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


Reality Check on Merkel Cell Carcinoma

Market access for Merkel cell carcinoma 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, about 53% of the lives under commercial formularies are covered with utilization management restrictions
  • Class Trends: In April 2020, the FDA approved the supplemental biologics license application (sBLA) for Merck & Co., Inc.’s Keytruda (pembrolizumab) to include an additional recommended dosage of 400 mg every six weeks across all adult indications. The new dosing option is in addition to the approved dosage of 200 mg every three weeks
  • Key Findings: Coverage may require pre-authorization or a retrospective review to determine if the physician followed the payer’s medical policy. Currently, all drugs in this class process primarily through the medical benefit, but they may process through the pharmacy benefit depending on the site of care

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.