact your market access plans from MMIT's team. Their clinical and policy backgrounds provide a unique and expert perspective to help expand your knowledge in the class and guide your decision-making process.

Download the full Reality Check now.

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